[Laparoscopic cholecystectomy on previous operated abdomen]

ABSTRACT

laparoscopic cholecystectomy is the "gold standard" reference treatment of gall bladder stones. Laparoscopy is still contra-indicated in the presence of abdominal scars due to the frequent post-operative adhesions which make access to the peritoneal cavity difficult. This study aimed to assess outcomes of laparoscopic cholecystectomy on a scarred abdomen. We have carried out a retrospective study on a number of consecutive patients operated between the first januar 2000 and 31 december 2006, who underwent laparoscopic cholecystectomy with previous abdominal surgery [one or several].during this period, laparoscopic cholecystectomy was performed on 2281 patients, including 233 patients who had at least one abdominal scar [10%]. We have noted on the records of these patients all the data relating to the epidemiological, clinical and therapeutical aspects. We have worked out a descriptive analysis of the series and we have thus studied the rate of operative and post-operative complications, the rate of conversion, the duration of the operation and the duration of post-operative stay. Then we have compared two groups of patients, those with an upper abdominal surgery group 1[G1] and those with lower abdominal surgery group 2 [G2]. The groups consist of 200 women and 33 men aged on average 13, 8 +/- 49, 6 years. The indication for cholecystectomy was a symptomatic cholelithiasis in 78%of cases [n=181], an acute cholecystitis in 22%of cases. The adhesions were believed numerous or very numerous in only 46 patients [20%]. Four patients had interventional adverse events a small intestine injury, a choledoch injury, a gastric injury and a least known colic injury. The rate of open conversion was 2, 1%. Post-operative complication was 2, 1%. The evolution was satisfactory in all cases. Mean operating time was 50 minutes [15-230]. Mean post operative stay was one day [1-29 days]. When comparing the above mentioned two groups of patients [G1 45 patients and G2188 patients], we can conclude that the first group [G1] is made up of more male patients aged over 60 years [p<10-3] It also appears that the existence of an upper umbilical scar is correlated to a, greater number of adhesions [p<10-3], an increased risk of operative complications [p=0, 01], a greater conversion rate [p<10-4], a prolonged operating time [p<10-3] and a longer stay [p=0, 017]. On the other hand, post-operative complications was similar in group I and 2. Previous abdominal operations, are not a contraindication to safe laparoscopic cholecystectomy. However, previous upper abdominal surgery is associated with a higher rate of adhesions, an increased risk of operative complications, a greater conversion rate, a prolonged operating time and longer stay