ABSTRACT
Objective To summarize the experience of laparoscopic cholecystectomy ( LC) for acute cholecystitis (AC).Methods A retrospective study was conducted on 382 patients with AC, who were underwent LC.Results Of all 382 cases,370 cases were successfully finished with LC,and other 12 cases were finished with open surgery(3.14% ).The operation methods are successively anterograde cholecystectomy(267 cases),retrograde cholecystectomy(59 cases) ,anterograde and retrograde cholecystectomy(44 cases).Abdominal drainage was placed in all cases.Post-operation complications occurred in 15 cases (3.93% ).The complications are suppurative infection of sub-ensistemum incision(9 cases) ,abdominal infection(2 cases) ,adhesive ileus(2 cases) ,sub-ensisternum incision hernia(2 cases).There are no death cases,transfusion cases or latrogenic injury in our study.Conclusion The best time window of LC for AC was with in 72 hours since the symptom.The key factors for the surgery were careful dissection of calot's triangle,properly handling with the incarcerated cystic duct stone and thickened cystic duct,avoiding injury of cystic artery and over-dissection of gallbladder bed.Transfer to open surgery when necessary could reduce complications and latrogenic injury.
ABSTRACT
Objective To investigate pre-and intra-operative preventive measures against immediate conversions to open surgery during laparoscopic cholecystectomy(LC).Methods We retrospectively reviewed 568 cases of LC,27 of which underwent an immediate conversion to open surgery.Causes of conversions,surgical techniques,and curative outcomes were analyzed.Results Causes of immediate conversions included: severe adhesion between the gallbladder and neighboring tissues(1.4%),severe acute cholecystitis(1.1%),freezing adhesion in the Calot triangle(0.9%),large stone obstruction proximal to the gallbladder(0.5%),abnormal anatomy of the cystic duct(0.4%),extensive adhesion around the umbilical port(0.4%),and uncontrollable hemorrhage of the gallbladder bed(0.2%).No fatal cases or intra-and post-operative complications were observed.Conclusions Preventive measures should be taken before and during laparoscopic cholecystectomy to minimize the possibility of immediate conversions to open surgery.