الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Laparoscopic cholecystectomy is the procedure of choice for symptomatic cholelithiasis as it provides all the advantages of open cholecystectomy such as relief of symptoms and removal of gall bladder with the advantages of minimally invasive techniques associated with minimal pain and disability, short hospital stay, much better cosmetic results and wide patient acceptance when compared to open cholecystectomy.
Earlier previous upper abdominal surgery were considered as a contraindication to laparoscopic cholecystectomy, patients with upper abdominal surgery were recommended not to undergo laparoscopy because of adhesion formation and the difficulty in visualization the gallbladder which increases the risk of bowel or vascular injury by 1st trocar insertion as well laparoscopic adhesiolysis performed would be more time consuming and potentially more hazardous than open adhesiolysis.
However with increased laparoscopic experience and advances in laparoscopic instrumentations, many surgeons found that the operation is feasible and can be completed safely but with some precautions.
The aim of this study was to assess the feasibility and outcome of laparoscopic cholecystectomy in patients who undergone previous upper abdominal surgery.
The study was carried out on 30 patients presented to the Gastrointestinal Surgery Unit, Main Alexandria University Hospital; 26 of them was complaining of chronic calcular cholecystitis, two patients were admitted with acute cholecystitis and two patients had a mucocele of GB. they were 17 females and 13 males with age range from 30 years to 62 years.
All patients were subjected to full history taking, clinical examination, laboratory investigations mainly white cell count, liver enzymes, alkaline phosphatase, total and direct bilirubin, and abdominal ultra-sonography.
Intraoperative data were assessed and there were adhesions in all patients which were graded from 1-4 according to their severity and there were 4 patients with grade 1adhesion while 14 patients with grade 2 in addition to 6 patients with grade 3 and lastly 6 patients with grade 4 in another regard 20 patients needed adhesiolysis while others had adhesions distant from our operative field , complications from adhesiolysis were found in 10 patients in the form of bleeding, small intestine injury and rupture of GB.
Operative time ranged from 45 minutes to 125 minutes, all converted patients took more time as a result of conversion, open method or hasson’s technique used in 15 patients for 1st trocar insertion and creation of pneumoperitoneum took more time than other methods (veress needle which used in 10 patients, palmer’s point where we inserted the first port in the left upper quadrant used in 4 patients and visiport trocar used in 1 patient)
In our study Laparoscopic cholecystectomy was feasible and completed safely in 27 patients while in 3 patients it was converted to open cholecystectomy and the causes of conversion were due to intra abdominal adhesions, we failed in creatinig pneumoperitoneum in one of the converted cases, in another patient there was dense adhesions in periportal area and the last patient to be converted was due to small intestine injury which was managed by direct repair of the injury.