Laparoscopic cholecystostomy with delayed cholecystectomy as an alternative to conversion to open procedure.

Autor: Kuster GG; Division of General Surgery, Scripps Clinic and Research Foundation, La Jolla, CA 92037, USA., Domagk D
Jazyk: angličtina
Zdroj: Surgical endoscopy [Surg Endosc] 1996 Apr; Vol. 10 (4), pp. 426-8.
DOI: 10.1007/BF00191631
Abstrakt: Background: Acute cholecystitis carries the highest incidence of conversion from planned laparoscopic cholecystectomy to open surgery due to unclear anatomy, excessive bleeding, complications, or other technical reasons.
Methods: Laparoscopic tube cholecystostomy was performed instead of immediate conversion to laparotomy in 9 patients with acute cholecystitis after unsuccessful attempts at laparoscopic dissection. Elective laparoscopic cholecystectomy was done 3 months later.
Results: Following this approach eight patients were treated successfully. After 3 months the acute process had subsided sufficiently to allow a safe laparoscopic cholecystectomy. One additional patient died of acute leukemia 6 weeks after cholecystostomy. Before adopting this technique we subjected 171 patients with acute calculous cholecystitis to laparoscopic cholecystectomy; there was an 11% (19 cases) rate of conversion. Since cholecystostomy has begun to be offered as an alternative to conversion, 121 patients with acute cholecystitis have had laparoscopic cholecystectomy and only 2 cases (1.5%) have been converted to immediate open cholecystectomy.
Conclusions: We recommend the alternative of performing a cholecystostomy with delayed laparoscopic cholecystectomy instead of conversion to open procedure when facing a case of acute cholecystitis not amenable to laparoscopic cholecystectomy.
Databáze: MEDLINE
Externí odkaz: