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LAPAROSCOPIC CHOLECYSTECTOMY – 14 YEARS OF EXPERIENCE IN THE SECOND SURGICAL CLINIC CLUJ - NAPOCA 156 Journal of Experimental Medical & Surgical Research Cercetãri Experimentale & Medico-Chirurgicale Year XIV Nr.4/2007 Pag. 156-166 Cerceta ri experimentale & medico-chirurgicale ) Correspondence to: Asist. Univ. Dr. STANCU BOGDAN M.D.Surgical Clinic IIUniversity of Medicine and Pharmacy“Iuliu Haþieganu” Cluj NapocaStr. Clinicilor, Nr. 4 – 6400006 Cluj Napoca, ROMÂNIA. E-mail: [email protected] ABSTRACT: Since its discovery, on the 1 st of March 1987, by Philippe Mouret from Lyon, the laparoscopic cholecystectomy (LC) has become the main treatment of symptomatic gallblader lithiasis. In the Second Surgical Clinic Cluj Napoca, the first LC was performed in february 1994 by a surgical team led by Prof. Dr. Aurel Andercou. The paper aims to present an analitic retrospective study of 901 patients, who underwent LC in our service between 1994 and 2007. Our study included all patients with acute or chronic cholecystitis, with or without lithiasis who underwent LC or where LC was only attempted. From our study group we found the highest incidence of chronic lithiasic cholecystitis on female patients, age between 40 and 59 years. Of all laparoscopic techniques, the retrograde LC is the most used procedure in our service. We notice the high incidence of acute lithiasic cholecystitis in our study group (23,3%), the conversion, intraoperative incidents and accidents as well as postoperative complications being more frequent in those cases. The LC is a safe surgical intervention under the circumstances of a proper selection of patients, an adequate intraoperative surveillance and a perfect surgical technique being followed by a simple and favourable postoperative evolution; regarding the quality of life and the economical aspects, LC is preferable to the classical procedure. KEYWORDS: Laparoscopic cholecystectomy, acute cholecystitis, complications. COLECISTECTOMIA LAPAROSCOPICà – 14 ANI DE EXPERIENÞà ÎN CLINICA CHIRURGIE II CLUJ NAPOCA REZUMAT De la introducerea sa, la 1 martie 1987, de cãtre Philippe Mouret din Lyon, colecistectomia laparoscopicã a devenit tratamentul chirurgical de referinþã al litiazei veziculare simptomatice. În Clinica Chirurgie II Cluj Napoca, prima colecistectomie laparoscopicã se efectueazã în februarie 1994 de cãtre o echipã operatorie condusã de cãtre Prof. Dr. Aurel Andercou. Lucrarea de faþã îºi propune sã prezinte un studiu retrospectiv analitic realizat pe 901 pacienþi, la care s-a practicat colecistectomie laparoscopicã în serviciul nostru, în perioada 1994 – 2007.Criteriul de includere în studiu a fost stabilit pentru pacienþii cu diagnosticul de colecistitã acutã sau cronicã respectiv litiazicã sau alitiazicã la care s-a practicat colecistectomia laparoscopicã sau la care s-a tentat colecistectomia laparoscopicã efectuându-se apoi conversia la colecistectomia clasicã. Din lotul de 901 pacienþi studiat se evidenþiazã incidenþa crescutã a colecistitei cronice litiazice la sexul feminin, mai ales în decadele 4 ºi 5 de viaþã. Dintre tehnicile laparoscopice, colecistectomia retrogradã laparoscopicã este tehnica cea mai frecvent utilizatã în cadrul serviciului nostru. De remarcat incidenþa crescutã a colecistitei acute litiazice în lotul studiat (23,3%), conversia, incidentele ºi accidentele intraoperatorii cât ºi complicaþiile postoperatorii fiind mai frecvente în cazul acesteia.Colecistectomia laparoscopicã este o intervenþie chirurgicalã sigurã în condiþiile unei selecþii adecvate a pacienþilor, a unei monitorizãri intraoperatorii adecvate ºi a unei tehnici chirurgicale desãvârºite fiind urmatã de o evoluþie postoperatorie mai simplã, mai favorabilã, atât în ceea ce priveºte calitatea vieþii pacienþilor cât ºi din punct de vedere economic faþã de pacienþii la care s-a practicat tehni ca clasicã. B. Stancu 1 , A. Andercou 1 , A. Mironiuc 1 , O. Andercou 1 , D. C. Leucuþa 2 Received for publication: 05.09.2007 Revised: 21.11.2007 1- Surgical Clinic II, “Iuliu Haþieganu” University of Medicine and Pharmacy, Cluj-Napoca 2 - Informatics Department, “Iuliu Haþieganu” University of Medicine and Pharmacy, Cluj-Napoca Experimental Medical Surgical RE SEARCH JOURNAL of

