Surgical Complications from Biliary Tract Surgery

Objective Cholecystectomy is the most commonly performed surgical procedure in general surgery. However, bile duct injury is a rare but one of the most common complications. The injuries are usually encountered when comparatively inexperienced surgeons are operating who are not familiar with the anatomy. These injuries some times present variably after the primary surgery. The timely detection and appropriate management affects the morbidity and mortality of the operation. Methods This is a study of 5 cases of iatrogenic bile duct injury managed at the Department of Surgery First Hospital, Xi＇an Jiaotong University. This study includes all the cases that underwent both the open and laparoscopic cholecystectomy and persistent injury to the biliary tract and were treated accordingly. Results Five cases were found to have various types of bile duct injuries. Four of them are female and one was male, and their average age was 52 years （youngest 22 and oldest was 64）. In two cases the injury occurred during LC and converted to OC surgery, while remaining three cases underwent open cholecystectomy. All the patients were operated and appropriate procedures were performed. Conclusion In case of IBDI it is necessary to perform the operation under the supervision of experienced surgeon who is specialized in the repair of bile duct injuries, and it is also necessary to detect     

Simultaneous laparoscopic excision for rectal carcinoma and synchronous hepatic metastasis

Background  Rectal carcinoma patients are often accompanied by hepatic metastasis. The aim of this study was to evaluate the therapeutic efficacy of simultaneous laparoscopic excision for rectal carcinoma with synchronous hepatic metastasis.

Methods  A total of 41 patients with rectal carcinoma and synchronous hepatic metastasis detected by CT scan were included in this study. Among them, 23 patients underwent laparoscopic surgery and 18 patients underwent traditional open surgery to simultaneously remove the rectal tumor and hepatic metastasis lesions. All patients received postoperative adjuvant chemotherapy. All the patients were followed up from 36 to 72 months (mean 45.3 months).

Results  All the operations were performed successfully and no patient was turned to open surgery in laparoscopic group. The mean blood loss, the mean postoperative hospital stay, the mean blood transfusion and the mean intestinal functional recovery time showed a significant difference between the two groups (P <0.05). The 1-, 3- and 5-year survival rates were 82.6%, 43.5% and 8.6% in the laparoscopic group, without significant difference compared with the open group (77.8%, 38.9% and 0) (P >0.05).

Conclusions  Simultaneous laparoscopic excision for rectal carcinoma and synchronous hepatic metastasis is safe and effective with similar survival achieved by the traditional open abdominal surgery.

     

Are there any disbenefits to patients in choosing laparoscopic gastrectomy by an expert in open gastrectomy？ Aspects of surgical outcome and radicality of lymphadenectomy

Background There may be concerns over disbenefits to patients who have chosen to undergo laparoscopic gastrectomy by experts in open gastrectomy, considering the disparity between the level of proficiency in open gastrectomy, at which they are already experts, and that in laparoscopic gastrectomy, at which they are beginners. The aim of this study was to compare surgical radicality and outcomes between laparoscopic gastrectomy and open gastrectomy during the learning period of laparoscopic gastrectomy for a senior surgeon who was already an expert in open gastrectomy. Methods Data of short-term surgical outcomes were obtained from patients following laparoscopy assisted distal gastrectomy （LADG） by a surgeon. The initial and following 30 experiences were grouped into LADG-I and LADG-II, respectively. Patients who underwent open distal subtotal gastrectomy （ODSG） and yet could have been candidates for LADG were grouped into ODSG. Known indicators of proficiency levels and the postoperative hospital course were compared. The consequences of extended lymphadenectomy, and the radicality of surgery by completing D2 lymphadenectomy were analyzed. Results The LADG group revealed longer operation time and less bleeding compared to the ODSG group （P 〈0.001）. The number of retrieved lymph nodes and the rate of complications were not significantly different. In the LADG-I group, the DI＋：D2 ratio was 4：1, showing significant differences from those in the LADG-II （0.36：1） and ODSG （0.16：1） groups （P 〈0.001）. The surgeon was able to complete D2 lymphadenectomy during LADG without significant change in the amount of bleeding and the rate of complications, but with a longer operation time （P=0.009）. The number of lymph nodes from the 12a station was not significantly different between the LADG and ODSG groups with D2 lymphadenectomy. Conclusions The surgical outcomes were comparable between LADG and ODSG even during the learning period of LADG, and the equivalence of radicality in lymphadenectomy was soon achieved. As long as the surgeon can accept a long operation time, an expert in open gastrectomy should not refrain from performing laparoscopic gastrectomy in well selected patients because of concerns about disbenefits to patients from choosing laparoscopic gastrectomy over open gastrectomy.     

