Author/Editor		Zajec, Mihael
Title		Urgentna laparoskopska holecistektomija zaradi akutnega holecistitisa
Translated title		Emergency laparoscopic cholecystectomy for acute cholecystitis
Type		članek
Source		Endoskopska revija
Vol. and No.		Letnik 10, št. 24
Publication year		2005
Volume		str. 113-21
Language		slo
Abstract		Background. Gallstone disease is one of the most common medical problems requiring surgery. The use of laparoscopic approach in patients with acute cholecystitis remains controversial because of technical difficulties that, compared to open cholecystectomy, may lead to higher complication rates. The author presents background data, indications and contraindications for this laparoscopic procedure and the optimal timing for operation. He describes a few surgical technical tricks, and summarizes his own and other authors experience with urgent laparoscopic operative treatment of patients with acute cholecystitis. Patients and methods. Of the 457 patients operated on for gallblader stones at our surgical department in 2004, 84 had emergency surgery, and 65 of them had histologically positive acute cholecystitis. Results. Operative procedures for acute cholecystitis were performed laparoscopically in 54 of 65 causes (83%) . Open cholecystecomy was done in 11 patients (17%), conversion in four and primarily open cholecystectomy in seven. Two operative complications and some minor postoperative problems were recorded. In the group of 392 nonselected scheduled cholecystectomies there were 18 open operations (4.8%). Conclusions. According to the experience of the authors institution, acute cholecystitis is amenable to urgent laparoscopic treatment. The procedure, however, is associated with a slightly higher rate of complications than open surgery and requires more effort in terms of organisation and surgical performance. Its advantages include reduce patient discomfort and shorter sick-leave period.
Summary		Izhodišča. Žolčni kamni so eno najpogostejših bolezenskih stanj, ki jih zdravimo z operacijo. Še vedno ni enotnega stališča glede laparoskopskega operiranja bolnikov z akutnim vnetjem žolčnika, predvsem zaradi tehničnih težav, ki so v primerjavi z odprtim operiranjem lahko številnejše in pogosteje pripeljejo do zapletov. Prikazujemo pregled osnovnih znanj, indikacij in kontraindikacij za ta laparoskopski poseg, govorimo o najprimernejšem času za operacijo, navajamo rešitve najpogostejših kirurških problemov in povzemamo tuje in lastne izkušnje s takojšnjim laparoskopskim operativnim zdravljenjem bolnikov z akutnim vnetjem žolčnika. Bolniki in metode. Med 457 bolniki, ki so bili leta 2004 na Oddelku za splošno in abdominalno kirurgijo (OSAK) operirani zaradi žolčnih kamnov, jih je bilo 84 urgentno operiranih, od teh pa jih je 65 prebolevalo akutni holecistitis, ki je bil histološko potrjen. Rezultati. Operacijo zaradi akutnega vnetja žolčnika smo opravili laparoskopsko v 54 primenh od 65 (83%), na odprt način z laparotomijo pa v 11 primerih (4 preklopi + 7 operacij primarno z laparotomijo), kar znaša 17%. Zabeležili smo 2 operativna zapleta in nekaj manjših pooperativnih problemov. V skupini neselekcioniranih programsko operiranih bolnikov zaradi žolčnih kamnov je bilo 18 odprtih operacij ali 4,8% od 392 bolnikov. Zaključek. Na osnovi lastnih izkušenj lahko zapišemo, da je laparoskopsko urgentno zdravljenje akutnega holecistitisa dobro izvedljivo, a povezano z nekoliko večjim številom zapletov in večjimi delovnimi in ter organizacijskimi napori kirurgov. Za bolnike pomeni tak način zdravljenja krajše obdobje preživljanja bolezenskih težav in krajši bolniški stalež.
Descriptors		CHOLECYSTITIS CHOLECYSTECTOMY, LAPAROSCOPIC EMERGENCIES TREATMENT OUTCOME