ABSTRACT
BACKGROUND: Identification of preoperative factors that indicate difficulties in the operation are in the function of primary prevention of intraoperative complications and require selection of an experienced surgical team, planning of operating program and timely provision of information to patients about the increased likelihood of conversion. AIM: Identification of preoperative factors of operative difficulties by analysis of routine clinical parameters. PATIENTS AND METHODS: A prospective cohort study of patients who underwent laparoscopic cholecystectomy from February 2005 to December 2009. All patients were operated by the same surgeon. There were 369 operated patients. Conversion was done in 10 patients. Main outcome measures were: duration of stages of laparoscopic cholecystectomy and conversion; identification of predictive parameters; assessment of their predictive value; assessment of the predictive value of individual parameters in respect to the duration of stages of laparoscopic cholecystectomy; correlation of parameter predictive value and duration of laparoscopic cholecystectomy stage. RESULTS: Multivariate stepwise linear regression analysis showed that previous history of acute cholecystitis, gallbladder wall thickness Ë 4 mm, acute cholecystitis to admission, size of calculus > 2 cm, > 5 attacks of pain that lasted longer of 4 hours, diabetes mellitus, duration of symptoms longer then 36 months and pericholecystic fluid collection were significant for prediction of difficulties of laparoscopic cholecystectomy. CONCLUSIONS: Based on clinical, laboratory and ultrasonographic parameters without the use of highly sophisticated diagnostic procedures and increasing medical costs it is possible to predict difficulties in the laparoscopic cholecystectomy.
Subject(s)
Cholecystectomy, Laparoscopic/adverse effects , Decision Support Techniques , Gallstones/surgery , Hospitals , Postoperative Complications/etiology , Adult , Aged , Biomarkers/blood , Chi-Square Distribution , Female , Gallstones/blood , Gallstones/diagnostic imaging , Humans , Linear Models , Logistic Models , Male , Middle Aged , Montenegro , Multivariate Analysis , Operative Time , Predictive Value of Tests , Prospective Studies , Risk Assessment , Risk Factors , Time Factors , Treatment Outcome , UltrasonographyABSTRACT
Laparoscopic cholecystectomy (LC) is the method of choice of surgical treatment of gallbladder diseases. Operations in elderly people over 65 years because of chronic diseases, are often associated with high operative and postoperative morbidity and mortality. The aim of this study was to analyze the outcome of LC in the treatment of cholelithiasis in patients older than 65 years. For evaluation of LC effectiveness and security in old patients, we did this prospective analysis of 81 patients surgically treated because of symptomatic cholelithiasis. We had analyzed associated diseases, operative and postoperative complications, the reasons of conversion to open cholecystectomy. The research points to the small percentage of operative and postoperative complications, short hospital stay, less postoperative pain, quick recovery and savings in treatment. The age can not be contraindication for LC in older patients. In uncomplicated symptomatic cholelithiasis in elderly people, LC is a successful and safe procedure. Complicated symptomatic cholelithiasis, because of longer duration of operations is looking for a good assessment of general condition and associated diseases for LC.
