Diez J, Delbene R, Ferreres A
Department of Surgery, University Hospital, B.A. Argentina.
HPB Surg. 1998;10(6):353-6. doi: 10.1155/1998/35456.
A retrospective study was carried in 1500 patients submitted to elective laparoscopic cholecystectomy to ascertain its feasibility in patients with previous abdominal surgery. In 411 patients (27.4%) previous infraumbilical intraperitoneal surgery had been performed, and 106 of them (7.06%) had 2 or more operations. Twenty five patients (1.66%) had previous supraumbilical intraperitoneal operations (colonic resection, hydatid liver cysts, gastrectomies, etc.) One of them had been operated 3 times. In this group of 25 patients the first trocar and pneumoperitoneum were performed by open laparoscopy. In 2 patients a Marlex mesh was present from previous surgery for supraumbilical hernias. Previous infraumbilical intraperitoneal surgery did not interfere with laparoscopic cholecystectomy, even in patients with several operations. There was no morbidity from Verres needle or trocars. In the 25 patients with supraumbilical intraperitoneal operations, laparoscopic cholecystectomy was completed in 22. In 3, adhesions prevented the visualization of the gallbladder and these patients were converted to an open procedure. In the 2 patients Marlex mesh prevented laparoscopic cholecystectomy because of adhesions to abdominal organs. We conclude that in most instances previous abdominal operations are no contraindication to laparoscopic cholecystectomy.
对1500例行择期腹腔镜胆囊切除术的患者进行了一项回顾性研究，以确定该手术在有腹部手术史患者中的可行性。411例患者（27.4%）曾接受过脐下腹腔内手术，其中106例（7.06%）接受过2次或更多次手术。25例患者（1.66%）曾接受过脐上腹腔内手术（结肠切除术、肝包虫囊肿手术、胃切除术等），其中1例接受过3次手术。在这25例患者中，第一根套管针和建立气腹是通过开放腹腔镜完成的。2例患者因既往脐上疝手术存在Marlex网片。既往脐下腹腔内手术并不影响腹腔镜胆囊切除术，即使是接受过多次手术的患者。Verres针或套管针未导致并发症。在25例有脐上腹腔内手术史的患者中，22例完成了腹腔镜胆囊切除术。3例因粘连无法看清胆囊，改行开放手术。2例因Marlex网片与腹部器官粘连而无法进行腹腔镜胆囊切除术。我们得出结论，在大多数情况下，既往腹部手术并非腹腔镜胆囊切除术的禁忌证。