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Page 1: LAPAROSCOPIC CHOLECYSTECTOMY - jmed.rojmed.ro/articole/103.pdf · LAPAROSCOPIC CHOLECYSTECTOMY – 14 YEARS OF EXPERIENCE IN THE SECOND SURGICAL CLINIC CLUJ - NAPOCA 156 Journal of

LAPAROSCOPIC CHOLECYSTECTOMY – 14 YEARS OFEXPERIENCE IN THE SECOND SURGICAL CLINIC

CLUJ - NAPOCA

156

Journal of Experimental Medical & Surgical Research

Cercetãri Experimentale & Medico-Chirurgicale

Year XIV · Nr.4/2007 · Pag. 156-166C e r c e t a r ie x p e r i m e n ta le &

m edico-chirurgicale

)

Correspondence to: Asist. Univ. Dr. STANCU BOGDAN M.D.Surgical Clinic IIUniversity of Medicine and Pharmacy“IuliuHaþieganu” Cluj NapocaStr. Clinicilor, Nr. 4 – 6400006 Cluj Napoca, ROMÂNIA. E-mail: [email protected]

ABSTRACT: Since its discovery, on the 1st of March 1987, by Philippe Mouret from Lyon, thelaparoscopic cholecystectomy (LC) has become the main treatment of symptomatic gallbladerlithiasis. In the Second Surgical Clinic Cluj Napoca, the first LC was performed in february 1994 by a surgical team led by Prof. Dr. Aurel Andercou. The paper aims to present an analiticretrospective study of 901 patients, who underwent LC in our service between 1994 and 2007.Our study included all patients with acute or chronic cholecystitis, with or without lithiasis whounderwent LC or where LC was only attempted. From our study group we found the highestincidence of chronic lithiasic cholecystitis on female patients, age between 40 and 59 years. Of all laparoscopic techniques, the retrograde LC is the most used procedure in our service. We noticethe high incidence of acute lithiasic cholecystitis in our study group (23,3%), the conversion,intraoperative incidents and accidents as well as postoperative complications being morefrequent in those cases. The LC is a safe surgical intervention under the circumstances of a proper selection of patients, an adequate intraoperative surveillance and a perfect surgical techniquebeing followed by a simple and favourable postoperative evolution; regarding the quality of lifeand the economical aspects, LC is preferable to the classical procedure. KEYWORDS: Laparoscopic cholecystectomy, acute cholecystitis, complications.

