الفهرس 
Material and methodsOnly 14 pages are availabe for public view
 |  | from | 270 |  |  |
| | | from | 270 | | |
Abstract
In our study, lapardscopic cholecystectomy was performed on 500
patients with symptomatic gall baldder disease, 450 patients of them with
chronic calcular cholecystitis, 15 patients with chronic non calcular
cholecystitis and 35 patients with acute calcular cholecystitis.
Thorough history taking , physical exammation and proper
investigations were carried out to detennine the presence of biliary and
non biliary problems that may adversely affect the outcome of
laparoscopic cholecystectomy.
Biliary problems included 10 patients who had stone common bile
duct with chronic calcular cholecystitis. They managed with preoperative
E.R.C.P. with stone extraction prior to laparoscopic cholecystectomy,
which was successfully performed in these patients, non biliary problems
, included patients with cardiopulmonary disease, coagulopathy,
cirrhosis, morbid obesity and previous abdominal surgery. so further
evaluation and cautious approach to the management of these individuals
had been taken.
Despite the liberalization of patients selection. not all individuals
were candidates for laparoscopic cholecystectomy - Our absolute
contraindications included inability to tolerate general anaesthesia or
laparotomy, uncorrected coagulopathy and generalized peritonitis.
183
laparoscopic cholecystectomy started through 3 puncture technique
in 10 patients, 4 puncture teclmique in 460 patients and insertion of
accessory fifth cannula was needed in 20 patients due to operative
difficulties.
So, closed laparoscopic technique was carried out in 490 patients
whereas open laparoscopy (Hasson Teclmique) was perfonned in 1
0
patients.
In our work, we were confronted with about 17 different difficulties
which was identified in 290 patients (58%) . Three conditions, morbid
obesity , history of previous upper abdominal surgery and presence of
umblical hemia specifically interfere with the ability of the surgeon to gain
access to the abdmominal cavity for laparoscopic cholecystectomy.
Conversion to open cholecystectomy happened in two patients
(0.4%) . In a patient conversion was perfonned for safety due to presence
of dense extensive adlH~sions (early mass) in cirrhotic patient with
obscured anatomy and dissection was so risky that vital structures might
be injured . In the other case conversion was carried out due to
complication as there was injury of common bile duct which was mistaken
for the cystic duct probably due to upward distraction of the bile duct by
the cephalad tractign applied to the neckof the gall bladder.
In our work , complications of laparoscopic cholecystectomy
happened in 65 patients (13%), they were either due to operative or
postoperative complications as a result of abnormal finding. These
184
complications were mostly of the nunor type and were managed
conservatively.
Serious intraoperative complications during the procedur~ were
infrequent. In our study, injurycommonbile duct happened in one case
(0.2%) which was detected intraoperativly, conversion to open
cholecystectomy , repair with Choledochoduodenostomy, and placement
of closed suction drain were carried out.