POSTCHOLECYSTECTOMY SYNDROME AFTER ACUTE AND ELECTIVE LAPAROSCOPIC CHOLECYSTECTOMY

The aim of this study is to evaluate the causes and rates of postcholecystectomy syndrome after acute and elective laparoscopic cholecystectomy. A prospective analysis was carried out on 110 patients with chronic cholecystitis (Group I) and 73 with acute cholecystitis (Group II) undergoing laparoscopic cholecystectomy at Pamukkale University Hospital between January 1995 and May 1996. The mean follow-up period was 12 months. Postcholecystectomy syndrome rates were 18.1 % in Group I and 5.4 % in Group II. The most common cause in postcholecystectomy syndrome was found to be gastroduodenitis. The other causes were peptic ulcus, peritonitis carcinomatosa, pancreatic carcinoma and choledocholithiasis. In group I, the rate of postcholecystectomy syndrome was significantly higher than in group II (p<0.05). We conclude that, physical examination and ultrasonography is sufficient in diagnosis of acute cholecystitis, and after elimination of the pathology causing the symptoms, rate of postcholecystectomy syndrome will be low. On the other hand, one should not be contented only with ultrasonography for elective cases and further upper gastrointestinal examinations should be carried out, especially for patients with dyspeptic symptoms and the patients must be informed that their symptoms may not subside despite the operation.

ACÝL VE ELEKTÝF LAPAROSKOPÝK KOLESÝSTEKTOMÝLERDE POSTKOLESÝSTEKTOMÝ SENDROMU

Amaç, acil ve elektif koþullarda laparoskopik kolesistektomi yapýlan olgularda postkolesistektomi sendromu oranlarýný ve nedenlerini saptamak, ve sendromun oranlarýný azaltabilecek yaklaþýmlara ýþýk tutmaktýr. Ocak 1995-Mayýs 1996 tarihleri arasýnda laparoskopik kolesistektomi yapýlan (110 elektif-Grup I, 73 acil-Grup II) toplam 183 olgu, prospektif olarak incelenmiþtir. Elektif koþullarda ameliyat edilen hastalarýn ameliyat öncesi þikayetleri bilier kolik, sað üst kadran aðrýsý ve dispepsidir. Asemptomatik hastalarda diabetes mellitus, geçirilmiþ akut pankreatit veya kolesistit ataðý ameliyat endikasyonu olmuþtur. Bir yýllýk takip sonunda Grup I'de 20 olguda (%18.1), Grup II'de 4 olguda (% 5.4) postkolesistektomi sendromu saptanmýþtýr. Sendromun en sýk sebebi her iki grupta da gastroduodenit olarak bulunmuþtur. Diðer nedenler, peptik ülser, koledok taþý, peritonitis karsinomatoza, pankreas kanseri ve trokar yerinde aðrýdýr. Grup I'de postkolesistektomi sendromu anlamlý þekilde yüksektir (p<0.05). Sonuç olarak akut kolesistitte doðru taný için fizik muayene ve ultrasonografi yeterli olabilmekte ve dolayýsýyla hastanýn þikayetlerine yol açan patoloji ortadan kaldýrýldýðýndan postkolesistektomi sendromu oraný düþük olmaktadýr. Elektif olgularda ise sadece ultrasonografi ile yetinilmemeli, özellikle dispeptik þikayetleri olan hastalarda üst gastrointestinal sistem incelenmeli ve hasta ameliyat öncesinde dispeptik þikayetlerinin devam edebileceði konusunda bilgilendirilmelidir.