COLECISTECTOMIA LAPAROSCOPICÃ – 14 ANI DE EXPERIENÞÃ ÎN CLINICA CHIRURGIE IICLUJ NAPOCA

REZUMAT De la introducerea sa, la 1 martie 1987, de cãtre Philippe Mouret din Lyon,colecistectomia laparoscopicã a devenit tratamentul chirurgical de referinþã al litiazei vezicularesimptomatice. În Clinica Chirurgie II Cluj Napoca, prima colecistectomie laparoscopicã seefectueazã în februarie 1994 de cãtre o echipã operatorie condusã de cãtre Prof. Dr. AurelAndercou. Lucrarea de faþã îºi propune sã prezinte un studiu retrospectiv analitic realizat pe 901pacienþi, la care s-a practicat colecistectomie laparoscopicã în serviciul nostru, în perioada 1994– 2007.Criteriul de includere în studiu a fost stabilit pentru pacienþii cu diagnosticul de colecistitãacutã sau cronicã respectiv litiazicã sau alitiazicã la care s-a practicat colecistectomialaparoscopicã sau la care s-a tentat colecistectomia laparoscopicã efectuându-se apoi conversiala colecistectomia clasicã. Din lotul de 901 pacienþi studiat se evidenþiazã incidenþa crescutã acolecistitei cronice litiazice la sexul feminin, mai ales în decadele 4 ºi 5 de viaþã. Dintre tehnicilelaparoscopice, colecistectomia retrogradã laparoscopicã este tehnica cea mai frecvent utilizatãîn cadrul serviciului nostru. De remarcat incidenþa crescutã a colecistitei acute litiazice în lotulstudiat (23,3%), conversia, incidentele ºi accidentele intraoperatorii cât ºi complicaþiilepostoperatorii fiind mai frecvente în cazul acesteia.Colecistectomia laparoscopicã este ointervenþie chirurgicalã sigurã în condiþiile unei selecþii adecvate a pacienþilor, a unei monitorizãriintraoperatorii adecvate ºi a unei tehnici chirurgicale desãvârºite fiind urmatã de o evoluþiepostoperatorie mai simplã, mai favorabilã, atât în ceea ce priveºte calitatea vieþii pacienþilor cât ºi din punct de vedere economic faþã de pacienþii la care s-a practicat tehni ca clasicã.

B. Stancu 1,A. Andercou 1, A. Mironiuc 1, O. Andercou 1, D. C. Leucuþa 2

Received for publication:

05.09.2007

Revised: 21.11.2007

1- Surgical Clinic II, “Iuliu Haþieganu” University of Medicine and Pharmacy, Cluj-Napoca2 - Informatics Department, “Iuliu Haþieganu” University of Medicine and Pharmacy, Cluj-Napoca

E x p e r i m e n t a l

M e d i c a l S u r g i c a l

R E S E A R C H

J O U R N A L o f

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INTRODUCTION

Since its introduction on the 1st of March 1987 by Dr.

Philippe Mouret from Lyon, the LC has become the main

treatment of symptomatic gallblader lithiasis.

The laparoscopic approach allows us to reduce the

postoperative pain and the consumption of painkillers,

the decrease of the length of hospitalization associated

with a more precocious resumption of the patient’s active

life; also we must remind the esthetic advantage of this

surgical procedure.

The first LC in Romania was performed in 1991 in

Constanþa by a french surgical team led by Prof. Dr. B.

Descot. The first LC completed by a romanian surgical

team was performed on 14th of December 1992 by a team

led by Prof. Dr. Sergiu Duca in The Third Surgical Clinical

Clinic Cluj Napoca. (1)

The first LC in the Second Surgical Clinic Cluj Napoca,

was performed in February 1994 by a surgical team led

by Prof. Dr. Aurel Andercou. (2)

MATERIAL AND METHOD

The aim of this paper is to present an analitic

retrospective study of 901 patients, who underwent LC in

our service between 1994 and 2007.

The inclusion criteria in our study were: patients with

acute or chronic cholecystitis, with or without lithiasis

who underwent LC and the cases where LC was

attempted and conversion to classic cholecystectomy

performed.

The exclusion criteria were: patients without

diagnosis of cholecystitis, respectively the patients with

cholecystitis who underwent classical cholecystectomy

without initial attempt to perform laparoscopic

technique.

The characteristics studied in our paper were: gender,

age, patient’s origin, length of hospitalization,

cholecystitis type, associated diseases, type of surgical

procedure performed, intraoperative detection of

cholecystic anatomical variants, intraoperative and

immediate postoperative complications.

