Thi-Qar Medical Journal (TQMJ):Vol(8) No(1) 2014(94-108)

EARLY COMPLICATIONS FOLLOWOING

LAPAROSCOPIC CHOLECYSTECTOMY IN
BASRAH GENERAL HOSPITAL
Hashim S Khayat*, Jawad Ramadhan Fadhl** and Hisham Salman***

ABSTRACT:
Background: Gall stone disease is one of the commonly encountered diseases
among the general population. Laparoscopic cholecystectomy has been replaced
open surgery and it is now considered the "golden standard". Numerous
complications might be encountered.

Objectives: To assess and evaluate the specific early postoperative complications

and its management and to assess the factors that might influence the development
of such complication.
Patients and methods: A prospective consecutive observational study was
conducted in Basrah General Teaching Hospital from January 2011 to December
2011. All adult patients with symptomatic gall stone were included in this study. The
entire demographic, preoperative, operative and postoperative patient's data were
collected and evaluated.
Results: A 546 patients were underwent laparoscopic cholecystectomy during the
study period, 454(83.2%) were female and 92(16.8%) were males. The mean age
were 40 years+/- 13.7. Gall bladder perforation with bile leak(with or without gall
stone spillage) was the commonest intraoperative complication that occurred in
49(8.97%) patients. Intraoperative bleeding reported in 26(4.76%) patients.
Intraoperative bile leak reported in 2(0.36%) patients. The conversion rate was
4.76% (26 patients).The commonest postoperative complication was wound related
complication, which was reported in 13 (2.38%) patients. Using logistic regression
analysis, we found that the age < 60years, male sex , acute gall bladder status,
operation time < 60 min and usage of drain were influenced the development of
intraoperative complication on the other hand all the factors failed to affect the
development of postoperative complication.

*Consultant Surgeon Head and Chairman of Department of Surgery.

** Specialist Surgeon, Lecturer, Department of Surgery, Basrah Medical College.

*** Resident in General Surgery.Basrah General Teaching Hospital.

 EARLY COMPLICATIONS FOLLOWOING LAPAROSCOPIC
CHOLECYSTECTOMY IN BASRAH GENERAL HOSPITAL

Conclusion:
We conclude that the laparoscopic
cholecystectomy that performed in anesthesia, peritoneal access, and to
our teaching center was performed pneumoperitoneum. The specific
safely with accepted rate of early complications of LC are hemorrhage,
postoperative complications in
gall bladder perforation, bile leakage,
comparison to the other studies
spillage of stone, bile duct injury,
worldwide, and these complications
were managed successfully in vast perihepatic collection, external biliary
majority of patient by simple fistula, wound related complication,
procedures with accepted conversion foreign body inclusions and
rate and no mortality was reported (5)
adhesions .The reported incidence of
during the period of study. early complications was ranging from
1.5-2.92% in western countries and
Introduction:
1.5-6.5% in eastern countries.LC was
Gall stone disease is one of the implemented in our teaching center
commonly encountered diseases for the last 10 years and we try in this
among the general population and its study to evaluate the specific
prevalence is variable in different complication related to this
countries ranging from10-15 %( procedure.
1)
.Removal of gall bladder is the only
Aim of the study:
treatment for gall bladder stones and
till the late of 1980s this was carried
out through open abdominal surgery 1- To assess and evaluate the
(2) specific early postoperative
. From that time, laparoscopic
cholecystectomy (LC) has been complications after LC and its
replaced open surgery and it is now management.
considered the “golden standard” 2- To assess the factors that might
(3)
.Although it has been anticipated influence the development of
that the intraoperative complication such complications.
during laparoscopic cholecystectomy
will diminish with increasing surgeon Patients and method:
experience, yet it is still reported to be This is a prospective consecutive
higher than the opened observational study carried out in
(4)
cholecystectomy .Numerous Basrah General Teaching Hospital from
complications might be encountered January 2011 to December 2011.All
during LC, some of them are specific to adult patients with symptomatic gall
this technique and others are related stone where included in this study. A
to laparoscopic surgery in general. The full history taking and thorough
general complications are related to physical examination were obtained in
addition to preoperative
 Thi-Qar Medical Journal (TQMJ):Vol(8) No(1) 2014(94-108)

investigations. Special investigations version15.We use the mean+/-

for patients with other associated standard deviation(SD) and the
medical problems were performed as percentages for the descriptive
required. We exclude pediatric age statistics in addition to the logistic
group and the cases which were regression analysis to assess the
complicated by common bile duct possible risk factors that might
stone. Special attention was taken for influence the development of
assessment of gall bladder status and complications. A p value > 0.05 was
its wall thickness by abdominal considered statistically significant.
ultrasound. The patients were
informed about the laparoscopic The results:
procedure, anesthesia, the possible Laparoscopic cholecystectomy was
complications and the possibility of performed in 546patients during
conversion to open surgery. A written January 2011 to December 2011 in
consent was taken and signed by Basrah Teaching general Hospital. A
every patient.All the patients 454 (83.2%) were females and 92
underwent laparoscopic (16.8%) males, giving female to male
ratio of 4.93:1.The mean age of
cholecystectomy under general
patients were 40 years+/_13.7 ranging
anesthesia using endotracheal from 16-80 years.The mean of body
intubation. Four ports, 2 of 10 mass index (BMI) was 27.69 +/- 3.39
millimeters and 2 of 5 millimeters ranging from 21-38.Table 1show the
were used. LC was performed using a state of gall bladder according to the
standardized technique by expert intraoperative finding which was
surgical teams.We have no influence further confirmed by histopathological
examination. It revealed that chronic
neither on the decision for conversion
calculuscholecystitis was encountered
to open surgery or on the in 501(91.8%) patients and acute
management of intra and calculus cholecystitis in 41(7.5%)
postoperative complications which patients. The mean time of surgery
were left for the operating surgical was 45.7 +/- 11.3minutes ranging
team. Preoperative cholangiography from30-120 minutes.Table 2 show the
intraoperative complications (IOC) and
was not available in our hospital. All
its management. The overall IOC were
the gall bladder specimens send for occurred in77 (14.1%) patients. The
histopathological examination to commonest IOC was gall bladder
confirm the clinical diagnosis.The perforation with bile leak which was
entire demographic, preoperative, encountered in 49(8.97%)
operative and postoperative patient's patients(with or without spillage of
data were collected in a preformed gall stones). A 26 (4.76%) patients with
bile leak were without gall stone
data sheath and tabulated in SPSS
spillage (GSS), they were managed by
(statistical package for social sciences) irrigation –suction (IS) plus subhepatic
 EARLY COMPLICATIONS FOLLOWOING LAPAROSCOPIC
CHOLECYSTECTOMY IN BASRAH GENERAL HOSPITAL

drain in 17 (3.11%) and by SI only in 9 13 (2.38%) patients, of which 7

(1.65%).The other 23 (4.21%) patients (1.28%) patients presented with
with GSS were managed by stone infected wound, 3 (0.55%) with
removal and sub hepatic drain in seroma, 2 (0.37%) with hematoma and
12(2.19%). In 11 patients few small one (0.18%) with discharging sinus. It
stones were left and treated only by IS was treated mainly by drainage or
in 6(1.1%) patients while in 5(0.92%) evacuation in 8 patients and by
patients a drain were left after IS. The conservative treatment in 4 patients.
second IOC was intraoperative One patient with discharging sinus
hemorrhage which occur in 26 (4.76%) needs opened surgery. Bile collection
patients. Bleeding was from gall was the second POC which were
bladder bed in 10(1.83%), from encountered in 4 (0.73%) patients.
greater omentum in7(1.28%), from Three patients managed successfully
cystic artery in 5(0.92%) and from liver by percutaneous drainage under
injury in 4(0.73%) patients. ultrasound guide and 1 by opened
Electrocoagulation (EC) was surgery. Retained common bile duct
satisfactory to stop the bleeding in 20 (CBD) stone occurred in 3 (0.55%)
patients (12 without drain and 8 with patients. Two of them managed by
drain). The bleeding from cystic artery endoscopic sphincterotomy and one
was controlled by clipping in 3 patient by opened surgery. Non
patients. Conversion to open surgery obstructive jaundice was encountered
was the decision to stop bleeding in 3 in 3 (0.55%) patients and treated
cases, one from gall bladder bed, one conservatively after exclusion of other
from cystic artery and one from liver causes like hepatitis, bile duct injury,
injury.Intraoperative bile leak was hemorrhage or hematoma. Sub-
occurred in 2(0.37%) patients, one hepatic abscess developed in 2
from cystic duct and the other from (0.37%) patients and were treated by
gall bladder bed, both managed by opened surgery. One (0.18%) patient
conversion.The conversion rate to developed postoperative
open cholecystectomy was 4.76% (26 haemorrhage which managed by
patients).We found that the most emergency opened surgery. No
common cause for conversion, as mortality was encountered during the
described by the operating surgeon, period of our study.Table 4 shows the
was the disturbed anatomy at Calot's logistic regression analysis of the
triangle in 21 (3.84%) out of 26 factors that might affect the
patients.The drain was used in 79 development of intraoperative and
(14.5%) patients. It is used whenever postoperative complications. Among
the surgeon need it or as a part of all the variables that we evaluate to be
management of IOC.Table 3 shows the a possible risk factor, we found that
postoperative complications(POC) and being a male and being with age more
its management. The overall POC than 60 years were associated with
occurred in 26(4.76%) patients. increased risk of IOC (P value 0.037,
Wound related complications 0.013). Acute gall bladder state and
represent the commonest operation time more than 60 minute
complication which were occurred in were associated with increased risk of
development of IOC (P value 0.001,
 Thi-Qar Medical Journal (TQMJ):Vol(8) No(1) 2014(94-108)

0.001). The use of the drain has a development of IOC (P value 0.105,
statistically significant association with 0.060). On the other hand all the
the development of IOC (P value variables fail to have a statistically
0.001). The BMI and the presence of significant effect on the development
medical illness failed to show a of POC (P value < 0.05).
statistically significant effect on the

Table 1:Shows the status of gall bladder(intraoperative diagnosis).

Diagnosis No. (%)

Chronic calculus cholecystitis 501 (91.75%)

Acute calculus cholecystitis 41 (7.50%)

Acalculuscholecystitis 2 (0.39%)

Gall bladder mucocele 1 (0.18%)

Empyema of gall bladder 1 (0.18%)

Total 546 (100%)

 EARLY COMPLICATIONS FOLLOWOING LAPAROSCOPIC
CHOLECYSTECTOMY IN BASRAH GENERAL HOSPITAL

Table 2: Intraoperative complications and its management

Complication Number (%) Management

Gall bladder Without GSS 26(4.76%) 17 IS + drain

perforation 9 IS
with bile leak
With GSS 23(4.21%) 12 IS. Stone removal + drain.
6 IS *
5 IS + drain*
Total 49(8.97%)
Intraoperative From liver bed 10 (1.83%) 8 EC +drain
hemorrhage 1Conversion
1 EC
From greater omentum 7 (1.28%) 5 EC
2 EC + drain
From cystic artery 5 (0.92%) 3 Clipping.
1 Conversion
1 EC + drain
From liver 4 (0.73%) 2 EC
Injury 1 EC + drain
1 Conversion

Total 26 (4.76%)
Intra operative Slipped cystic duct clips
bile leak 2 (0.37%) 2 Conversion
From hepatic bed
Total 77 (14.1%)
GSS: gall stone spillage. IS: irrigation- suction. EC: electrocoagulation. *: stones not
completely removed.
 Thi-Qar Medical Journal (TQMJ):Vol(8) No(1) 2014(94-108)

Table 3:Thepostoperative complication and its management.

POC Number Management

(%) Conserva Minimal access Open Drainage
-tive surgery or
treatme evacuatio
nt n

Wound Infection 7 (1.28%) 4 3

related Hematoma 2 (0.37%) 2
complic- Seroma 3 (0.55%) 3
ation sinus 1 (0.18%) 1

total 13(2.38%) 4 1 8
Bile collection 4 (0.73%) 3 by 1
percutaneous
drainage under
USS guide
Retained CBD stone 3 (0.55%) 2 by ES 1
Non obstructive jaundice 3 (0.55%) 3
Sub hepatic abscess 2 (0.37%) 2
Postoperative 1 (0.18%) 1
hemorrhage
Total 26(4.76%) 7 5 6 8
POC: postoperative complication. USS: ultrasound scan. ES: endoscopic
sphinctrotomy.

Table 4: Shows the logistic regression analysis of the factors that might affect the
development of intraoperative and postoperative complications.

FACTOR IOC POC

SEX( male) +ve p= 0.037 -ve p = 0.580
Age(> 60) +ve p= 0.013 -ve p = 0.229
BMI -ve p= 0.105 -ve p = 0.558
MI(present) -ve p= 0.060 -ve p = 0.901
Acute state +ve p= 0.001 -ve p = 0.360
0peration time(>60 min) +ve p= 0.001 -ve p = 0.289
Use of drain +ve p =0.001 -ve p = 0.739
IOC= intraoperative complication. POC= postoperative complication. BMI=Body
mass index. MI=medical illness. P= p value.
 EARLY COMPLICATIONS FOLLOWOING LAPAROSCOPIC
CHOLECYSTECTOMY IN BASRAH GENERAL HOSPITAL

Discussion:
Over the last two decades, LC has (8.97%) patients (26 (4.76%)
gained worldwide acceptance to be withoutGSS,23 (4.21%) associated
the 'gold standard' in the surgical with GSS). Perforation of the gall
management of symptomatic bladder occurs fairly frequently during
(6)
cholecystolithiasis . It is the laparoscopic cholecystectomy and the
commonest operation performed reported incidence in the range of
laparoscopically(7). This study was 10%–40% in various series (10, 11). GSS
specially aimed to focus on the specific is less frequent and the true incidence
intraoperative and postoperative of unretrieved stones is difficult to
complications of LC and its determine ranging from 6%–30%(12),
management.In our study the mean other reported incidence of
( 13)
age of patients were 40 years +/_13.7 approximately 2 % . In our study the
ranging from 16-80 years. The females incidence of gall bladder perforation
were predominant 454 (83.2%), giving and GSS were within the reported
female to male ratio of 4.93:1.We use range.Perforation of gall bladder can
the 4 ports standerdised technique for occur during dissection of the gall
all patients and the first trocar access bladder off the liver bed, tearing with
performed through opened technique. grasping forceps, or during extraction
In this study we do not report any of the gall bladder through one of the
injury to great vessels (aorta, inferior port sites(12). Stones spilled may
vena cava, inferior epigastrics, iliac or remain in the peritoneal cavity
mesenteric) or visceral injury and all adjacent to the liver or may migrate to
trocar site bleeding was simple and various distant sites, these stones can
stopped at the end of the procedure. cause a complication and in the
This finding could be explained by the majority of cases, these stones usually
use of opened method for first trocar cause no bother and remain benign.
access which permits direct vision Complications that result from these
that contributed to considerable stones may occur in 0.08%–0.3% of
limitation of the vascular or visceral patients (10, 14). In our study there was
injuries(8). In a large collective study, no reported complication in all
the reported incidence of major patients with GSS even those with
vessels injury was zero using open some unretrieved stones. Tearing by
method versus 0.075% in closed the grasping forceps was the common
method, on the other hand the cause in our study followed by spillage
incidence of visceral injury was 0.048% during gall bladder extraction.In our
in opened versus 0.83% closed study there was 26 (4.76%) cases
method 8,9.Out of 546 patients in this developed intraoperative hemorrhage.
study, 77(14.1%) patients were In 20 patients the bleeding were
developed various specific simple and was controlled by EC.
intraoperative complications. Gall Intraoperative bleeding complication
bladder perforation with bile leak with account for up to one third of all major
or without gall stone spillage was the complications seen in LC(15,16). The
most common complication in 49 reported incidence of uncontrollable
 Thi-Qar Medical Journal (TQMJ):Vol(8) No(1) 2014(94-108)

bleeding in LC is 0.03 -10 %( 15, 17-19), Calot's triangle exists. This rate could
with the conversion rate of 0.26% (19). be reduced more if the intraoperative
In our study 3(0.54%) patients cholangiography performed, which
developed bleeding that necessitates not available in our hospital. The
conversion to control. In 3(0.54%) reported conversion rate ranged from
patients with bleeding from cystic 1.5% to 7.7% (25) . We had 26 (4.76%)
artery were controlled successfully by patients with conversion, mainly due
clipping of cystic artery. We do not to disturbed anatomy at Calot's
report significant port site as most triangle (dense adhesions) in 13
bleeding stopped after completion of patient, acutely inflamed gall bladder
LC. The reported incidence of bleeding in 5 patients, contracted small fibrotic
from the port site is 9.97%, that adherent gall bladder in 3 patients,
mainly treated by pressure but some intraoperative bleeding in 3 patients
need exploration and ligation of the and intraoperative bile leak in 2
vessel (15).Many factors such as patients.The overall POC in our study
assistant( camera man) experience, were occurred in 26 (4.76%) patients.
operator experience or mechanical The most common POC encountered
malfunction of instruments may lead was wound related complications that
to such a problem (20).The incidence of happened in 13 (2.38%) patients. All
major vascular injuries in laparoscopy patients respond well to simple wound
(including aorta, iliac vessels, vena care measures apart from one patient
cava, inferior mesenteric arteries and with discharging sinus which require
lumbar arteries) is 0.07%–0.4% and for surgery.Wound infection usually
minor injuries (branches of the involves the cannulation port and the
epigastric vessels, mesenteric and epigastric port through which the
omentum vessels) is 0.1% – 1.2% (21,22). gallbladder is extracted, with a
We do not report major vascular injury reported incidence of 0.3% to 4.84%
(26,27)
in our study.Two (0.37%) patients . In our study the wound infection
developed intra operative bile leak, rate was 1.28%(7patients), this rate
one from liver bed after removal of could be improved more by using gall
gall bladder, the other was from bladder retrieval bag, as most
slipped clips from short cystic duct, common site of infection in our study
both treated by conversion. The cystic was the epigastric port which we
duct was short that preclude safe usually use to extract the gall
clipping. The bile leak from the liver bladder.We reported 4(0.73%)
bed was discovered to be from sizable patients who developed
accessory duct.Bile duct injury is a postoperative bile collection. Three of
severe and potentially life threatening them were managed by percutaneous
complication of LC and several studies drainage under USS guide and one
reports an incidence of 0 % to 1.4% patient by open surgery. Successful
(23,24)
. We do not report intraoperative management by percutaneous
bile duct injury (CBD or hepatic duct) drainage of 3patients out of the 4
in our study. This could be explained suggests that there was no injury for
by a lower threshold for conversion in major bile duct. In the fourth patient
our hospital when any doubt no apparent cause could be identified
concerning the safe dissection of during exploratory laparotomy and the
 EARLY COMPLICATIONS FOLLOWOING LAPAROSCOPIC
CHOLECYSTECTOMY IN BASRAH GENERAL HOSPITAL

patient recovered smoothly. The ction during its dissection (31).We had 3
incidence of bile leak after (0.55%) cases of non-obstructive
laparoscopic cholecystectomy ranges jaundice which is resolved
between 0.2% and 2%, and may cause spontaneously and uneventfully. If a
intra-abdominal collections, fistula patient has fever or jaundice after LC
formation or life threatening bile which is prolonging for more than
peritonitis (8). The presence of bile three days, bile duct injury should be
collection and associated biliary injury suspected and should be assessed by
often went unsuspected for a time ultrasonography or computed
(32)
until symptoms worsened and delays tomography (CT) .These
in diagnosis and treatment allowed investigations may show perihepatic
bile peritonitis and serious illness to fluid collection, although the absence
develop (28).It usually comes from the ofthese findings does not exclude
cystic duct stump due to injury (33). In our study, we exclude
misplacement of the clips, from these possibilities by doing MRCP in
common bile duct injury or from a addition to the above investigation.
missed accessory duct or small bile We reported 2 (0.37%) patients who
ducts of the gallbladder bed, i.e. presented with sub- hepatic abscess.
Luschka's duct(8) .In our study there Both were managed successfully by
were 3 (0.54%) patients presented open surgery. The reported incidence
with retained CBD stones who of this complication ranged
(22,31)
presented during the 30 days of follow between0.1% and2.9% . The
up. It was treated by ERCP with incidence in our study was within the
sphincterotomy and stone extraction reported incidence.We had 1 (0.18%)
in 2 cases and 1case treated by open patient presented with postoperative
surgery. The reported incidence of bleeding which discovered to be from
retained CBD stones is 0.14%(29). We the greater omentum and he saved by
reported a higher incidence which emergency exploratory laparotomy.No
could be explained by the lack of 30- day's mortality was reported
preoperative cholangiography or poor during the study period. The reported
preoperative assessment for some mortality was >1 %( 22).We try to assess
patients.Although magnetic resonance statistically the effect of possible risk
cholangiography (MRC) is valuable for factors on the development of the
preoperative evaluation of common specific IOC and POC using the logistic
bile duct (CBD) stones before regression analysis test. We found that
laparoscopic cholecystectomy , this being a male with age more than 60
examination is not routinely years presenting with acute
performed in many institutions cholecystitis will increase the risk of
because of cost–benefit concerns. development of IOC. The operation
Therefore, unexpected CBD stones time and the use of drain could be
may cause biliary obstruction after consequences of these complications
laparoscopic cholecystectomy (5,30). or as a part of its management.
Rarely, small gallbladder stones Although the obesity and comorbidity
maymigrate into the CBD in patients reported to be associated with
with a patulous cystic duct when the increased risk of development of IOC
(33)
gallbladder is pulled in a cephalic dire , they fail to do so in our study,
 Thi-Qar Medical Journal (TQMJ):Vol(8) No(1) 2014(94-108)

Conclusion:
possibly because the numbers of We conclude that the LC that
morbidly obese patients in our study performed in our teaching center was
were less in comparison to these performed safely with accepted rate
studies. By assessing the effect of of early postoperative complications in
these factors on the development of comparison to the other studies
POC, none of them have statistically worldwide, and these complications
significant association, this could be were managed successfully in vast
explained by the concentration of our majority of patient by simple
study on early POC during 30 days procedure with accepted conversion
postoperatively and some of these rate and no mortality was reported
complications might developed after during the period of study.
the study period of observation.
 EARLY COMPLICATIONS FOLLOWOING LAPAROSCOPIC
CHOLECYSTECTOMY IN BASRAH GENERAL HOSPITAL

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 ‫)‪Thi-Qar Medical Journal (TQMJ):Vol(8) No(1) 2014(94-108‬‬

‫المضاعفات المبكرة ما بعد عملية استئصال المرارة بالناظور في مستشفى البصرة العام‪.‬‬

‫الخالصة‬

‫الخلفية‪ :‬حصاة الم اررة من األمراض الشائعة في المجتمع واستئصال الم اررة بواسطة الجراحة المنظارية أصبح البديل‬
‫المثالي لمعممية فتح البطن عمى الرغم من إحاطتها ببعض المضاعفات‪ .‬تهدف الدراسة إلى تقييم المضاعفات المبكرة‬
‫والتي تخص عممية استئصال الم اررة بالناظور وطرق معالجتها والعوامل التي قد تساعد عمى حدوثها‪.‬‬

‫المرضى والطريقة‪ :‬أجريت دراسة مستقبميه متعاقبة و رصدية في مستشفى البصرة العام التعميمي العام ابتدأت من‬
‫كانون الثاني ‪ 3122‬إلى كانون األول ‪ .3122‬وشممت الدراسة المرضى البالغين المصابين بحصاة الم اررة‪ .‬تم رصد‬
‫عوامل مختمفة كديموغرافية المصابين مثل العمر‪،‬الجنس ومعمومات ما قبل العممية والمضاعفات أثناء وما بعد‬
‫العممية وتحميمها وتقييمها‪.‬‬

‫النتائج‪ :‬شممت الدراسة ‪ 657‬مصاب أجريت لهم عممية استئصال الم اررة بالناظور‪565 ،‬منهم (‪ )%94.3‬نساء و‬
‫‪ )%27.9(:3‬رجال‪ ،‬متوسط عمر المرضى ‪ 51‬سنه ‪ .24.8 -/+‬أكثر المضاعفات الحاصمة أثناء العممية كانت‬
‫انثقاب الم اررة مع نضح الصفراء (مع أو بدون سقوط حصاة الم اررة) حدثت عند ‪ )%9.:8(5:‬مريض ثم يميها النزف‬
‫أثناء العممية عند ‪ )%5.87(37‬مريض‪ .‬النضح المراري داخل العممية حدث في مريضين (‪ . )%1.47‬التحويل من‬
‫الجراحة بالناظور إلى فتح البطن حدثت في ‪ )%5.87( 37‬مريض‪ .‬لم تحدث حاالت وفيات أثناء الدراسة ‪ .‬أكثر‬
‫المضاعفات التي حدثت خالل ‪41‬يوم بعد العممية تتعمق بجرح العممية وحدثت عند ‪ )%3.3( 24‬مريض‪ .‬باستخدام‬
‫نظام التحميل اإلحصائي المنطقي وجدنا إن العوامل التالية العمر أكثر من ‪ 71‬سنه‪ ،‬الجنس الذكر‪ ،‬حالة الم اررة‬
‫الحادة‪ ,‬استغراق العممية ألكثر من ‪ 71‬دقيقه واستخدم أنبوب البزل جميعها تؤثر وبداللة إحصائية عمى إمكانية ظهور‬
‫المضاعفات أثناء العممية ولكنها ال تؤثر عمى نسبة المضاعفات ما بعد العممية‪.‬‬

‫االستنتاج‪:‬‬

‫استئصال الم اررة بواسطة التنظير في مستشفانا هي طريقه أمينه وفعاله مع نسبة مقبولة من المضاعفات المبكرة‬
‫مقارنتا بالدراسات العالمية وهذه المضاعفات تعالج بنجاح بتداخالت بسيطة لمعظم الذاالت وبنسبة مقبولة للتذول‬
‫من الجزادة المنظارية إلى فتخ البطن‪.‬‬