- citati u SCIndeksu: 0
- citati u CrossRef-u:0
- citati u Google Scholaru:[
 ]
- posete u poslednjih 30 dana:2
- preuzimanja u poslednjih 30 dana:1
|
|
|
2016, vol. 55, br. 3, str. 13-20
|
|
Analiza faktora rizika za konverziju laparoskopske holecistektomije u otvorenu operaciju
Analysis of risk factors that indicate conversion of laparoscopic cholecystectomy to open surgery
aHirurška klinika Kliničko-bolničkog centra Priština, Gračanica + Univerzitet u Prištini sa privremenim sedištem u Kosovskoj Mitrovici, Medicinski fakultet bKlinički centar Niš, Klinika za opštu hirurgiju cKlinički centar Niš, Klinika za opštu hirurgiju + Univerzitet u Nišu, Medicinski fakultet dOpšta bolnica Pirot, Pirot
e-adresa: slobodan.arandjelovic@med.pr.ac.rs
Sažetak
Laparoskopska holecistektomija (LC) predstavlja 'zlatni standard' u lečenju hirurških oboljenja žučne kese. Međutim, pojedini slučajevi još uvek zahtevaju konverziju u otvorenu proceduru (OC). Preoperativna procena o tome kod kojeg bolesnika će verovatno doći do konverzije i identifikacija faktora rizika za konverziju je relativno teška i neprecizna. Cilj istraživanja bio je identifikovati faktore rizika koji mogu zahtevati konverziju laparoskopske u otvorenu proceduru holecistektomije. Izvršena je retrospektivna analiza 65 bolesnika, oba pola, sa oboljenjem žučne kese, operisanih u periodu od 01. 01. 2007. do 01. 06. 2013. godine na Hirurškoj klinici KC Niš, kod kojih je izvedena konverzija LC u OC. U navedenom periodu izvedene su 1292 laparoskopske holecistektomije. Retrospektivno su analizirani sledeći parametri: učestalost konverzije u toku otvorene i laparoskopske hole-cistektomije; karakteristike bolesnika kod kojih je izvršena konverzija (demografske karakteristike (pol, starost, BMI); karakteristike patološkog supstrata (akutni holecistitis, hronični komplikovani holecistitis sa adhezijama, simpleks kalkuloza ili polipoza žučne kese); parametri koji se odnose na hirurga (broj izvedenih LC procedura i vremenski period od prvog izvođenja). Postupak konverzije laparoskopske holecistektomije u otvorenu izveden je kod 5,03% bolesnika. Veća učestalost konverzija registrovana je kod operisanih osoba ženskog pola (53,84%) bez statističke značajnosti. Najveći procenat bolesnika sa konverzijom, je u VI i VII dekadi života (25,8%) (p <0,05). Procenat konverzija je veći kod bolesnika sa BMI>30 (6,56%), u odnosu na grupe sa BMI 25-30 (5,62%), BMI 20-25% (2,6%) i BMI ispod 20 (1,09%), ali bez statističke značajnosti. Procenat konverzija kod bolesnika operisanih zbog akutnog holecistitisa iznosi 26,95%, hroničnog simpleks holecistita 1,16%, kompleksnog hroničnog holecistita 8,46%, benignih tumora žučne kese (3,5%,) (p<0,05). Najveći procenat konverzija (12,67%) registrovan je u grupi hirurga sa najmanjim brojem LC (25-50), u poređenju sa hirurzima sa iskustvom od preko 200 LC (1,4%) (p<0,05). Konverzije se dešavaju statistički značajno češće u toku operacija kod starijih bolesnika, kod bolesnika sa akutnim ili kompleksnim hroničnim holecistitisom i operisanih od strane nedovoljno iskusnih hirurga. Pol, visok BMI, postojanje anatomskih anomalija i varijacija, prethodne operacije trbuha i tehnički problemi nisu od većeg statističkog značaja kao faktori odgovorni za konverziju LC u OC.
