Laparoscopic cholecystectomy [LC]; A retrospective study of 870 patients

ABSTRACT

Laparoscopic cholecystectomy [LC] is considered the gold standard for the treatment of cholelithiasis. Nevertheless, possible complications must not be underestimated. From July 1993 to May 1998, 870 patients with cholelithiasis underwent laparoscopic cholecystectomy. There was no operative mortality. One case died on the first postoperative day form causes not related to the procedure. In 31 patients [3.56%], the procedure was changed to laparatomy. Out of these 31 patients, three cases [0.34%] conversion was mandatory due to severe complications bleeding in the hepatic hilar [which was controlled by ligation of the proximal end of the retracted cystic artery], injury of the common hepatic duct [C.H.D] during dissection of the cystic duct [T-tube drainage with suturing of the C.B.D.], injury of the transverse colon during introduction of the first trocar [primary repair of the transverse colon by suturing of the opening using Vicryl 3/0]. In the remaining 28 patients [3.22%] conversion was carried out selectively. In 21/28 [2.4%] due to unclear anatomy of Callot's triangle, technical difficulties or choledocholithiasis. In 3/28 patients [0.34%] had problems with anaesthesia. In 4/28 [0.46%] due to instrument or equipment malfunction. In the postoperative period there were few complications. In 12/870 [1.38%] patients. 4/12 developed postoperative jaundice [missed stones, complete or partial ligation of the C.B.D.]. In 2/12 patients had a bile leak. 3/12 developed a haemoperitoneum. The remaining 3 patients had different complications, [bilateral pneumthorax, subhepatic collection and a gastric fistula]. In this series 6/870 patients [0.69%] underwent reintervention, all by open laparotomies. This study demonstrates the safety of laparoscopic cholecystectomy. Complications are relatively rare. Conversion must not be considered a failure but a wise decision in the face of major difficulties