Akademik Veri Yönetim Sistemi
Laparoscopic Endoscopic Surgical Science, sa.2, ss.1-15, 2018 (Hakemli Dergi)
INTRODUCTION: The objective of this study was to present the experience of 1 center with early and elective laparoscopic cholecystectomy (LC), which can be performed in state hospitals but requires further specialized treatment when serious complications develop.
METHODS: Cases of LC performed as an elective or an emergency procedure in a 100-bed county state hospital between June 2015 and February 2018 were retrospectively reviewed. Patient demographic characteristics; the presence of systemic disease; clinical, laboratory, and radiological findings; transition to open surgery; duration of hospital stay; and complications were analyzed.
RESULTS: A total of 142 patients were included in the study, of which 115 (80.9%) were female and 27 (19.1%) were male. The mean age of the patients was 49.31 years (range: 17–75 years). LC was performed early in 35 patients (24.6%) due to acute cholecystitis. The mean duration of surgery was 49.01 minutes (range: 30–120 minutes) for an elective LC, 86.6 minutes (range: 45–180 minutes) for an early LC, and 152 minutes (range: 120–185 minutes) for open surgery. The duration of hospitalization averaged 3.4 days (range: 2–10 days) for elective patients and 4.6 days (range: 3–5 days) for emergency cases. The duration of surgery and hospital stay were extended in patients who underwent early LC or open surgery compared with elective cases. The LC cases that were converted to open surgery included 5 acute cholecystitis patients (14.2%) with difficult dissections and 1 in which the hepatocystic triangle could not be isolated. One elective LC (0.9%) was also transitioned to open surgery due to hemorrhage. Intraoperative biliary injury was encountered in only 1 patient (0.7%) who was subsequently referred to an advanced hospital center.
DISCUSSION AND CONCLUSION: LC can be reliably performed in county state hospitals when there is adequate laparoscopic experience, knowledge, equipment, and assistant health personnel available. In cases of complications, directing those patients to more advanced centers where hepato- pancreato-biliary surgery is performed is thought to be beneficial regarding morbidity and mortality.
Keywords: Acute cholecystitis, hepato-pancreato-biliary; laparoscopic cholecystectomy.