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Laparoscopic cholecystectomy in patients with previous upper or lower abdominal surgery

  • A. J. KarayiannakisEmail author
  • A. Polychronidis
  • S. Perente
  • S. Botaitis
  • C. Simopoulos
Original article

Abstract

Background: Previous abdominal surgery has been reported as a relative contraindication to laparoscopic cholecystectomy. This study specifically examined the effect of previous intraabdominal surgery on the feasibility and safety of laparoscopic cholecystectomy. Methods: Data from 1,638 consecutive patients who underwent laparoscopic cholecystectomy were reviewed and analyzed for open conversion rates, operative times, intra- and postoperative complications, and hospital stay. Results: Of the 1,638 study patients 473 (28.9%) had undergone previous abdominal surgery: 58 upper and 415 lower abdominal operations. The 262 patients who had undergone only a previous appendectomy were excluded from further analysis. Adhesions were found in 70.7%, 58.8% and 2.1% of patients respectively, who had previous upper, lower or no previous abdominal surgery with adhesiolysis required, respectively, in 78%, 30% and 0% of these cases. There were no complications directly attributable to adhesiolysis. Patients with previous upper abdominal surgery had a longer operating time (66.4 ± 34.2 min), a higher open conversion rate (19%), a higher incidence of postoperative wound infection (5.2%), and a longer postoperative stay (3.4 ± 2.1 days) than those who had undergone previous lower abdominal surgery (50.8 ± 24 min, 3.3%, 0.7%, and 2.6 ± 1.4 days, respectively) and those without prior abdominal surgery (47.4 ± 25.6 min, 5.4%, 1.2%, and 2.8 ± 1.9 days, respectively). Conclusions: Previous abdominal operations, even in the upper abdomen, are not a contraindication to safe laparoscopic cholecystectomy. However, previous upper abdominal surgery is associated with an increased need for adhesiolysis, a higher open conversion rate, a prolonged operating time, an increased incidence of postoperative wound infection, and a longer postoperative stay.

Keywords

Laparoscopic cholecystectomy Adhesions Complications Abdominal surgery 

Notes

Acknowledgments

The authors thank Professor A. Zbar, University of the West Indies, Barbados, for critical revision of the manuscript.

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Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • A. J. Karayiannakis
    • 1
    Email author
  • A. Polychronidis
    • 1
  • S. Perente
    • 1
  • S. Botaitis
    • 1
  • C. Simopoulos
    • 1
  1. 1.Second Department of SurgeryDemocritus University of Thrace, Medical School, 6 I. Kaviri Street, 68 100 AlexandroupolisGreece

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