Laparoscopic Cholecystectomy in Patients with a History of Upper Abdominal Surgery

Bae, Young Sik; Lee, Sang Mok; Kim, Joo Hyun; Kim, Bum Soo; Joo, Sun Hyung

Abstract

PURPOSE
Laparoscopic cholecystectomy is currently the treatment of choice for gallbladder disease. Previous abdominal surgery was considered as a relative contraindication for laparoscopic cholecystectomy due to the presence of intraabdominal adhesion and the difficulty in visualization. Several recent studies have suggested that previous abdominal surgery is no longer a contraindication for laparoscopic surgery by virtue of the accumulation of surgeons' experience and the evolution of laparoscopic instruments. In this study, we evaluated the impact of previous upper abdominal surgery on laparoscopic cholecystectomy.
METHODS
The data of 706 consecutive patients who underwent laparoscopic cholecystectomy from September 2004 to December 2007 was retrospectively analyzed. Thirty-three patients had undergone pervious upper abdominal surgery and 673 patients had not. We compared the operative time, the type of trocar that was used, the postoperative complications, the frequency of open conversion and the length of the postoperative hospital stay between the two groups
RESULTS
The operative time was longer (141.8+/-88.7 min vs. 74.1+/-37.4 min, p<0.001) and larger trocars were used more often (p<0.001) in the previous upper abdominal surgery group. There was no significant difference in the open conversion rate, the major postoperative complication rate and the length of the postoperative hospital stay.
CONCLUSION
Laparoscopic cholecystectomy might be an optimal treatment for patients with a history of previous upper abdominal surgery. Previous upper abdominal surgery is not a contraindication for laparoscopic cholecystectomy when it is performed by experienced laparoscopic surgeons.