上腹部手術既往を有する患者に対する腹腔鏡下胆嚢摘出術の検討

Abstract

Laparoscopic cholecystectomy (LC) was widely accepted as a treatment for gall bladder disease. In the early days of this procedure, previous upper abdominal surgery was a relative contraindication to LC. However, some studies reported that an indication for LC extended to these patients. To assess the feasibility of LC for patients who had previous upper abdominal surgery, we retrospectively analyzed our cases. Between January 1998 and November 2000, 217 patients with gall bladder disease were considered as candidates for cholecystectomy. Patients were divided into three groups (Group A: LC for patients with no abdominal surgery or lower abdominal surgery, Group B: LC for patients with upper abdominal surgery, Group C: Open cholecystectomy (OC) for patients with upper abdominal surgery) and compared with regard to operation time, removal of nasogastric tube, start of oral intake and postoperative hospitalization. There were no statistically significant differences in operation time within the three groups. As for removal of nasogastric tube, start of oral intake and postoperative hospitalization, group B was significantly earlier than group C. If patients are selected carefully, LC will be a useful procedure for patients who had previous upper abdominal surgery.