The objectives of our study were:

n The evaluation of the associated factors that

influenced the type of cholecystitis;

n The evaluation of the association between the type

of cholecystitis and the type of the surgical

procedure, intraoperative and immediate

postoperative complications;

n The evaluation of differences connected with the

length of hospitalization depending on the type of

the surgical procedure respectively the type of

cholecystitis;

Data was analyzed using the chi-square Test, the

Exact Fisher’s Test, Mann-Whitney Test and One-Way

ANOVA Test, all tests performed with the SPSS 13.0

software. (3,4)

157

Fig. 1 Distribution of the type of cholecystitis depending on patients’ gender

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RESULTS

In the first stage of the study our aim was to evaluate

the factors which were associated with the type of

cholecystitis, thus we estimated the distribution of the

type of cholecystitis relying on the patients’ gender and

we found the following results (Fig. 1.).

Chi - square Test was used to study this association

and it was found a a p value of 0.002.

We also analyzed the distribution of the type of

cholecystitis depending on patients’ age and found a high

incidence of chronic lithiasic cholecystitis in the 5th and

6th decades as pictured in Fig. 2.

158

Fig. 2 Age groups and the type of cholecystitis

Fig. 3 Patients’ origin and the type of cholecystitis

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As a part of our study we evaluated the distribution of

the type of cholecystitis relying on the patients’ origin and

we obtained the results from Fig. 3. Chi - square Test was

used to study this association and we found a p value of

0.31.

Among the associated diseases we looked for the

distribution of the type of cholecystitis depending on the

existence of the obesity at the patients from our study

and we obtained the results from Fig. 4.

The Chi - square Test was used in this case and we

found a p value of 0.005 which is statistical eloquent.

In the second stage of our study we tried to evaluate

the association between the type of cholecystitis and the

type of surgical procedure, intraoperative complications

and immediate postoperative complications.

The analysis of the distribution of the type of surgical

procedure depending on the type of cholecystitis

revealed the results from Fig. 5.

Using Fisher's Exact test and we found a p value of

0.29.

159

Fig. 4 The obesity and the type of cholecystitis

Fig. 5 Type of cholecystitis and the type of surgical procedure

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We also studied the distribution of the presence of

intraoperative adherences relying on the type of

cholecystitis and the results are presented in Fig. 6.

The chi - square test was used to study this

association and we found p value of < 0.001, which is

statistically significant.

We evaluated the distribution of the presence of

anatomical variants of the gallbladder depending on the

type of cholecystitis an we found the results from Fig. 7.

The chi - square test was used in this case and it was

found p value of<0.001 which is statistically significant.

160

Fig. 6 Type of cholecystitis and the presence of intraoperative adherences

Fig. 7 Type of cholecystitis and the presence of anatomical variants of the gallbladder.

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We also studied the incidence of intraoperative

hemorrhage, as a complication during the intraoperative

dissection, depending on the type of cholecystitis and

we found the results corresponding to Fig. 8, with a p

value of 0.001.

161

Fig. 8 Type of cholecystitis and the presence of intraoperative bleeding

Fig. 9 Type of cholecystitis and the presence of immediate postoperative wound infection / granuloma

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162

Fig. 10 Type of cholecystitis and the presence of postoperative haemorrhage

Fig. 11 The differences of the length of hospitalization depending on the type of surgical procedure

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As an immediate postoperative complication, we

followed the distribution of the appearance of wound

infection and granuloma, relying on the type of

cholecystitis; the results are shown in Fig. 9.

By using Fisher's Exact test we found a p value of

0,68.

Looking at the distribution of postoperative

haemorrhage, as another immediate postoperative

complication, depending on the type of cholecystitis, we

found the results from Fig. 10.

Fisher's Exact test was used to study this association

and we found a p value of 0,032, showing the existence

of a connection between the two variables.

In the third part of our study we tried to evaluate the

differences in connection with the patient’s length of

hospitalization depending on the type of surgical

procedure an we found the results from Fig. 11.

The Mann-Whitney test was used in this case and we

found a p value of < 0,001, showing the existence of a

connection between the two variables.

We also followed the differences between the

duration of hospitalization relying on the type of

cholecystitis; the results are shown in Fig. 12.

The One-Way ANOVA test was used to found if there

are differences between the length of hospitalization

concerning the type of cholecystitis and it was found a p

value of <0,001 (F=6,765), showing the existence of a

connection between the two variables.

