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The Feasibility of Laparoscopic Cholecystectomy in Patients with Previous Abdominal Surgery

机译:腹腔镜胆囊切除术在既往腹部手术患者中的可行性

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摘要

A retrospective study was carried in 1500 patients submitted to elective laparoscopic cholecystectomy to ascertain its feasibility in patients with previous abdominal surgery. In 411 patients (27.4%) previous infraumbilical intraperitoneal surgery had been performed, and 106 of them (7.06%) had 2 or more operations. Twenty five patients (1.66%) had previous supraumbilical intraperitoneal operations (colonic resection, hydatid liver cysts, gastrectomies, etc.) One of them had been operated 3 times. In this group of 25 patients the first trocar and pneumoperitoneum were performed by open laparoscopy. In 2 patients a Marlex mesh was present from previous surgery for supraumbilical hernias. Previous infraumbilical intraperitoneal surgery did not interfere with laparoscopic cholecystectomy, even in patients with several operations. There was no morbidity from Verres needle or trocars. In the 25 patients with supraumbilical intraperitoneal operations, laparoscopic cholecystectomy was completed in 22. In 3, adhesions prevented the visualization of the gallbladder and these patients were converted to an open procedure. In the 2 patients Marlex mesh prevented laparoscopic cholecystectomy because of adhesions to abdominal organs. We conclude that in most instances previous abdominal operations are no contraindication to laparoscopic cholecystectomy.
机译:回顾性研究在1500例行选择性腹腔镜胆囊切除术的患者中进行,以确定其在先前腹部手术患者中的可行性。在411例患者中(27.4%)曾进行过脐下腹膜内手术,其中106例(7.06%)进行了2次或以上手术。二十五名患者(1.66%)曾做过脐上腹膜内手术(结肠切除术,包虫肝囊肿,直肠切除术等),其中一名曾接受过3次手术。在这25例患者中,首先通过开放式腹腔镜进行套管针和气腹。在2例患者中,先前的手术中出现了用于脐上疝的Marlex网片。以前的脐带下腹腔手术即使在进行多次手术的患者中也不会干扰腹腔镜胆囊切除术。 Verres的针头或套管针没有发病。在25例脐上腹腔手术患者中,22例完成了腹腔镜胆囊切除术。3,粘连阻止了胆囊的可视化,这些患者被转为开放手术。在2例患者中,Marlex Mesh由于与腹部器官的粘连而无法进行腹腔镜胆囊切除术。我们得出的结论是,在大多数情况下,以前的腹部手术并不是腹腔镜胆囊切除术的禁忌症。

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