腹腔镜逆行肝脏Spiegel叶切除术一例报道：一种多样化手术方式选择

The first laparoscopic hepatectomy case was reported by Reich et al in 1991. Initially the laparoscope was utilized diagnostically for resection and biopsy of superficial liver lesions. Recently due to the technological advancement and instrumental improvement, the laparoscopic hepatic resection procedures have evolved significantly.     

完全腹腔镜下主髂动脉手术的操作相关性并发症分析

Background Totally laparoscopic aortoiliac surgery has been newly developed in China.It is known as the most complex laparoscopic technique to learn because of its high-risk procedures.Analysis of the operation-related complications of this surgery is supposed to be helpful for the early success of this technique.Methods Twelve male patients （56-70 years old） with aortoiliac occlusive disease underwent totally laparoscopic aortoiliac bypass surgery （TLABS） in our institute.Clinical data and operation-related complications were retrospectively analyzed.Results Of the 12 patients,TLABS succeeded in nine and conversion to open surgery occurred in three.One of the converted patients finally died of pulmonary infection.Operation-related complications included bleeding from arterial injury,perforation from colonic injury,graft embolism,residual aortic stenosis,and hydronephrosis.Bleeding in two patients and colonic perforation in one patient resulted in three conversions to open surgery.Intraoperative graft embolectomy and postoperative aortic stenting were performed to resolve the thrombus/embolus-referring complications.Left hydronephrosis,which was thought to result from intraoperative injury and treated with ureteric intubation drainage,recovered 6 months after TLABS.Conclusions Good understanding and avoidance of operation-related complications are important to guarantee the technical success of TLABS.Immediate conversion to open surgery is necessary for saving the patient＇s life in case of lifethreatening complications.     

Small incision combined with laparoscopy for ureteropelvic junction obstruction: comparison with retroperitoneal laparoscopic pyeloplasty

Background Laparoscopic dismembered pyeloplasty is technically feasible for ureteropelvic junction （UP J） obstruction although it is still challenged by its technical difficulty and time-consuming. In this study, we compared the initial results of retroperitoneal laparoscopic pyeloplasty versus a combined laparoscopic dissection and open reconstruction through a small incision in the treatment of UPJ obstruction.
Methods Sixty-four patients with primary UPJ obstruction underwent pyeloplasty： 32 patients underwent laparoscopic procedure and 32 patients underwent open assisted laparoscopic surgery including two steps, ie, laparoscopic dissection of the UPJ transperitoneally and then pyeloplasty via an extended small incision. The demographic data and intraoDerative, postoperative and follow-up conditions of patients were compared between the two groups.
Results Preoperative data were comparable in the patients of the two groups. The operative time was shorter （60.9 minutes vs 157.7 minutes, P 〈0.0001） and the complication rate was lower （9.4% vs 31.3%, P 〈0,05） in the open assisted group than in the laparoscopic group. The estimated blood loss （42.3 ml vs 47.8 ml）, time to have normal diet （37.6 hours vs 33.8 hours）, and hospital stay （6.7 days vs 6.2 days） were equivalent, The operative success rate was 97% for the open assisted group and 91% for the laparoscopic group. Conclusions The procedure of combined small incision with laparoscopy for UPJ obstruction is technically easy, and the results are promising. It can be used as an alternative to conventional procedures.     

Shoulder and elbow surgery in China

Chinese shoulder and elbow surgery started late and lagged behind the developed countries.However,it began to thrive and grow in the last decade. In fact,the predecessors of Chinese orthopaedic surgeons,including Profs.Feng Chuanhan,Guo Shiba,and Huang Gongyi,published Shoulder Surgery,which systematically stated the professional acknowledgment of shoulder surgery in China.1 The communication with foreign counterparts has intensified nowadays as increasing numbers of doctors have devoted themselves to shoulder surgery.They have accepted foreign advanced ideas and taught them in China,which has been helpful to improve the technical level of shoulder surgery.     