DISCUSSIONS

The female patients represent 81,2% of the study grop.

Using the chi- square test we found a p value of 0,002

which shows the existence of a connection between the

female gender and the apperarance of cholecystitis.(

Regarding the distribution of the cholecystitis’ type

relying on the age of patients we found a high incidence

of chronic lithiasic cholecistitis in the 5th and 6th

decades, observation which corresponds to data from

medical literature. In older patients the risk of

complications was higher because of the associated

diseases with difficult anesthesia.(6,7)

About the patient’s origin we remark a higher

incidence of patients from urban areas in 65,7% of cases.

Considering the aetiology of cholecystitis the chronic

lithiasic cholecystitis prevailed (64,5%), followed by the

163

Fig. 12 The differences of the length of hospitalization depending on the type of cholecystitis

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acute lithiasic cholecystitis (22,1%), non-lithiasic

chronic cholecystitis (12,2%) and acute non-lithiasic

cholecystitis (1,2%).(9)

Arterial hypertension was found as associated disease

in 31,6% patients, diabetes melitus type II in 8,9%

patients and hypercholesterolemia in 13,1% cases.

Among associated diseases, only obesity found in

25,1% cases, has been prooved, using the chi- square

test, to be associated with the type of cholecystitis

(p=0,005) (10)

In our study group we performed in 97,4% cases

retrograde LC.The percentage of conversion to classic

cholecystectomy represented 2,33% of cases. In medical

literature the conversion was necessary in 2,8% cases

(Alecu L., Bucureºti) respectively 1,99% cases (Radu H.,

Cluj Napoca). (11,12,13,14)

In the group of patients with acute cholecystitis,

23,3% of cases, the conversion rate was 3,8%.

We analyzed the association between the type of

cholecystitis and several intraoperative complications;

we observed the presence of intraoperative adherences

at 61,2% patients. Using the chi - square test we found p

< 0,001, showing the existence of a connection

between the two variables. This is explainable from the

point of view of the physiopathological evolution of the

cholecystitis with severe and repeated accesses, with

the appearance of the oedema of th gallbladder wall

followed by the inflammatory infiltrate and latter, by

fibrosis or chronic inflammatory infiltrate. (10,13)

The presence of the anatomic variants of the

gallbladder (bifid, with septum or 'intrahepatic'

gallbladder) was identified with preoperative and

intraoperative ultrasound in 7% of cases. We studied the

association between the presence of gallbladder

malformation and the type of cholecystitis using chi -

square test and we found a p value < 0,001, showing the

existence of a connection between the two variables.

The malformations of gallbladder seems to play a

favourable role for the appearance of cholecystitis in

patients with chronic forms of cholecystitis (6,3% of

cases).

Another anatomical variant of the biliary ducts - a short

cystic duct was identified in 10,9% cases.

It has been proved in our group of study that the

anatomical variants of the cholecyst are statistically

important. Regardless of the perturbation created in the

physiology of the biliary system, those variants must be

well known by the surgeon to avoid major accidents

during the laparoscopic surgery. (15)

Regarding the study of intraoperative complications,

we followed the correlation of intraoperative

haemorrhage (9,7% of cases), with the type of

cholecystitis and found a p value of 0,001 which is

statistical signifficant. The bleeding results in most of the

cases by perforation of Glisson's capsule, during the

cholecyst dissection from the gallbladder’s bed. We must

not forget the possibility of bleeding from the cystic

artery because of it’s large number of division and

anatomic variation, which reach in the medical literature

a percent of 40% cases, and only in 54-60% cases the

cystic artery goes through the Calot triangle parallel with

the cystic duct. (1,2,5,16)

