Feasibility of Laparoscopic Cholecystectomy in Patients with Previous Upper Abdominal Surgery

Abstract

Background: Previous abdominal surgery usually lead to adhesion formation, which considered as a contraindication of laparoscopic cholecystectomy (LC). However, it had been reported that, careful adhesiolysis could be performed and thus LC becomes feasible. Aim of the work: To assess the feasibility and outcome of laparoscopic cholecystectomy in patients with previous upper abdominal surgery. Patients and Methods: This study included 30 patients, who were presented by symptomatic gallstones. All participants assessed clinically. Then, a full lab profile was performed. Finally, abdominal ultrasound was done and if there was a dilatation of common bile duct, patients were submitted to magnetic resonance cholangiopancreatography. Both intra-and postoperative data were collected and any complications were documented.Results: 26 patients (86.7%) had chronic calcular cholecystitis, two had acute calcular cholecystitis and two had mucocele of gallbladder. Adhesions were grade 1 in 13.3%, grade 2 in 46.7%, grade 3 in 20% and grade 4 in 20.0%. Adhesiolysis was needed in twenty patients (66.7%). Intraoperative complications were reported in nine patients (40%). Bleeding reported in six patients and preformation of the gall bladder in three patients (10%). Three patients (10%) were converted to open surgery. Postoperatively, 12 patients (26.7%) had complications [3, 1, 2, 1 and 5 for port site wound infection, bile leakage, bleeding, and chest infection respectively). Post operative pain was mild in half of patients and moderate in other half. Conclusion: laparoscopic cholecystectomy after previous abdominal operations is relatively feasible and relatively safe, as nearly one third of patients had difficulties and complications.

Keywords

• laparoscopic cholecystectomy
• adhesions
• feasibility
• upper abdomen
• surgery