Superiority of Laparoscopy in the Peritoneal Dialysis Catheter Reset Surgery

Peritoneal dialysis catheter surgery has been used in clinical treatment for nearly 40 years, and open surgery under local anesthesia is the conventional method. However, catheter displacement after open surgery is still the thorny issue during our clinical practice. Then the reset surgery is often required to be taken again. Nowadays, laparoscopic peritoneal dialysis catheter draws our attention due to its advantages of accurate positioning, smaller incision, and less pain, and its clinical application has been limited. While laparoscopic surgery is recognized, there are few relevant studies on whether there is difference during the catheter reset process between the two surgical approaches. In this study, we mainly discussed the rate of secondary catheter migration, the incidence of complications after catheter reset for two surgical approaches and the hospital stay as well as the total clinical cost for the two surgical approaches. In this study, we retrospectively analyzed 25 cases of end-stage renal disease, who received catheterization for peritoneal dialysis and regular peritoneal dialysis in our hospital from March 2010 to December 2013, and had a medical history of catheter migration. We collected the relevant clinical data for all patients. Fifteen patients selected laparoscopic catheter reset, and 10 patients selected the traditional surgical method for catheter reset by themselves. For all patients enrolled, we analyzed the incidence of secondary catheter migration and postoperative complications, hospitalization time, and total cost for different methods of reset. Through the studies above, we found that laparoscopic peritoneal dialysis catheter surgery offered accurate catheter location and a small incision that was easy to heal. Besides, the incidence of postoperative complications for the laparoscopic surgery was lower than that for traditional surgical approach for catheter reset. The average hospitalization time for laparoscopic surgery was shorter than that for the traditional surgical approach. The total cost of laparoscopic surgery was more than that of the traditional surgery. Therefore, the rational application of a laparoscopic peritoneal dialysis catheter and reset surgery can increase the success rate of peritoneal dialysis, reduce the complications, shorten hospitalization time of patients, and thus enhance patient’s confidence to stick it out.     

手术机器人腹腔镜联合胰十二指肠切除术－手术技术与近期疗效分析

In recent years, the use of minimally invasive surgery in pancreas has been gradually rising in importance. There has been growing interest in performing pancreatectomy by the laparoscopic approach. However, laparoscopic pancreaticoduodenectomy （LPD） is very complicated and difficult to control and requires surgeons to have a high level of laparoscopic skills. Since LPD provides no significant benefits in terms of blood loss, morbidity rate,     

Oncol2012: 机器人直肠癌前切除术

Background  The Da Vinci system is a newly developed device for colorectal surgery. With advanced stereoscopic vision, lack of tremor, and the ability to rotate the instruments surgeons find that robotic systems are ideal laparoscopic tools. Since conventional laparoscopic total mesorectal excision is a challenging procedure, we have sought to assess the utility of the Da Vinci robotic system in anterior resections for rectal cancer.

Methods  Between November 2010 and December 2011, a total of 22 patients affected by rectal cancer were operated on with robotic technique, using the Da Vinci robot. Data regarding the outcome and pathology reports were prospectively collected in a dedicated database.

Results  There were no conversions to open surgery and no postoperative mortality of any patient. Mean operative time was (220±46) minutes (range, 152–286 minutes). The median number of lymph nodes harvested was (14.6±6.5) (range, 8–32), and the circumferential margin was negative in all cases. The distal margin was (2.6±1.2) cm (range, 1.0–5.5 cm). The mean length of hospital stay was (7.8±2.6) days (range, 7.0–13.0 days). Macroscopic grading of the specimen was complete in 19 cases and nearly complete in three patients.

Conclusions  Robotic anterior resection for rectal surgery is safe and feasible in experienced hands. Outcome and pathology findings are comparable with those observed in open and laparoscopy procedures. This technique may facilitate minimally invasive radical rectal surgery.

     

A novel case of laparoscopic ureterolithotomy in a partial duplex ureteric collecting system: can open procedures still be justified in the minimally invasive era?

Background

Impacted ureteric stones can pose a treatment challenge due to the high level of failure of ESWL and endourological approaches. Laparoscopic ureterolithotomy can provide a safe and successful alternative to these and open, invasive procedures.

Methods

Interval laparoscopic ureterolithtomy was carried out following placement of a percutaneous nephrostomy. This was performed through an trans-peritoneal approach with the ureterotomy closed by intracorporeal suturing and placement of a JJ stent without the need for an abdominal wound drain.

Conclusion

Laparoscopic ureterolithotomy is a safe, minimally invasive method of managing large, impacted ureteric stones with minimal associated patient morbidity.     

Laparoscopic right hemicolectomy for intestinal intussuception

Introduction

Adult intussusception is rare and usually associated with carcinoma in 50% of the cases. These have traditionally been managed using an open technique. We herein describe a laparoscopic extended right hemicolectomy in a 62-year-old lady with an intussuception secondary to a transverse colonic tumor.

