Evolution of experience in laparoscopic cholecystectomy

ABSTRACT

A prospective study of 100 consecutive laparoscopic cholecystectomies was initiated with the introduction of the procedure. Patients presented with chronic calcular cholecystitis [81], acute cholecystitis [8], gall stone pancreatitis [4], chronic calcular cholecystitis with common bile duct [CBD] stone [4], mucocele of gall bladder [2] and acalculous cholecystitis [1]. Obesity, cirrhosis, previous abdominal surgery and thick wall gall bladder were not considered contraindication for the procedure. No mortality was reported and major morbidity occurred in only 3 cases one post-operative bleeding, one CBD injury and one subphrenic abscess. Also mild cellulitis around the umbilicus occurred in 4 patients and gall bladder perforations dealt with during the surgery in 9 cases. Operative cholangiogram was done in 38 cases and was technically impossible in 2 cases. Conversion to open cholecystectomy was necessary in 4 cases one for CBD injury, one for instrument failure, one for technical difficulites and the fourth one for common hepatic duct stone. The mean operative time was 88.4 minutes [range 20-200 minutes] and the mean post operative hospital stay was 2.23 days [range 1-10 days] and median time to return to normal activity and work was 8.7 days. These results confirm previous reports that laparoscopy has actually revolutionized the procedure of cholecystectomy