Laparoscopic cholecystectomy in patients with previous upper or lower abdominal surgery

Karayiannakis, Anastasios J.; Polychronidis, Alexandros; Perente, Sebachedin; Botaitis, Sotirios; Simopoulos, C.

doi:10.1007/s00464-003-9001-4

Cited by 108 publications

(44 citation statements)

References 15 publications

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“…This is similar to the results of Karayiannakis et al [23] who reported a higher conversion rate in patients who had undergone upper abdominal operations (19 vs. 5%). In our opinion, a history of upper abdominal operation should not be considered a contraindication to LC.…”

Section: Discussionsupporting

confidence: 82%

Risk Factors for Conversion during Laparoscopic Cholecystectomy: Retrospective Analysis of Ten Years' Experience at a Single Tertiary Referral Centre

Sultan

Nakeeb²,

Elshehawy³

et al. 2013

Dig Surg

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Background/Purpose: Laparoscopic cholecystectomy (LC) is the standard treatment for symptomatic benign gallbladder disease. The identification of factors that reliably predict the need to convert LC to open cholecystectomy (OC) would help with patient education and counseling. Methods: Between January 2000 and December 2009, 4,698 patients underwent cholecystectomy. LC was attempted in 4,434 patients (94.4%) and OC from the start was performed in 264 patients (5.6%). The causes for conversion were evaluated. The change in conversion rate between 2000 and 2004 and between 2005 and 2009 was analyzed. Factors predictive of conversion were identified by univariate and multivariate analysis. Results: Conversion to OC from an initial LC approach was required in 234 patients (5.3%). The main cause for conversion was dense adhesions (54.7%). Independent risk factors in multivariate analysis were male gender (p < 0.001), increased age (p < 0.001), a history of previous upper abdominal surgery (p < 0.001), a WBC count >9 × 10³/μl, and urgently indicated cholecystectomy (p <0.001). The conversion rate decreased significantly from 6.7 to 3.6% over the two time intervals (p < 0.001). Conclusions: Those at highest risk for conversion are elderly male patients with prior abdominal surgery who present emergently with laboratory evidence of biliary inflammation.

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Section: Discussionsupporting

confidence: 82%

Risk Factors for Conversion during Laparoscopic Cholecystectomy: Retrospective Analysis of Ten Years' Experience at a Single Tertiary Referral Centre

Sultan

Nakeeb²,

Elshehawy³

et al. 2013

Dig Surg

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show abstract

“…To expand the indications, the safety of the procedure as well as the oncologic aspects need to be assessed. Two earlier studies on the impact of previous abdominal surgery showed little influence on the short-term outcome after laparoscopic and open procedures, but included a relatively small number of patients [12,14]. Compared with those reports, our series included a larger number of patients, so the findings are probably more reliable.…”

Section: Discussioncontrasting

confidence: 41%

“…There have been few reports about the impact of previous abdominal surgery on laparoscopic procedures including colorectal surgery [11,12,13], but this issue should be studied further in order to expand the indications of laparoscopic surgery and benefit to patients. To expand the indications, the safety of the procedure as well as the oncologic aspects need to be assessed.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Colorectal Surgery in Patients with Prior Abdominal Surgery

Fukunaga

Kameyama²,

Kawasaki³

et al. 2011

Dig Surg

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Purpose: We retrospectively investigated the impact of prior abdominal surgery on the outcome of laparoscopic colorectal surgery. Patients: Among 607 colorectal cancer patients who underwent laparoscopic surgery, 192 patients had previously undergone abdominal surgery (S group) and 415 had not (non-S group). Results: The percentage of female patients was higher in the S group than in the non-S group. The incidence of conversion to open surgery was higher in the S group (5.2%, 10/192) than in the non-S group (2.6%, 11/415), but the difference was not significant (p = 0.108). Although the mean operating time and estimated blood loss were similar in the two groups, right and transverse colectomy after prior gastrectomy and ipsilateral colectomy after prior colectomy took longer and were associated with greater blood loss. The morbidity rates of the two groups were similar (S group: 15.6%, 30/192; non-S group: 14.5%, 60/415). There were 5 intraoperative small-bowel injuries or postoperative small-bowel perforations in the S group, especially in the patients with prior gastrointestinal-tract surgery. Conclusion: Our findings suggest that there is no reason to avoid laparoscopic procedures in most patients with prior abdominal surgery despite a higher conversion rate, but caution is warranted in patients who have undergone major gastrointestinal-tract surgery.

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“…7,26,27 Finally, prior abdominal surgery has also been associated with a higher likelihood of conversion in numerous studies. 7,8,28 Prior surgery, especially in the upper abdomen, may result in adhesions around the gallbladder, limiting visualization, retraction, and dissection. 28 Adhesions were the most commonly cited reason for conversion in the present study, and almost half of the patients undergoing conversion had a history of abdominal surgery.…”

Section: Discussionmentioning

confidence: 99%

“…7,8,28 Prior surgery, especially in the upper abdomen, may result in adhesions around the gallbladder, limiting visualization, retraction, and dissection. 28 Adhesions were the most commonly cited reason for conversion in the present study, and almost half of the patients undergoing conversion had a history of abdominal surgery. While the aforementioned patient factors certainly contribute to unsuccessful LCs, it is generally accepted that the most important factors are surgeon-specific.…”

Section: Discussionmentioning

confidence: 99%