Methods

The patient presented with 6?weeks of crampy, colicky, abdominal pain. Her CT scan reported intussuception of the proximal large bowel. She underwent an extended laparoscopic right hemicolectomy with primary anastomosis.

Results

Her post-operative recovery was uneventful and the histology reported a large bowel adenocarcinoma (pT4, N0, M0) with none out of 25 nodes involved.

Conclusion

When operative intervention is required, intussuception may be managed using a minimally invasive technique. However, large bowel intussuception in adults may have a malignant cause thus laparoscopic resection should only be performed by surgeons experienced in laparoscopic resections for colorectal malignancies as oncological safety must be the primary concern. This laparoscopic approach facilitates rapid recovery and earlier time to adjuvant therapy if required.     

A Comparative Study of Laparoscopic with Conventional Open Donor Nephrectomy in Renal Transplantation

Background

Laparoscopic donor nephrectomy (LDN) has been gaining popularity among kidney donors. There have been concerns about the safety and efficacy of the procedure as compared to open donor nephrectomy (ODN). We compare our results on LDN with ODN.

Methods

We retrospectively analysed our data of LDN and ODN. Duration of surgery, blood loss, period of hospitalisation, per oral intake and analgesic requirements.

Result

22 LDNs were done, the operation time ranged from 220-300 minutes, and blood loss from 100-150ml. In the first 10 laparoscopic operations four cases required conversion to open surgical dissection. Only one case was converted to open surgery in the subsequent 12 laparoscopic cases. Oral intake was started on the first postoperative day. Analgesic requirement in laparoscopy cases was less. Patients were mobilised on the first day after surgery. Patients were discharged by seventh day. There was no significant difference in the functioning of the graft after revascularisation in the recipient.

Conclusion

Laparoscopic donor nephrectomy is a safe and effective technique of donor nephrectomy.Key Words: Laparoscopy, Laparoscopic donor nephrectomy, Living kidney donors, Kidney transplantation     

Laparoscopic Simulators : Are They Useful!

Background

Laparoscopic surgery has changed the face of medical care forever. The benefits of laparoscopic open surgery have been demonstrated in virtually all major abdominal surgical procedures. Laparoscopy has introduced a new skill set that must be mastered and requires dedicated training. The teaching of laparoscopic operative skills in the clinical setting is constrained by the complexity of procedures, medicolegal and ethical concerns, fiscal and time limitations. This has created the need for formal training outside the operating room. Simulator-based training holds great promise in enhancing surgical education and providing a safe, cost-effective means for practicing techniques prior to their use in the operating room.

Methods

The surgical residents of two batches were recruited for the study. The residents were randomized to either a group that received training on a simulator or a controlled group that did not receive the training or to a group that received training twice.

Result

The residents who received training on a simulator demonstrated better psychomotor skills in the operation theatre than those who did not. Training in simulator environment can contribute to the development of technical skills relevant to the performance of laparoscopic surgery in vivo. Training at regular intervals will benefit the residents in gaining significant improvement of their psychomotor skills.

Conclusion

Laparoscopic trainer is a promising tool for training in laparoscopic surgery.Key Words: Laparoscopic simulator, Endotrainer, Training, Laparoscopic surgery     

Provision of general paediatric surgical services in a regional hospital

Background

In Ireland, specialist paediatric surgery is carried out in paediatric hospitals in Dublin. General surgeons/consultants in other surgical specialities provide paediatric surgical care in regional centres. There has been a failure to train general surgeons with paediatric skills to replace these surgeons upon retirement.

Aim

To assess paediatric surgical workload in one regional centre to focus the debate regarding the future provision of general paediatric surgery in Ireland.

Methods

Hospital in-patient enquiry (HIPE) system was used to identify total number of paediatric surgical admissions and procedures. Cases assessed requiring hospital transfer.

Results

Of 17,478 surgical patients treated, 2,584 (14.8%) were under 14 years. A total of 2,154 procedures were performed.

Conclusion

Regional centres without dedicated paediatric surgeons deliver care to large numbers of paediatric patients. The demand for care highlights the need for formal paediatric services/appropriate surgical training for general surgical trainees.     

