[Laparascopic cholecystectomy on a previously operated abdomen]

Laparoscopic cholecystectomy is the "gold standard" reference treatment of gall bladder stones. Laparoscopy is still contra-indicated in the presence of abdominal scars due to the frequent post-operative adhesions which make access to the peritoneal cavity difficult.

This study aimed to assess outcomes of laparoscopic cholecystectomy on a scarred abdomen.

We have carried out a retrospective study on a number of consecutive patients operated between the first januar 2000 and 31 december 2006, who underwent laparoscopic cholecystectomy with previous abdominal surgery (one or several) during this period, laparoscopic cholecystectomy was performed on 2281 patients, including 233 patients who had at least one abdominal scar (10%). We have noted on the records of these patients all the data relating to the epidemiological, clinical and therapeutical aspects. We have worked out a descriptive analysis of the series and we have thus studied the rate of operative and post-operative complications, the rate of conversion, the duration of the operation and the duration of post-operative stay. Then we have compared two groups of patients, those with an upper abdominal surgery: group 1 (G1) and those with lower abdominal surgery: group 2 (G2).

The groups consist of 200 women and 33 men aged on average 13.8 +/- 49.6 years. The indication for cholecystectomy was a symptomatic cholelithiasis in 78% of cases (n = 181), an acute cholecystitis in 22% of cases. The adhesions were believed numerous or very numerous in only 46 patients (20%). Four patients had interventional adverse events: a small intestine injury, a choledoch injury, a gastric injury and a least known colic injury. The rate of open conversion was 2.1%. Post-operative complication was 2.1%. The evolution was satisfactory in all cases. Mean operating time was 50 minutes (15-230). Mean post operative stay was one day (1-29 days). When comparing the above mentioned two groups of patients (G1: 45 patients and G 2: 188 patients), we can conclude that the first group (G1) is made up of more male patients aged over 60 years (p < 10-3). It also appears that the existence of an upper umbilical scar is correlated to a greater number of adhesions (p < 10-3), an increased risk of operative complications (p = 0.01), a greater conversion rate (p < 10-4), a prolonged operating time (p < 10-3) and a longer stay (p = 0.017). On the other hand, post-operative complications was similar in group 1 and 2.

Previous abdominal operations, are not a contraindication to safe laparoscopic cholecystectomy. However, previous upper abdominal surgery is associated with a higher rate of adhesions, an increased risk of operative complications, a greater conversion rate, a prolonged operating time and longer stay.