The possibilities of single-port laparoscopic access in cholecystectomy after operations on the abdominal cavity organs
DOI:
https://doi.org/10.14739/2310-1210.2017.3.100840Keywords:
single-port access, laparoscopic cholecystectomy, cholelithiasis, adhesion process, chronic calculous cholecystitisAbstract
Aim. To assess the possibility and effectiveness of single-port access in cholecystectomy using for chronic calculous cholecystitis in patients who were previously operated on the abdominal organs.
Materials and Methods. For the period from September 2015 to March 2017, 27 patients were been operated by laparoscopic cholecystectomy using single-port access for chronic calculous cholecystitis.
All patients were divided into 2 groups. The first group included 12 (44.4%) patients with previous surgery on the abdominal organs, who were performed laparotomy. The second group (2) included 15 (55.5%) patients who didn’t have surgical interventions on the abdominal organs.
Results and Discussion. The average duration of surgical intervention in patients of the 1st group (n = 12) was 87.66 ± 4.03 minutes. In all cases chronic calculous cholecystitis was observed. There was no transition to open cholecystectomy. The average bed-day was 2.41 ± 0.20. Drainage of the abdominal cavity was carried out only for 7 patients (58.3%). In 7 (58.3%) patients opioid analgesics were prescribed once to reduce postoperative pain. Activation of patients occurred on the first day after the operation. After 2 days the ultrasound of the abdominal cavity was performed. In 2 (16.6%) patients there was a slight accumulation of fluid in the region of the removed gallbladder that did not require puncture.
Patients in the second group in all cases were performed a single-port cholecystectomy without additional trocars. The average duration of the operation was 38.93 ± 1.85 minutes. In all cases chronic calculous cholecystitis was observed. Conversions to the open methodology have not been noted. The average bed-day was 2.06 ± 0.07.Drainage of the abdominal cavity has not been performed. In 2 (13.3%) cases opioid analgesics were prescribed once for postoperative pain relieving. Activation of patients occurred on the next day after the operation. After 2 days on the day of releasing from the hospital the ultrasound of the postoperative zone was performed, fluid accumulation in the area of the gallbladder bed was noted in 1 (6.6%) of the patient.
Conclusions. The use of single-port access in laparoscopic cholecystectomy performing is an effective way. The features of a single port structure provide the possibility of curved instruments additional application, increase the number of single-port laparoscopic interventions in patients with chronic calculous cholecystitis.
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