U Ates, G Gollu, E Ergun, B Turedi, F Mammadov, M Bingol-Kologlu, A Yagmurlu, T Aktug, H Dindar, AM Cakmak

Abstract

Introduction: The aim of this study is to evaluate and analyse the reasons for conversion to open surgery in laparoscopic cases in childhood, compared to the adult literature and differentiate the preventive measures for decreasing the rates for conversions. Patients and methods: The charts of 2068 patients who had appendectomy, Nissen fundoplication, cholecystectomy and splenectomy operations between 2003-2015 were reviewed retrospectively. Laparoscopic and open procedures and the cases that were converted from laparoscopy to open surgery and the reasons of conversions were analysed. Results: Between the years of 2003-2015, total of 2068 cases; appendectomy (1539), cholecystectomy (120), Nissen fundoplication (323) and splenectomy (86) operations were performed. Among these procedures, 181 (8.8%) of them were performed by laparotomy, 1887 (91.2%) of them were intended to be performed by laparoscopy. Among laparoscopically started cases, 1848 (97.9%) of them were completed laparoscopically and in 39 cases (2.1%) conversions were required. The conversion rates were 0.34%, 9.7%, 2.8% and 7.4% in appendectomy, Nissen fundoplication, cholecystectomy and splenectomy, respectively. Conclusion: Preoperative detailed and specific examinations before laparoscopic procedures can decrease the conversion rates in laparoscopic surgery. Complications do not have to be the only conversion indication and elective conversion must be performed without wasting time to avoid complications.

前言：本研究旨在評估和分析兒童腹腔鏡手術轉換為開放式手術的原因，並與有關的成年人病例的文獻進行比較，對降低中轉開腹率的預防措施進行分辨。患者及方法：回顧性分析2003-2015年間2068例闌尾切除術、尼森胃底折疊術、膽囊切除術和脾切除術的病例。分析了腹腔鏡手術與開放手術的異同，和由腹腔鏡轉開放手術的病例以及中轉開腹的原因。結果：2003-2015年共2068例；行闌尾切除術（1539例）、膽囊切除術（120例）、尼森胃底折疊術（323例）和脾切除術（86例）。其中181例（8.8%）為剖腹手術，1887例（91.2%）為腹腔鏡手術。在腹腔鏡手術開始的病例中，1848（97.9%）完成了腹腔鏡手術，39例（2.1%）需要轉為開放式手術。闌尾切除術、尼森胃底折疊術、膽囊切除術和脾切除術的中轉開腹率分別為0.34%、9.7%、2.8%和7.4%。結論：腹腔鏡手術術前詳細細緻的以及特異性檢查可降低腹腔鏡手術的中轉開腹率。併發症不一定是唯一的中轉開腹適應症，為了避免併發症必須進行選擇性中轉開腹時也無需猶豫。