We also studied the distribution of the postoperative

haemorrhage as an immediate postoperative

complication, which was identified in 0,77% cases,

depending on the type of cholecystitis. Fisher's exact test

was used to study this association and we found a p

value of 0,032. We must notice that in 6 out of 7 cases

with postoperative haemorrhage, the diagnosis was

acute lithiasic cholecystitis. The explanation correspond

to incomplete hemostasis at the level of numerous

sectioned adherences and in the hepatic gallbladder’s

bed as main cause, all those postoperative bleedings

being minor and moderate, corresponding to class II A

after Clavien classification and requiring only

conservative treatment. (1,6,8,17)

Other postoperative compliactions were: wound

infection and granuloma (2,1%), postoperative bile

leakage (0,9%), peritonitis (0,55%), subhepatic absecss

(0,77%), postoperative decease (0,77%), postoperative

lithiasis (0,33%), thrombophlebitis (0,33%), angiocholitis

(0,11%) and lesions of extrahepatic bile ducts (0.33%).

The postoperative death (0,77%) occured after 24-48

hours from the surgical intervention, caused by acute

myocardial infarction or pulmonary embolia.

The appearance of the complications increased the

length of the hospitalization and the cost of treatment.

The prevention of those complications is very useful in

order to emphasize the multiple advantages of the LC.

(18)

A longer length of hospitalization was found in

patients where conversion was performed and the

explanationa are: higher pain symptoms because of the

bigger incision, later patient’s mobilization, the risk of

postoperative adherences and wound infection and also

164

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the risk of incisional hernia and evisceration. Analyzing

the correlation between length of hospitalization and

surgical procedure we found a p value < 0,001.

The One-Way ANOVA test was used to see if there are

differences in regarding the length of hospitalization and

type of cholecystitis and we found a p value < 0,001

(F=6,765) which is statistical signifficant. We searched

for differences between the types of cholecystitis two by

two, and found a longer hospitalization length in case of

acute lithiasic cholecystitis with an average of

hospitalization of 10,75 days. This is explainable because

of the intensity of the local, inflammatory and

degenerative changes, the more severe symptoms, the

longer duration of the surgical procedure and more

frequent postoperative complications. (9,19)

CONCLUSIONS

Laparoscopic cholecystectomy is a safe surgical

intervention necessitating a proper selection of patients,

an adequate intraoperative surveillance and a perfect

surgical technique. LC is followed by a simple and more

favourable postoperative evolution, with signifficant

improvement of the patient’s quality of life and the

economical aspect compared with the classical

procedure.

We found a higher incidence of chronic lithiasic

cholecystitis in female patients, especially in the 5th and

6th decades, from urban origin.

In most LC performed we used the retrograde

technique.

Perihepatic adherences were found intraoperative in

61,2% cases. From the intraoperative accidents we

identified more often the haemorrhage due to the

dissection of the gallbladder from it’s hepatic bed and

because of the existence of some cystic artery anatomic

variants.

The management of the complications of LC vary from

local conservative treatment to surgical or laparoscopic

reintervention.

Statistically significant differences were found

concerning the length of hospitalization for patients who

underwent conversion in comparison with those who

underwent LC because of the more invasive incision of

the classical technique and the longer time needed for

wound healing. We searched for statistical differences

between the types of cholecystitis and we found a a

significantly longer hospitalization length in case of acute

lithiasic cholecystitis.

We remark the higher incidence of acute lithiasic

cholecystitis in our study group, conversion rate,

intraoperative incidents as well as postoperative

complications being more frequent in this cases.

In LC, the experience is the surgeon’s best quality that

leads to the decrease of intraoperative complications,

and from there to the importance of the learning curve

which must be reached during the training program for

future specialist surgeons.

165

References:

1. Duca S., Chirurgia Laparoscopicã, Ed. Paralela 45, Cluj Napoca 2001: 131-167;

2. Andercou A., Propedeuticã chirurgicalã, Ed. Mediamira, Cluj Napoca 2000;

3. Achimaº Cadariu A., Metodologia cercetãrii ºtiinþifice medicale, Ed. Medicalã Universitarã Iuliu Haþieganu, Cluj Napoca

1998: 83-88;