The delivery of general paediatric surgery in Ireland: a survey of higher surgical trainees

Background

The delivery of general paediatric surgery is changing in Ireland. Fewer paediatric surgical procedures are being performed by newly appointed consultant general surgeons, resulting in increased referrals to the specialist paediatric surgeons of uncomplicated general paediatric surgical problems. We surveyed current higher surgical trainees about their views on provision of paediatric surgical services.

Methods

A questionnaire regarding provision of paediatric surgery was developed by incorporating dichotomous and qualitative questions. This was emailed to all higher surgical trainees in Ireland. Responses were analysed anonymously.

Results

There was a response rate of 54%. Most questions drew divided responses. More than half of the responders were opposed to mandatory paediatric surgical training on their scheme and would not be willing to provide paediatric surgery as a consultant. The most common reasons were limited training time and the unlikelihood of becoming competent in paediatric surgery with brief exposure. Sixty-four percent of responders felt that general paediatric surgery should be provided by paediatric surgeons in the future.

Conclusions

The opinions expressed here suggest that the current system of local provision of general paediatric surgery is unsustainable. Alternative training arrangements or regionalisation of paediatric surgery may be necessary to avoid overwhelming specialist paediatric centres.     

Incidence of early symptomatic port-site hernia: a case series from a department where laparoscopy is the preferred surgical approach

Introduction

Potential benefits of laparoscopic surgery include decreased post-operative pain, improved cosmesis and a shorter hospital stay. However as the volume and complexity of laparoscopic procedures increase, there appears to be a simultaneous increase in complications relating to laparoscopic access. Development of a port-site hernia is one such complication.

Aims

The aim of this study was to evaluate our experience relating to the incidence, presentation and interventions for early, symptomatic port-site hernias following laparoscopic surgery in a unit where minimal access surgery is the preferred approach.

Materials and methods

A retrospective review of the medical records of all patients who underwent laparoscopic procedures performed by the colorectal service over a 3-year period was conducted. Patients who developed port-site hernias were identified. Additional information on patient demographics, patient co-morbidities, the length and nature of the laparoscopic procedure, the presenting symptoms, the timing of these symptoms as well as the relative investigations and interventions were recorded. All trocars used in this series were bladed.

Results

A total of 647 patients underwent laparoscopic procedures over a 3-year period. Eight (1.23%) hernias were identified as occurring at the trocar entry site. All were symptomatic and all required surgical intervention.

Conclusions

Development of a port-site hernia in the early post-operative period can be associated with significant morbidity. This complication should be considered in patients presenting with post-operative bowel obstruction. With meticulous closure of port sites 10?mm and bigger, the incidence of hernia may be reduced.     

Laparoscopic permanent sigmoid stoma creation through the extraperitoneal route versus transperitoneal route: A meta-analysis of stoma-related complications

Objectives:

To compare laparoscopic extraperitoneal colostomy with transperitoneal colostomy for construction of a permanent stoma by measuring the incidence of parastomal hernia, and other postoperative complications related to colostomy.

Methods:

The meta-analysis was carried out in the General Surgery Department of the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China in 2014. A literature search of Medline, EMBASE, Cochrane database, and the Chinese Biomedical Literature Database (CBM) from the years 1990 to 2014 was performed. The literature searches were carried out using medical subject headings and free-text words: extraperitoneal colostomy, transperitoneal colostomy, laparoscopic extraperitoneal colostomy, rectal cancer, laparoscopic abdominoperineal resection, parastomal hernia, permanent stoma, and colostomy-related complications. Two different reviewers carried out the search and evaluated studies independently.

Results:

One randomized controlled trial and 6 retrospective studies were included. A total of 378 patients (209 extraperitoneal colostomy and 169 transperitoneal colostomy) were identified. Our analysis showed that there was a significantly lower rate of parastomal hernia (odds ratio 0.10; 95% confidence interval 0.03-0.29, p<0.0001) in the extraperitoneal colostomy group. However, the other stoma-related complications were not significantly different between the 2 groups.

