IS ACUTE CHOLECYSTITIS A CONTRAINDICATION TO LAPAROSCOPIC APPROACH?

The purpose of this retrospective study was to investigate which is acute cholecystitis contraindication for laparoscopic surgery or not? Most of early articles described taparoscopic cholecystectomy for chronic cholecystitis. Acute cholecystitis was considered a contraindication to this approach. As more experience was obtained, acute cholecystitis became not a contraindication for laparoscopic cholecystectomy. The laparoscopic cholecystectomy operaLions that were performed in Kahramanmaraþ State Hospital, between December 1997-June 1999 were analyzed retrospectively. The patients were divided into two groups. The patients of first group had acute cholecystitis. The cases of second group had chronic cholecystitis. Both group compared to operation times, complications, conversion rate, and drain uses. Between December 1997-June 1999,250 patients underwent laparoscopic cholecystectomy. Of the patients, 46 (18.4%) had acute cholecystitis and 204 (81.6%) had chronic cholecystitis. When we compared two groups, we found significant differences between operation times and drain uses (p < 0.05). Laparoscopic cholecystectomy for acute cholecystitis takes longer and surgeons use more drain for acute cholecystitis. There were no differences between complications and conversion rates. In conclusion, we decided that in experienced hands, laparoscopic surgery could safely be performed in patients with acute cholecystitis. It does not increase the morbidity rate.

AKUT KOLESÝSTÝT LAPAROSKOPÝK YAKLAÞIM ÝÇÝN BÝR ENGEL MÝDÝR?

Laparoskopik cerrahinin ilk yýllarýnda akut kolesistit laparoskopik yaklaþým için kontrendikasyon kabul edilirdi. Zamanla tecrübeler arttýkça akut kolesistit içinde baþarýlý sonuçlarýn yayýnlanmasý, akut kolesistitte de laparoskopik yaklaþýmýn birinci tercih olabileceðini göstermektedir. Kahramanmaraþ Devlet Hastanesinde Aralýk 1997 - Haziran 1999 tarihleri arasýnda laparoskopik kolesistektomi uygulanan 250 olgu retrospektif olarak incelendi. Olgular akut taþlý kolesistit (AK) ve kronik taþlý kolesistit (KK) olarak iki gruba ayrýldý. Her iki grup ameliyat süreleri, komplikasyon, dren kullanýmý ve açýk kolesistektomiye geçime oranlarý açýsýndan karþýlaþtýrýldýlar. Laparoskopik kolesistektomi (LK) uygulanan 250 olgudan, 46 (%18.4) olgu AK, 204 (%81.6) olgu da KK nedeniyle ameliyat edildiler. Her iki grupta da taný anamnez,fizik muayene ve ultrasonografi ile konuldu. Ortalama yaþ KK grubunda 51.3±13.9 SD, KK grubunda ise 49.2± 1.0 SD idi. Ortalama ameliyat süreleri AK grubunda 65.7±22.3 SD dakika iken, KK grubunda 53.7 ± 18.7 SD dakika idi ve aradaki fark anlamlý idi (p < 0.001). AK grubunda 2 (%4) olguda komplikasyon izlenirken, KK grubunda 6 (%3) olguda komplikasyon izlendi ve aradaki fark anlamlý deðildi (p>0.05). AK grubunda 18 (%39.1) olguda dren kullanýlýrken, KK grubunda 26(%12.7) olguda dren kullanýldý ve aradaki fark anlamlý bulundu (p<0.05). Açýk Kolesistektomiye AK grubunda 1 (%2) olguda geçilirken, KK grubunda 3 (%1.5) olguda geçildi (p > 0.05). Sonuç olarak, AK için yapýlan laparoskopik cerrahi daha uzun sürmekte ve daha fazla dren kullanýlmaktadýr. LK'nin genel avantajlarý göz önüne alýndýðýnda, akut ve kronik kolesistit nedeniyle uygulanan LK'ler arasýnda morbiditeyi arttýrýcý bir fark olmamasý, AK içinde LK, tecrübeli ellerde güvenli ve efektif bir yöntemdir.