RESUMEN
There is no data on the special complications of micro (less than 4 cm incision) and modern mini laparotomy cholecystectomies (4.1-6 cm incision). Out of 710 non selected patients, 643 micro laparotomy cholecystectomies were performed and 61 modern mini laparotomies due to choledocholithiasis. On three occasions, conventional mini (6.1-10 cm) laparotomy was performed and in another three, conventional laparotomy (over 10 cm incision) was executed. Intraoperative bleeding was encountered in 15 cases (2.1%) while accidental hepatic duct clipping occurred in one case (0.1%). Damage to the bile duct did not occur in any case reported. Postoperative bleeding was reported in 8 cases (1.1%) and delayed bile leakage was reported in 10 cases (1.4%). Special complications reported as a result of pathological alteration in the bile tract as follows: Intraoperative bleeding encountered during simple cholecystectomy-1% but cholecystectomy due to obstructive cholecystitis 3.8%, also caused by intraoperative bleeding. Delayed bile leakage in simple cholecystectomy was not observed, but after cholecystectomy for obstructive cholecystitis it encountered in 3.4%. Special complications resulted in four early reoperations (0.5%). Two other patients were re-operated within three weeks, independent of special complications. The percentage of both intra and postoperative complication was significantly higher in obstructive cholecystitis with an operative delay of 11 or more days.
Asunto(s)
Colecistectomía/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Pérdida de Sangre Quirúrgica/prevención & control , Colecistectomía/efectos adversos , Colecistitis/cirugía , Colelitiasis/cirugía , Femenino , Cálculos Biliares/cirugía , Humanos , Obstrucción Intestinal/etiología , Obstrucción Intestinal/prevención & control , Ictericia/etiología , Ictericia/prevención & control , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , ReoperaciónRESUMEN
The conventional and laparoscopic cholecystectomy is as already every day utilized method, the operation procedure is well developed and the instruments used allow a reliable operation. The cholecystectomy performed by minilaparotomy is not yet a widespread procedure, since there is no established method and the instruments needed are not readily available, as well as the fact that special complications' rates is not yet well known. In order to further elaborate on the procedure and to demonstrate it's true value, 710 micro- and modern minilaparotomies, without exclusion or selection, were analyzed and the operation procedures were then summarized. The operations were completed with microlaparotomy (smaller than 4 cm incisions) in 643 cases (90.6%) with modern minilaparotomies (4.1-6 cm) in 61 cases (8.6%), with conventional mini (6.1-10 cm), and the incisions longer than 10 cm with conventional laparotomies in 3-3 instances (0.4-0.4%). We performed a complete cholecystectomy in 97.2%, a longer cystic stumps was left in 1.7%, subtotal and partial cholecystectomies in 0.7% and 0.3% respectively. In 69 of the cases (9.7%) simultaneous choledocholithiasis was discovered and resolved. 21.2% of the operations were termed as difficult. 2/3 of the intra and postoperative complications as well as early reoperations occured in cases where they followed a delayed operation of obstructive cholecystitis. One patient was lost (0.14%) due to non-surgical complication. These experiences show that cholecystectomy performed by micro and modern minilaparotomy is a realistic alternatives to the conventional and laparoscopic cholecystectomies.