Laparoskopska kirurgija na Odjelu endoskopske kirurgije Kliničke bolnice - komplikacije i konverzije

Laparoskopski pristup prihvaćen je u potpunosti na području abdominalne kirurgije. Više gotovo i nema klasičnih zahvata koji nisu izvedeni laparoskopski dok su neki, kao što je laparoskopska kolecistektomija, postali zlatni standard u kirurškom liječenju bolesti. Cilj ovoga rada bila je analiza rezultata našeg odjela u laparoskopskoj kirurgiji. Materijali i metode: Na Odjelu endoskopske kirurgije KB Dubrava u 2011. godini izvršeno je 620 operativnih zahvata, od čega 150 laparoskopskih. Od svih laparoskopskih operacija učinjeno je 98 elektivnih i 52 hitna laparoskopska zahvata te su analizirane njihove komplikacije i postotak konverzija. Rezultati: Najčešća operacija među elektivnim laparoskopskim zahvatima bila je laparoskopska kolecistektomija dok je kod hitnih zahvata nešto češće izvođena laparoskopska apendektomija. Uz te operacije, laparoskopski su izvedene još i laparoskopska splenektomija, laparoskopska pericistektomija ehinokoknih cisti jetre i slezene, ekstirpacija simpleks ciste Douglasovoga prostora, laparoskopske suture perforiranoga duodenuma i sigmoidnoga kolona te laparoskopske eksploracije trbušne šupljine, elektivne i hitne. U svim tim operacijama zabilježene su samo tri komplikacije (apsces lože žučnjaka, postoperativni paralitički ileus i krvarenje iz uprapubičnoga porta), uz napomenu da su se sve tri komplikacije javile nakon hitnih operativnih zahvata. Stopa konverzije u elektivnih laparoskopskih zahvata iznosila je 3%, a u hitnih 11%. Zaključak: Laparoskopski zahvati sve više postaju primarna metoda izbora i u elektivnim i u hitnim operacijskim zahvatima. Uz dokazane prednosti laparoskopske kirurgije, kao što je brži postoperativni oporavak i blaži kirurški stres, unaprjeđenjem laparoskopskih tehnika i većom educiranosti osoblja još se više smanjuje, ionako malen, broj postoperativnih komplikacija i stopa konverzija.
Laparoscopic approach in abdominal surgery has been fully established and accepted. There is practically no classic abdominal operation that has not been successfully performed laparoscopically, whereas some of them, like laparoscopic cholecystectomy, have long ago become golden standard in treating cholelithiasis and cholecystitis. The goal of this study was to analyze the results in laparoscopic surgery, which had been obtained at our department during 2011. Materials and methods: At our Department in year 2011 the authors had performed 620 surgical procedures, 150 of which were laparoscopic procedures. Of all laparoscopic procedures, 98 were elective and 52 urgent procedures. We analysed complications and conversion rates of those procedures. Results: The most common laparoscopic procedure among elective laparoscopic operations was laparoscopic cholecystectomy, while among urgent procedures it was laparoscopic appendectomy. Some other laparoscopic procedures were also performed, such as laparoscopic splenectomy, laparoscopic pericystectomy of echinococcal cyst of liver and spleen, extirpation of simple cyst from the cavity of Douglas, laparoscopic sutures of perforated duodenum and sigmoid colon and laparoscopic explorations of abdominal cavity, both urgent and elective. Only three complications were recorded (gallbladder abscess, postoperative paralytic ileus and bleeding from the supraumbilical port), and all three complications appeared after urgent procedures. Conversion rate in elective procedures was 3%. Conclusion: The popularity of laparoscopic procedures is increasing in both elective and urgent laparoscopic procedures. Some benefits of laparoscopic surgery, like shorter postoperative recovery and milder surgical stress, have already been established. Advancing laparoscopic techniques and training of surgical staff will bring the, already low, number of postoperative complications and conversion rates to a minimum.