الفهرس | Only 14 pages are availabe for public view |
Abstract In our study, lapardscopic cholecystectomy was performed on 500 patients with symptomatic gall baldder disease, 450 patients of them with chronic calcular cholecystitis, 15 patients with chronic non calcular cholecystitis and 35 patients with acute calcular cholecystitis. Thorough history taking , physical exammation and proper investigations were carried out to detennine the presence of biliary and non biliary problems that may adversely affect the outcome of laparoscopic cholecystectomy. Biliary problems included 10 patients who had stone common bile duct with chronic calcular cholecystitis. They managed with preoperative E.R.C.P. with stone extraction prior to laparoscopic cholecystectomy, which was successfully performed in these patients, non biliary problems , included patients with cardiopulmonary disease, coagulopathy, cirrhosis, morbid obesity and previous abdominal surgery. so further evaluation and cautious approach to the management of these individuals had been taken. Despite the liberalization of patients selection. not all individuals were candidates for laparoscopic cholecystectomy - Our absolute contraindications included inability to tolerate general anaesthesia or laparotomy, uncorrected coagulopathy and generalized peritonitis. 183 laparoscopic cholecystectomy started through 3 puncture technique in 10 patients, 4 puncture teclmique in 460 patients and insertion of accessory fifth cannula was needed in 20 patients due to operative difficulties. So, closed laparoscopic technique was carried out in 490 patients whereas open laparoscopy (Hasson Teclmique) was perfonned in 1 0 patients. In our work, we were confronted with about 17 different difficulties which was identified in 290 patients (58%) . Three conditions, morbid obesity , history of previous upper abdominal surgery and presence of umblical hemia specifically interfere with the ability of the surgeon to gain access to the abdmominal cavity for laparoscopic cholecystectomy. Conversion to open cholecystectomy happened in two patients (0.4%) . In a patient conversion was perfonned for safety due to presence of dense extensive adlH~sions (early mass) in cirrhotic patient with obscured anatomy and dissection was so risky that vital structures might be injured . In the other case conversion was carried out due to complication as there was injury of common bile duct which was mistaken for the cystic duct probably due to upward distraction of the bile duct by the cephalad tractign applied to the neckof the gall bladder. In our work , complications of laparoscopic cholecystectomy happened in 65 patients (13%), they were either due to operative or postoperative complications as a result of abnormal finding. These 184 complications were mostly of the nunor type and were managed conservatively. Serious intraoperative complications during the procedur~ were infrequent. In our study, injurycommonbile duct happened in one case (0.2%) which was detected intraoperativly, conversion to open cholecystectomy , repair with Choledochoduodenostomy, and placement of closed suction drain were carried out. |