Abstract
Laparoscopic cholecystectomy (LC) has become the 'gold standard' in the surgical treatment of gallbladder disease. However, in some cases LC needs conversion to open cholecystectomy (OC). Preoperative assessment that should determine in which patient conversion should be performed as well as identification of the risk factors for conversion are relatively difficult and imprecise. The aim of this study was to identify the risk factors for conversion of LC to OC. We performed the retrospective analysis of 65 patients, of both genders, with gallbladder disease, operated in the period from 01/01/2007 to 06/2013, in whom conversion of LC to OC was performed. A total of 1292 laparoscopic cholecystectomies (LCs) was done in this period. The authors analyzed: total conversion rate; the conversion rate according to patient characteristics (age, gender, body mass index (BMI)); local pathological condition (acute cholecystitis, chronic complicated cholecystitis, simple calculosis or gallbladder polyposis); surgeon-related parameters (number of performed LCs and total surgical experience). Total conversion rate (conversion of LC to OC) was 5,03%. Higher conversion rate was registered in the female patients (53.84%), but there were no statistically significant differences. The highest conversion rate was registered in the groups of patients in the 6th and 7th decade (p<0.05). Conversion rate was higher in patients with BMI>30 (6.56%), compared with those with lower BMI, but there was no statistical significance. Patients operated for acute cholecystitis had statistically significantly higher conversion rate (26.95 %), compared with those with the diagnosis of chronic simple cholecystitis (1.16 %), complicated chronic cholecystitis (8.46%), benign gallbladder polyposis (3.5%,) (p<0.05). Surgeons with a lower number of performed LCs (25-50) had higher conversion rate (12.67%), compared with experienced surgeons that performed over 200 LCs (1.4%) (p<0.05). Conversions are statistically significantly more present in older patients during surgery, in patients with the diagnosis of acute or complex chronic cholecystitis, and in those operated by inexperienced surgeons. Gender, high BMI, anatomical anomalies and variations, previous laparotomy or technical problems were not statistically significant conversion factors.
|
|
|
|
Reference
|
|
|
*** (1992) Gallstones and laparoscopic cholecystectomy. u: NIH Consensus Statement, Online; 10(3): 1-28. [PubMed]
|
|
1   
|
Angrisani, L., Lorenzo, M., de Palma, G., Sivero, L., Catanzano, C., Tesauro, B., Persico, G. (1995) Laparoscopic cholecystectomy in obese patients compared with nonobese patients. Surgical laparoscopy & endoscopy, 5(3): 197-201
|
|
|
Archer, S.B., Brown, D.W., Smith, C.D., Branum, G.D., Hunter, J.G. (2001) Bile duct injury during laparoscopic cholecystectomy: results of a national survey. Annals of surgery, 234(4): 549-58; discussion 558-9
|
|
|
Beltramo, M., Benussi, G., Cazzaniga, M., Fraquelli, M. (1995) Cholecystectomy with laparoscopy and laparotomy: Analysis of the complications. Minerva Chir, 50(7-8): 627-31. [PubMed]
|
|
|
Bohacek, L., Pace, D.E. (2009) Advanced laparoscopic trainingand outcomes in laparoscopic cholecystectomy. Can J Surg, 52(4); 291-4
|
|
|
Carey, L.C. (1992) Cholecystectomy—A New Standard. Annals of Surgery, 216(6): 617
|
|
|
Chang, Y.C. (2005) A proposed laparoscopic inflammationgrading system for laparoscopic cholecystectomy. Hepato-gastroenterol, 52: 33-6
|
|
1
|
Collet, D., Edye, M., Magne, E. (1992) Laparoscopic cholecystectomy in the obese patient. Surg Endosc, 6(4): 186-8
|
|
1
|
Constant, E., Janssen, P., Nys, J.M., Fouly, el P.E., Lemmens, F., Hachez, L., Hauters, P. (1995) Prospective analysis of 192 consecutive cholecystectomies: a comparative study between laparoscopy and laparotomy. Acta Chir Belg, 95(6); 254-60
|
|
|
Cuschieri, A., Buess, G., Perissat, J. (1994) Operative manual of Endoscopic surgery 2. Berlin: Springer-Verlag
|
|
1  
|
Čolović, R. (2010) Forensic aspects of operative bile ducts injuries. Vojnosanitetski pregled, vol. 67, br. 2, str. 176-178
|
|
1
|
