Abstract

Background: Previous abdominal surgery has been reported as a relative contraindication to laparoscopic cholecystectomy. Previous abdominal surgery particularly is associated with difficulty placing the initial trocar and obtaining adequate exposure to the gallbladder. Aim of the study: This study specifically examined the effect of previous intraabdominal surgery on the feasibility and safety of laparoscopic cholecystectomy. Methods: Data from 161 consecutive patients who underwent laparoscopic cholecystectomy were prospectively analyzed for method and site of first port insertion, operative times, CO₂ consumption, adhesion score, intra- and postoperative complications, and open conversion rates for patients with previous abdominal surgery. Results: 161 patients had undergone previous abdominal surgery: 13 upper and 148 lower abdominal operations. Adhesions were found in 92 %, 37.8% of patients respectively, who had previous upper or lower abdominal operations. There were complications directly attributable to adhesiolysisis and or to Veress needle insertion. Patients with previous upper abdominal surgery had a longer operating time (65.33 ± 46.76 min), a higher CO₂ consumption mean+-SD (98.78±57.84L),higher complication(46.1%),higher open conversion rate (30.8%), than those who had undergone previous lower abdominal surgery (50.06 ± 22.38 min , 89.51+-52.68, 14.2%, 2% 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 adhesiolysisis, a higher open conversion rate, a prolonged operating time