Problems of Laparoscopic Surgery treatment and Factors for Transformation to “Open” Way of Operating

Over the the past few years, a trend has taken place in surgery demanding the re-training of countless numbers of physicians. This stunning change has come about because of the fast growth and growth of endovideosurgical (minimally invasive) technological innovation and the growth of its area of program. Many physicians have quickly implemented the laparoscopic strategy in a extensive variety of functions. This has outlined the primary benefits of the laparoscopic strategy over “open” surgery, such as decreased postoperative pain, smaller medical center remains and smaller times of impairment.

Naturally, improvement non-invasive technological innovation delivers with it new difficulties. The main one of them being the problem of safe and appropriate incorporation of laparoscopic functions in stomach surgery.

Unfortunately, laparoscopic treatments are not without complications attribute of “open surgery”. Furthermore, therefore complications. Problems, as well as complicated physiological circumstances experienced during laparoscopic surgery, can be the real purpose for transition/conversion to an approach of working.

Material and methods

We are introducing the skills of complications and risks experienced by Citizen Surgeons when executing laparoscopic treatments completed in our medical medical center since 2013. During the period from Sept 2013 to Apr 2015, 1812 laparoscopic operations were conducted, using the Karl Storz endoscopy.

Since the explanation why for alterations vary for each pathology, we present below an research of the explanation why for certain types of functions.

Conversion to laparotomy during laparoscopic cholecystectomy

Laparoscopic cholecystectomy has almost changed traditional start cholecystectomy as the defacto conventional for attribute cholelithiasis and swelling of the gall bladder. The laparoscopic strategy delivers several benefits at the cost of higher problem prices, especially in training features, it has been implemented quickly by most physicians and accepted happily by the public.

In our medical center, there has been a effectively recognized reduce in the number of failed efforts at laparoscopic cholecystectomy due to the getting of expertise of each working resident physician in particular and the working room employees as a whole. The greater part of problems included surgery of a shrunken gall bladder and serious calculous cholecystitis.

Reasons for conversion during Laparoscopic cholecystectomy:

I. Lack of ability to carry out laparoscopic surgery due to morphological changes in body parts and cells.

1) a heavy integrate in the gall bladder.

In the situation of laparoscopic department of the integrate, there is a big opportunity of harm to body parts engaged in it. Sometimes these loss go unseen during the function. This was the real purpose for the conversion of 24 findings, which included 53.4% of complete alterations for serious calculous cholecystitis and 10 (26.3%) in serious calculous cholecystitis. Dense integrate in serious calculous cholecystitis is also seen in a number, when the medical indication is according to serious swelling of the gall bladder, heavy infiltration is usually clinically diagnosed in schedule sufferers intraoperatively. In 9 (20%) sufferers with serious calculous cholecystitis, the real purpose for conversion was the mixture of heavy integrate with pericholecystic abscess.

2) Mirrizzi problem, inner biliary fistula.

We found Mirrizzi problem in 5.3% of all alterations in serious calculous cholecystitis, in serious calculous cholecystitis, this pathology was not experienced.

3) Large adhesions in the stomach hole.

Visible adhesions in the area of the gall bladder were the real purpose for conversion in 5 (13.2%) sufferers with serious calculous cholecystitis. In 2 (5.3%) circumstances, we could not execute laparoscopic viscerolysis due to an formerly stomach surgery. The sticky process was more extreme in the projector screen of stomach cuts and places of great harm to the peritoneum. Extensive adhesions were seen in sufferers formerly managed on for intra-abdominal lose blood, peritonitis and after gynecological functions.

4) Proof of sclerosis in the throat of the gall bladder with the lack to distinguish its framework.

In this situation, we could not complete the function laparoscopically in 2 (5.3%) circumstances with serious calculous cholecystitis.

5) Melanoma of the gall bladder was clinically diagnosed intraoperatively in two circumstances, composed of 4.4% of all alterations in serious calculous cholecystitis.

6) choledocholithiasis, such as the impaction of large rocks in the distal common bile duct, which was not possible to get rid of laparoscopically, triggered the conversion of 4 (10.5%) sufferers with serious calculous cholecystitis.

7) Gangrene of the gall bladder walls.

When there is gangrene of the gall bladder walls, it drops its durability, making it difficult for grip. This pathology was the cause of conversion in 2 (4.4%) circumstances with serious calculous cholecystitis due to any mistakes of the preoperative ultrasound examination result.

8) cholecystogastric, cholecysto-duodenal, cystocolic fistula: in two circumstances (4.4%) the cause of the conversion during laparoscopic cholecystectomy was cholecystogastric fistula in serious calculous cholecystitis; in another – cholecysto-duodenal fistula in serious calculous cholecystitis (2.6%).