4. Jaba E., Grama A., Analiza statisticã cu SPSS sub Windows, Ed. Polirom, Iaºi 2004;

5. Chamberlain R.S., Blumgart L.H., Hepatobiliary surgery, Ed. Landes Bioscience, Georgetown 2003: 156-164;

6. Angelescu N., Tratat de patologie chirurgicalã, Ed. Medicalã, Bucureºti 2003: 1914-1925;

7. A-Hon Kwon, Yoichi Matsui, Laparoscopic cholecystectomy in patients aged 80 years and over, World J Surgery, vol.30/

July 2006, Ed. Springer, New York 2006: 1204-1210;

8. Târcoveanu E., Tehnici chirugicale, Ed. Polirom, Iaºi 2003: 241-269;

9. Mironiuc A., Stancu B., Slabâi A., Restea S., Consideraþii privind indicaþiile ºi tehnica colecistectomiei laparoscopice

pentru colecistita acutã, Chirurgia Numãr special – Rezumate, vol. 101/2006, Nr. 2 (S), Ed. Celsius, Bucureºti 2006:

260-261;

10. Stancu B., Andercou A., Mironiuc A., Andercou O., Incidente, accidente ºi complicaþii ale colecistectomiei

laparoscopice, Chirurgia Supliment, vol.101/2006, Nr. 4, Ed. Celsius, Bucureºti 2006: 25-26.

11. Radu H., Colecistectomia laparoscopicã în circumstanþe speciale,Ed. Medicalã Universitarã “Iuliu Haþieganu”, Cluj Napoca

2005: 83-182

12. Alecu L., Atlas de tehnici de chirurgie laparoscopicã a cãilor biliare, Ed. Universitarã “Carol Davilla”, Bucureºti 2003:

281-287;

Page 11: LAPAROSCOPIC CHOLECYSTECTOMY - jmed.rojmed.ro/articole/103.pdf · LAPAROSCOPIC CHOLECYSTECTOMY – 14 YEARS OF EXPERIENCE IN THE SECOND SURGICAL CLINIC CLUJ - NAPOCA 156 Journal of

References (continued):

13. S. Ibrahim, T. K. Hean, L. S. Ho, T. Ravintharan, T. N. Chye, C. H. Chee, Risk factors for conversion to open surgery in

patients undergoing laparoscopic cholecystectomy, World J Surgery, vol.30/September 2006, Ed. Springer, New York

2006: 1698-1704;

14. E. Târcoveanu, D. Niculescu, ªt. Georgescu, Oana Epure, C. Bradea, Conversia în chirurgia laparoscopicã, Chirurgia

vol.100/2005, Nr.5, Ed. Celsius, Bucureºti 2005: 437-444;

15. C. Paraskevas, B. Papaziogas, K. Natsis, S. Sparidon, P. Kitsoulis, K. Atmatzidis, P. Tsikaras, An accessory double

cystic duct with single gallbladder, Chirurgia vol.102/2007, Nr.2, Ed. Celsius, Bucureºti 2007: 223-225;

16. O. Creþu, L. Sima, D. Iliescu, F. Huþ, M. Nicolau, D. Pãºcuþ, I. Avram, V. Fluture, Colecistectomia laparoscopicã ºi cea

prin “laparotomie minimã” subcostalã, ca metode de tratament eficiente ºi complementare ale afecþiunilor litiazice ale

veziculei biliare, Cercetãri experimentale medico-chirurgicale, anul XI, Nr.3/2004, Ed. Hestia, Timiºoara 2004: 102-105.

17. C. Dragomirescu, Colecistectomia laparoscopicã, Chirurgia vol.100/2005, Nr.1, Ed. Celsius, Bucureºti 2005: 53-56.

18. C. Pãun, P. Nicolcescu, I. Georgescu, F. Purcaru, 194 de colecistectomii laparoscopice. Particularitãþi ºi aspecte ale

actului chirurgical ºi anestezic, Chirurgia vol.101/2006, Nr.5, Ed. Celsius, Bucureºti 2006: 491-495;

19. Nicolau A.E., Chirurgie laparoscopicã de urgenþã, Ed. CNI Coresi, Bucureºti 2004: 72-85.