Deziel, D.J., Millikan, K.W., Economou, S.G., Doolas, A., Ko, S.T., Airan, M.C. (1993) Complications of laparoscopic cholecystectomy: A national survey of 4,292 hospitals and an analysis of 77,604 cases. Am J Surg, 165(1): 9-14
|
|
1
|
Frazee, R.C., Roberts, J.W., Symmonds, R., Snyder, S.K., Hendricks, J., Smith, R., Custer, M.D. (1992) What are the contraindications for laparoscopic cholecystectomy?. American journal of surgery, 164(5): 491-4; discussion 494-5
|
|
|
Fried, G.M., Barkun, J.S., Sigman, H.H., Joseph, L., Clas, D., Garzon, J., Hinchey, E.J., Meakins, J.L. (1994) Factors determining conversion to laparotomy in patients undergoing laparoscopic cholecystectomy. Am J Surg, 167(1): 35-9; disc
|
|
|
Glättli, A., Allemann, A., Metzger, A., Barras, J.P., Baer, H.U. (1994) Laparoscopic cholecystectomy in morbid obesity. Schweizerische medizinische Wochenschrift, 124(40): 1758-63
|
|
|
Hussain, A. (2011) Difficult Laparoscopic Cholecystectomy. Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 21(4): 211-217
|
|
|
Jaffary, S.A., Shamim, M.S., Razza, S.J., Dastagir, A. (2007) Instrument failure: A Preventable cause of conversion in laparoscopic cholecyestectomy. Pak J Surg, 23: 92-5
|
|
|
Jeremić, M. (2010) Benigne strukture žučnih puteva. u: Jeremić M. [ur.] Abdominalna hirurgija, Niš: Medicinski fakultet
|
|
|
Kama, N.A., Kologlu, M., Doganay, M., Reis, E., Atli, M., Dolapci, M. (2001) A risk score for conversion from laparoscopic to open cholecystectomy. American journal of surgery, 181(6): 520-5
|
|
|
Kaplan, M., Salman, B., Iyikosker, H.I., Yalcin, H.C., Yilmaz, U. (2007) The reasons and risk factors for conversion to open in laparoscopic cholecystectomy. New of the Medicine, 24: 146-51
|
|
|
Kum, C.K., Eypasch, E., Lefering, R., Paul, A., Neugebauer, E., Troidl, H. (1996) Laparoscopic cholecystectomy for acute cholecystitis: is it really safe?. World journal of surgery, 20(1): 43-8; discussion 48-9
|
|
|
Kwon, A., Matsui, Y. (2006) Laparoscopic cholecystectomy in patients aged 80 years and over. World journal of surgery, 30(7): 1204-10
|
|
|
Lillemoe, K.D. (1997) Benign post-operative bile duct strictures. Bailliere's clinical gastroenterology, 11(4): 749-79
|
|
3
|
Liu, C.L., Fan, S.T., Lai, E.C., Lo, C.M., Chu, K.M. (1996) Factors affecting conversion of laparoscopic cholecystectomy to open surgery. Arch Surg, 131(1): 98-101
|
|
|
Memon, M.R., Muhammad, G., Arshad, S., Jat, M.A., Bozdar, A.G., Shah, S.Q. (2010) Study of open conversion inlaparoscopic cholecystectomy. Gomal Journal of Medical Sciences, 9(1)
|
|
1
|
Peters, J.H., Krailadsiri, W., Incarbone, R., Bremner, C.G., Froes, E., Ireland, A.P., Crookes, P., Ortega, A.E., Anthone, G.A., Stain, S.A. (1994) Reasons for conversion from laparoscopic to open cholecystectomy in an urban teaching hospital. Am J Surg, 168(6): 555-8; discussion 558-9
|
|
|
Rosen, M., Brody, F., Ponsky, J. (2002) Predictive factors for conversion of laparoscopic cholecystectomy. American journal of surgery, 184(3): 254-8
|
|
1 
|
Roslyn, J.J., Binns, G.S., Hughes, E.F., Saunders-Kirkwood, K., Zinner, M.J., Cates, J.A. (1993) Open cholecystectomy. A contemporary analysis of 42,474 patients. Ann Surg, 218(2): 129-37
|
|
|
Sakpal, S.V., Bindra, S.S., Chamberlain, R.S. (2010) Laparoscopic Cholecystectomy Conversion Rates Two Decades Later. JSLS : Journal of the Society of Laparoendoscopic Surgeons, 14(4): 476-483
|
|
|
Schrenk, P., Woisetschläger, R., Wayand, W.U. (1995) Laparoscopic cholecystectomy. Cause of conversions in 1,300 patients and analysis of risk factors. Surgical endoscopy, 9(1): 25-8
|
|
1
|
Tang, B., Cuschieri, A. (2006) Conversions During Laparoscopic Cholecystectomy: Risk Factors and Effects on Patient Outcome. Journal of Gastrointestinal Surgery, 10(7): 1081-1091
|
|
1
|
Tucker, J.J., Yanagawa, F., Grim, R., Bell, T., Ahuja, vanita (2011) Laparoscopic cholecystectomy is safe but underused in the elderly. American surgeon, 77(8): 1014-20
|
|
|
Uragami, A., Matsumoto, H., Yamashita, K., Hirai, T., Tsunoda, T. (2005) Results of questionnaire surveys at several affiliated institutions regarding intraoperativebiliary tract injuries. Tando (J Jpn Biliary Assoc), 19: 299
|
|
|
|
|