Wangmo Sangay, Dargay Sonam, ChhodenR Sonam
Faculty of Postgraduate Medicine Khesar Gyalpo University of Medical Sciences of Bhutan Thimphu Bhutan.
Department of Surgery Jigme Dorji Wangchuck National Referral Hospital Thimphu Bhutan.
Public Health Chall. 2023 Sep 17;2(3):e122. doi: 10.1002/puh2.122. eCollection 2023 Sep.
Prediction of difficult laparoscopic cholecystectomy may help in making necessary arrangements for optimal intraoperative requirements and postoperative care. This study was conducted to examine the factors associated with and outcomes of difficult laparoscopic cholecystectomy performed at the Bhutan's largest hospital in 2020.
This was a cross-sectional study with a convenience sampling method. Data on clinical features, ultrasonography and intraoperative factors of patients who underwent laparoscopic cholecystectomy were extracted from their medical records, investigation reports and intraoperative surgery note. Difficult laparoscopic cholecystectomy was defined on the basis of the duration of the surgery, injury to bile duct or artery, or conversion to open cholecystectomy. Data were double entered and validated in EpiData 3.1 and analysed in STATA 13.0.
Data from 134 patients were extracted. The mean age of the sample was 43 (±SD 13) years. "Difficult laparoscopic cholecystectomy" was reported in 83 patients (62%) and easy laparoscopic cholecystectomy in 51 patients (38%). Those patients having simple adhesions up to the body of the gall bladder were 1.6 times more likely to encounter difficult laparoscopic cholecystectomy (adjusted PR = 1.60, 95% CI 1.04-2.48, = 0.034). The majority did not have any post-operative complications (130 cases, 97%). The indications of laparoscopic cholecystectomy were symptomatic gall stone disease (129, 96%), acalculous cholecystitis (2, 1%) and gall bladder polyp (3, 2%).
The proportion of difficult laparoscopic cholecystectomy is high, but the rates of post-operative complications were minimal with no mortality or injury to bile duct or arteries.
预测困难的腹腔镜胆囊切除术有助于为最佳术中需求和术后护理做出必要安排。本研究旨在探讨2020年在不丹最大医院进行的困难腹腔镜胆囊切除术的相关因素及结果。
这是一项采用便利抽样方法的横断面研究。从患者的病历、检查报告和术中手术记录中提取接受腹腔镜胆囊切除术患者的临床特征、超声检查和术中因素数据。困难腹腔镜胆囊切除术根据手术持续时间、胆管或动脉损伤或转为开腹胆囊切除术来定义。数据在EpiData 3.1中进行双录入和验证，并在STATA 13.0中进行分析。
提取了134例患者的数据。样本的平均年龄为43（±标准差13）岁。83例患者（62%）报告为“困难腹腔镜胆囊切除术”，51例患者（38%）为简单腹腔镜胆囊切除术。胆囊体部仅有简单粘连的患者发生困难腹腔镜胆囊切除术的可能性高1.6倍（调整后的PR = 1.60，95%可信区间1.04 - 2.48，P = 0.034）。大多数患者没有任何术后并发症（130例，97%）。腹腔镜胆囊切除术的指征为有症状的胆结石病（129例，96%）、无结石性胆囊炎（2例，1%）和胆囊息肉（3例，2%）。
困难腹腔镜胆囊切除术的比例较高，但术后并发症发生率极低，无死亡病例，也无胆管或动脉损伤。
