THE IMPACT OF PRIOR INTRAABDOMINAL SURGERY ON LAPAROSCOPIC CHOLECYSTECTOMY

The presence of abdominal wall scarring and intra-abdominal adhesions following prior abdominal surgery has been proposed as a relative cont raindication to the performance of laparoscopic cholecystectomy. The i mpact of prior abdominal surgery on the management of symptomatic gall bladder disease were retrospectively reviewed. Three groups were eval uated: open, laparoscopic, and laparoscopdic converted to open cholecy stectomy. Clinical factors analyzed included lengths of operative time , postoperative hospitalization stay, medical risk (ASA Classification ), and postoperative complications. In addition, factors contributing to the conversion from a laparoscopic to open procedure were evaluated to determine the impact of prior surgery on conversion. The records o f 504 consecutive patients undergoing open and laparoscopic cholecyste ctomy were reviewed. Individuals having additional intra-abdominal pro cedures were excluded. A total of 175 patients were identified who had prior abdominal surgery and underwent a cholecystectomy. In patients requiring cholecystectomy who have had prior abdominal surgery, the fo llowing observations can be made regarding laparoscopic cholecystectom y: 1) The operative time is less compared to open cholecystectomy. 2) The advantage of a shorter postoperative stay is realized. 3) The conv ersions rate (7/185) is low. Five of the seven conversions were due to the dense adhesion that prevented safe needle/trocar placement. 4) Th e complication rate is not increased. 5) The successful completion rat e of laparoscopic cholecystectomy following prior intra-abdominal surg ery (95.6%) is high.