Jurnalul de Chirurgie
 Jurnalul de chirurgie
Aparitie trimestriala in a doua luna a trimestrului
Published quarterly in the second month of the quarter
ISSN: 1584 - 9341 Vol.10 Nr.3 - Iulie-Septembrie 2014 | sâmbătă, 23 martie 2019
ISSN: 1584 - 9341 Vol.10 No.3 - July-September 2014
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LAPAROSCOPIC CHOLECYSTECTOMY AT THE PATIENTS WITH THE ASSOCIATE PATHOLOGY AND DIFFICULT SURGICAL TECHNIQUES
A. Lesco

State Medical and Pharmaceutical University „N. Testemitanu”, Chisinau, Rep. Moldova
Jurnalul de chirurgie 2006; 2 (1):107-110
Full text: Format multimedia HTML  PDF Format (English)

Abstract:

This paper present an analysis made on 1210 cases of laparoscopic cholecystectomies (LC). From these, 88 patients had associated pathology. The age of the patients was 11 – 82 yo. The indication for LC was large. In the study group (88 cases), the Acid-Base Balance (ABB), blood gasses, blood pressure, the central venous pressure (CVP), intra-cranial pressure (ICP), inspiratory resistance, temperature changes and also peritoneal biopsy were analysed.

Methods: The multilateral study clinic-instrumental examinations of associate pathology in preoperative period were determined. Determination of the risk group and patients for LC has been allowed.

Results: The CO2 pneumoperitoneum (PP) (7-12 mmHg) determines changes of the: 1) ABB (intra operator blood pH was 7.37 before and 7.25 after the procedure); 2) partial carbon dioxide (before 40, after 47); 3) blood pressure; 4) mean CVP (before operation - 6.67±0.17 and 10.73±0.29 after procedure (p<0.01)); 5) ICP (8.65±0.19 mm, p<0.01); 6) inspiratory resistance; 7) temperature changes (due to the CO2 temperature).

The conversion rate was (0,41%): complicated acute cholecystites (1), dense multiple adhesions (1), the incidence of significant hemorrhage (2), bile duct injury (1). The postoperative mortality were 0,33% (4 cases) due to pulmonary artery tromboemboly. Billiary lesions during LC occur with a frequency of 0,41% (5 patients): four bile duct injuries and leaks and one case – right billiary accessory duct, were solved following another operation three days after the initial procedure. Wound infection was more frequently, occurring in 21 cases (1,74%).

The other complications (14 cases) include: subcutaneous emphysema and insufflations of the pro-peritoneal space, omentum, or mesentery. Conclusions: LC is a safety technique even in the patients with associated pathology, but the morbidity and mortality are high. No presumed ductal or vascular structure should be divided until its anatomical features have been completely demonstrated. If the ductal and vascular structures are so obscured by dense inflammation then the procedure should be converted to an open laparotomy.

Intra-operative cholangiography will supply the surgeon with accurate details concerning the juncture of the cystic and common bile ducts. To avoid intra-operative bleeding during emergency cholecystectomy it is important to carefully dissect and identify both branches of the cystic artery as well as the main trunk before any suspected vascular structures are divided. Often the most difficult sources of bleeding to avoid in patients with acute cholecystitis is bleeding from the gallbladder fossa.

KEYWORDS: LAPAROSCOPIC CHOLECYSTECTOMY



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Jurnalul de chirurgie [Journal of Surgery] by Editorial Board, Department of Surgery University of Medicine and Pharmacy Iasi, E. Tarcoveanu, R. Moldovanu is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.
Based on a work at www.jurnaluldechirurgie.ro.