Original article
Results of treatment of cholecystitis and appendicitis with laparoscopic technique in General Surgery of Western Hospital in Grodzisk Mazowiecki

Introduction: The General Surgery Department of Western Hospital was opened on 28 February 2005. During the first year 434 laparoscopic operations were performed including 378 cholecystectomies and 36 appendectomies (LA). The aim of the study is the analysis of surgery technique indications and results of cholecystectomies and appendectomies performed in the first year with the laparoscopic technique. Material and methods: From a total of 426 patients qualified for gall bladder removal, 74 men and 333 women aged from 27 to 81 years were qualified for laparoscopic cholecystectomy (LCh). The surgery procedure was typical with the use of 4 trocars. From 57 patients qualified for appendectomy, 18 men and 21 women were qualified for laparoscopic appendectomy (LA). 33 patients were operated inside the peritoneum using 3 or 4 trocars, and 6 patients using the 2-trocar outside technique. Results: Among 378 performed laparoscopic cholecystectomies, 48 patients were recognized with acute cholecystitis (hydrocholecystitis, empyema). LCh at emergency service was performed on 38 patients. 6 patients had mid- and after-surgery complications. In 2 cases the bile ducts were damaged – one through cut unrecognized during surgery (death in 42 days after surgery), and one contiguous damage treated after the conversion was done. In one case the transverse colon was damaged – treated with laparoscopy during the same operation. In 3 cases as late complications: 2 perihepatic abscesses were recognized (one treated with laparoscopy, the other with laparotomy) and 1 case of collection in infrahepatic region of bile liquid from additional bile ducts. In 29 cases conversion to open surgery was done. Among 36 performed laparoscopic appendectomies, 27 were emergency surgeries and 9 delayed surgeries after preliminary observation. Discussion: The main cause of conversions was major inflammatory infiltration in the Calot triangle region which prevented proper estimation of anatomy. LA was done by 63% patients with preoperative diagnosis of appendicitis. The cause of conversions was inflammatory infiltration of the caecum region that prevented preparation in that region. 1 patient was reoperated on the 4th postoperative day because of intraabdominal lesions. Conclusions: The results of our presentation show that there is a possibility to operate on patients due to appendicitis and cholecystitis in emergency conditions using laparoscopic techniques. It requires the presence of an experienced team. The most common cause of conversion is inflammatory infiltration of the treated region which prevents safe preparation and identification of proper anatomy