Department of Surgery, Gachon University Gil Medical Center, Gachon University School of Medicine, Namdong-daero, Namdong-gu, Incheon, 774-2121565, Korea.
Surg Endosc. 2022 Feb;36(2):1424-1432. doi: 10.1007/s00464-021-08427-9. Epub 2021 Mar 26.
Previous upper midline abdominal surgery is a reported relative contraindication to laparoscopic cholecystectomy. We aimed to investigate the effects of previous upper abdominal surgery on the feasibility and safety of laparoscopic cholecystectomy; we evaluated the effects of the previous upper abdominal surgery type on laparoscopic cholecystectomy with respect to complications and conversion to open surgery.
We prospectively evaluated 1,258 patients who underwent laparoscopic cholecystectomy, including those who underwent upper midline abdominal surgery previously, at a single tertiary referral center. The perioperative and postoperative outcomes-open conversion rate, operation time, intraoperative and postoperative complications, and length of hospital stay-were evaluated. Patients were grouped according to the previous surgical method into the gastric (n = 77), non-gastric (n = 40), and control (n = 1141) groups. Patients in the gastric + non-gastric groups (n = 117) were 1:1 matched with those in the control group (n = 117) using propensity score matching (PSM).
Before PSM, age, sex, open conversion rate, gallbladder status, port number, overall morbidity, and postoperative hospital stay duration did not significantly differ between the gastric and non-gastric groups; the body mass index (22.3 ± 3.4 versus 24.1 ± 3.8 kg/m, p = 0.009) and operation time (129.9 ± 63.6 versus 97.9 ± 51.1 min, p = 0.004) significantly differed. After PSM, age, sex, body mass index, and American Society of Anesthesiology score did not significantly differ between gastric + non-gastric (n = 117) and conventional groups (n = 117; the operation time (118.9 ± 61.3 versus 75.8 ± 37.1 min, p < 0.001), open conversion rate (n = 6, 5.1% versus n = 0, 0.0%, p = 0.013), port number, overall morbidities (n = 26, 22.2% versus n = 10, 8.5%, p = 0.004), and postoperative hospital stay duration (6.7 ± 4.3 versus 5.5 ± 3.2 days, p = 0.031) significantly differed.
Previous upper midline abdominal surgery was not contraindicative to safe laparoscopic cholecystectomy. Patients with previous upper midline abdominal surgery undergoing laparoscopic cholecystectomy should be informed preoperatively of the probability of conversion to open surgery, lengthened duration, and associated morbidities.
既往中上腹部手术是腹腔镜胆囊切除术的一个相对禁忌证。本研究旨在探讨既往上腹部手术对腹腔镜胆囊切除术可行性和安全性的影响；评估既往上腹部手术类型对腹腔镜胆囊切除术并发症和中转开腹的影响。
我们前瞻性评估了在一家三级转诊中心接受腹腔镜胆囊切除术的 1258 例患者，包括既往接受过上中腹部手术的患者。评估围手术期和术后结果（中转开腹率、手术时间、术中及术后并发症、住院时间）。根据既往手术方法将患者分为胃组（n=77）、非胃组（n=40）和对照组（n=1141）。胃+非胃组（n=117）与对照组（n=117）采用倾向评分匹配（PSM）进行 1:1 匹配。
PSM 前，胃组和非胃组的年龄、性别、中转开腹率、胆囊状态、切口数量、总发病率和术后住院时间无显著差异；两组的体质量指数（22.3±3.4 vs. 24.1±3.8kg/m2，p=0.009）和手术时间（129.9±63.6 vs. 97.9±51.1min，p=0.004）差异有统计学意义。PSM 后，胃+非胃组（n=117）和对照组（n=117）的年龄、性别、体质量指数和美国麻醉医师协会评分差异无统计学意义；手术时间（118.9±61.3 vs. 75.8±37.1min，p<0.001）、中转开腹率（n=6，5.1% vs. n=0，0.0%，p=0.013）、切口数量、总发病率（n=26，22.2% vs. n=10，8.5%，p=0.004）和术后住院时间（6.7±4.3 vs. 5.5±3.2d，p=0.031）差异有统计学意义。
既往中上腹部手术不是腹腔镜胆囊切除术的禁忌证。既往中上腹部手术患者行腹腔镜胆囊切除术应在术前告知中转开腹的概率、手术时间延长和相关并发症。
