Videolaparoscopic cholecystectomy in patients with previous abdominal surgery. Personal experience and literature review.
Clin Ter
; 168(6): e357-e360, 2017.
Article
en En
| MEDLINE
| ID: mdl-29209684
ABSTRACT
OBJECTIVES:
Laparoscopic cholecystectomy (LC) is today the "gold standard" treatment of gallbladder stones. Role of LC is still debated in the presence of abdominal scars due to the frequent post-operative adhesions which make access to the peritoneal cavity difficult. This study aim to assess role and outcomes of LC on a previous abdominal surgery on the scarred abdomen. MATERIALS ANDMETHODS:
We have carried out a retrospective study on 499 consecutive patients who had undergone LC from 2009 to 2015; 21 of these (4.2%) undergone previous abdominal surgery. In all 21 cases the pneumoperitoneum was established with Veress needle at the Palmer's point and the procedure was carried out after adhesiolysis in 62% of cases.RESULTS:
The mean operative time was 79±12 minutes; none of the patients with previous abdominal surgery required conversion to open cholecystectomy and there were no postoperative complications related to Veress introduction or to the adhesiolysis. The difficult dissection and adhesiolysis were more frequent in the patients with upper abdomen scar (62%) respect to lower abdomen scar (38%).CONCLUSIONS:
Patients with scarred abdomen for previous abdominal surgery had obviously more adhesions in the abdomen than patients without preceding surgery, but today previous abdominal surgery should not constitutes absolute contraindications to LC. Moreover, patients with previous lower abdominal incisions had fewer adhesions in the upper abdomen than did patients with upper incision and, probably, in these cases adhesiolysis is unnecessary, if the surgical field is well exposed whereas adhesiolysis is mandatory when the adhesions are thick and widespread, to the anterior and posterior abdominal wall.Palabras clave
Texto completo:
1
Bases de datos:
MEDLINE
Asunto principal:
Colelitiasis
/
Colecistectomía Laparoscópica
Tipo de estudio:
Etiology_studies
/
Observational_studies
Límite:
Adult
/
Aged
/
Aged80
/
Female
/
Humans
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Male
/
Middle aged
Idioma:
En
Revista:
Clin Ter
Año:
2017
Tipo del documento:
Article
País de afiliación:
Italia