Conclusion:

Colostomy construction via the extraperitoneal route using a laparoscopic approach can largely reduce the incidence of parastomal hernia. Laparoscopic permanent sigmoid stoma creation through the extraperitoneal route should be the first choice after laparoscopic abdominoperineal resection.Although the sphincter-preserving operation is widely used for the treatment of low rectal cancer, approximately 10-20% of patients still need a permanent colostomy after abdominoperineal resection (APR).1 The stoma relates to the quality of life of patients after APR. The existence of stoma changes the bowel evacuation habits of the patients and puts them under enormous psychological pressure; stoma-related complications make it harder for them. Of all the complications, parastomal hernia is one of the most common troublesome complication in patients with a permanent stoma. The incidence ranges from 4-48.1%.2 In open surgery, several techniques have reported to prevent parastomal hernia.3 The extraperitoneal route for stoma construction, which first reported by Goligher 4 in 1958, has been widely used. Many studies have proved that the extraperitoneal approach for sigmoid colostomy in open surgery presents a lower risk of herniation in comparison with the transperitoneal route. Lian et al5 recently revealed a significantly lower rate of parastomal hernia in the extraperitoneal colostomy group in his meta-analysis. Lian’s meta-analysis, which compared extraperitoneal colostomy with transperitoneal colostomy, provides guidance for surgeons to choose the route for stoma construction.With the further development of laparoscopic rectal surgery, a permanent stoma can be constructed using the laparoscopic technique following APR.6 Hamada et al7 developed a laparoscopic technique to create an end-sigmoid colostomy through the extraperitoneal route and achieved good short-term outcomes. He also compared laparoscopic extraperitoneal colostomy with the transperitoneal colostomy, using the application of CT to follow up, and found that laparoscopic extraperitoneal stoma can reduce the incidence of postoperative parastomal hernia.7,8 Akamoto9 used a special retractor to make extraperitoneal laparoscopic sigmoid colostomy easier and more feasible.9However, an extraperitoneal colostomy is technically much more difficult in laparoscopic APR than open APR, because the laparoscopic dissection via the extraperitoneal route is a technically demanding procedure.8 Because of its difficulty, laparoscopic extraperitoneal colostomy construction is rarely practiced. Although the transperitoneal route for laparoscopic construction of a sigmoid colostomy increases the chance of a parastomal hernia, it still used after laparoscopic APR. The choice of the extraperitoneal or transperitoneal route for permanent stoma is still confusing for many surgeons. Therefore, the aim of this study is to compare these 2 different route in terms of the operation time, and the incidence of stoma-related complications after laparoscopic APR. This study was designed to address whether an extraperitoneal route for colostomy in laparoscopic APR surgery can reduce the risk of stoma-related complications.     

Sub-optimal asthma control in teenagers in the midland region of Ireland

Background

Internationally, many children with asthma are not attaining achievable asthma control.

Aims

To examine the prevalence of asthma in teenagers in four midland counties, their asthma control and the barriers, if any, to gaining control of asthma.

Methodology

International Study of Asthma and Allergies in Children (ISAAC) methodology was used in a survey of Junior Cycle Year 2 second-level students.

Results

The prevalence of “wheeze ever” was 49.8%, “wheeze in the last 12 months” was 32.6% and “asthma ever” was 23.5%. Of teenagers with current asthma, 96% had evidence of sub-optimal asthma control during the previous year. For the majority of the teenagers with asthma, treatment was not guideline concordant; infrequent lung function testing, insufficient review after acute care and poor use of written asthma action plans. Barriers included lack of awareness of need for treatment.

Conclusions

If asthma guidelines are implemented fully, these children may experience better health.     

Is Laparoscopic Hepatectomy a Safe,Feasible Procedure in Patients with a Previous Upper Abdominal Surgery?

Background:

Laparoscopic liver resection has become an accepted treatment for liver tumors or intrahepatic bile duct stones, but its application in patients with previous upper abdominal surgery is controversial. The aim of this study was to evaluate the feasibility and safety of laparoscopic hepatectomy in these patients.

Methods:

Three hundred and thirty-six patients who underwent laparoscopic hepatectomy at our hospital from March 2012 to June 2015 were enrolled in the retrospective study. They were divided into two groups: Those with previous upper abdominal surgery (PS group, n = 42) and a control group with no previous upper abdominal surgery (NS group, n = 294). Short-term outcomes including operating time, blood loss, hospital stay, morbidity, and mortality were compared among the groups.

Results:

There was no significant difference in median operative duration between the PS group and the NS group (180 min vs. 160 min, P = 0.869). Median intraoperative blood loss was same between the PS group and the control group (200 ml vs. 200 ml, P = 0.907). The overall complication rate was significantly lower in the NS group than in the PS group (17.0% vs. 31.0%, P = 0.030). Mortality and other short-term outcomes did not differ significantly between groups.

Conclusions:

Our study showed no significant difference between the PS group and NS group in term of short-term outcomes. Laparoscopic hepatectomy is a feasible and safe procedure for patients with previous upper abdominal surgery.