Læknablaðið - 15.06.1998, Síða 9

LÆKNABLAÐIÐ 1998; 84
461
Gallkaganir á Landspítalanum
Fyrstu 353 tilfellin
Kristján Óskarsson, Margrét Oddsdóttir, Jónas Magnússon
Óskarsson K, Oddsdóttir M, Magnússon J
Laparoscopic Cholecystectomy at Landspítalinn,
University Hospital of Iceland. The first 353 cases
Læknablaðið 1998; 84: 461-5
Objective: Since the first laparoscopic cholecys-
tectomy done at the Department of Surgery in
November 1991, our aim has been to operate on all
presenting patients by this method.
Material and methods: From November 17th 1991
until September 30th 1994, 384 cholecystectomies
were performed. Open cholecystectomy was perfor-
med in 31 patients. The most frequent causes for
open operation were; suspected stones in the chole-
dochus, acute cholecystitis or biliary sepsis. The ob-
jective of this study was to determine the frequency
of procedure-related complications and the fre-
quency of conversion to open surgery. Furthermore,
the operation time, the length of post-operative hos-
pital stay, mortality and morbidity were studied.
Results: A retrospective analysis of patients under-
going cholecystectomy during this period was per-
formed. Post-operatively patients were also contac-
ted by telephone. There were 121 males and 263
females, ranging between three and 91 year of age.
Mean age was 53.2 years. Urgent operations (opera-
tion performed after emergency admission) were
43.9%, being highest in the last period of the study.
Conversion to open surgery was needed in 63 cases
(17.8%). The reasons were; adhesions (39.7%), un-
clear anatomy (17%) and bleeding (15.9%). Conver-
Frá handlækningadeild Landspítalans, læknadeild Há-
skóla íslands. Fyrirspurnir, bréfaskipti: Jónas Magnússon
handlækningadeild Landspítalans, sími 560 1330, bréf-
sími 560 1329, netfang: jonas@rsp.is
Lykilorð: gattkögun, fylgikvillar, aðgerðartími, legutími.
sion rate was 13% for elective operations but 24%
for acute cases. Reoperation was needed in 11 cases
(3.8%). Seven patients were reoperated during the
same hospital admission but four later on. The
reasons were; bleeding (four), bile leakage (three),
common duct stone (two), subphrenic abscess (one)
and injury to the common bile duct (one). One pa-
tient (83 years old male) died of pulmonary embolus
after a converted operation. The mean operation time
for laparoscopic cholecystectomy was 94.9 minutes
(30-210 minutes). For the first 100 operations the
mean operative time was 99.3 minutes but 85.5
minutes for the last 100. The mean hospital stay after
laparoscopic cholecystectomy was 3.1 days (ranging
from just few hours to 60 days). Data on 257 patients
after laparoscopic cholecystectomy showed that the
mean loss of work or preoperative activity level was
17.6 days (2-87 days). There was a statistically
significant difference between preoperative activity
level in the emergency versus the elective group
(21.4 or 15 days, p<0.05).
Conclusions: We conclude that laparoscopic chole-
cystectomy is a safe procedure and its safety will in-
crease as surgeons gain more experience. Further-
more, this technique may be recommended for elec-
tive and emergency cases. Shorter hospital stay and
fewer working days lost, followed by decreased ex-
penses both for the patient as well as the community
as a whole, must also be considered as a major
advantage.
Kewords: laparoscopic cholecystectomy, complications,
operative time, hospital stay.
Ágrip
Inngangur: I nóvember 1991 voru fyrstu
gallkaganirnar á Landspítalanum gerðar. Frá
upphafi var tekin sú stefna að reyna gallkögun
án tillits til bráðleika eða fyrri aðgerða ef um
gallsjúkdóm var að ræða.
Efniviður og aðferðir: Frá 17. nóvember
1991 til 30. september 1994 voru framkvæmd-
ar 384 gallblöðruaðgerðir á Landspítalanum en