National survey on laparoscopic cholecystectomy in Spain. Results of a multiinstitutional study conducted by the Committee for Endoscopic Surgery (Associación Española de Cirujanos).

We present a joint study conducted by the Committee for Endoscopic Surgery in Spain. Sixty-nine surgeons reported 2,342 laparoscopic cholecystectomies (LCs) performed until November 1992. The conversion rate was 5.1%. The overall morbidity was 7.1%. The biliary morbidity was 0.45%: Seven severe bile duct injuries were recognized at laparoscopy (0.28%) and four lesions were postoperatively diagnosed (0.16%). Bile leak unrelated to bile duct lesion occurred in 14 patients (0.7%), leading to five reoperations. The mortality was 0.12% and was unrelated to the laparoscopic approach in two cases. The risk factors for biliary complications were obesity, previous history of jaundice, and previous hospital admissions. Surgeon experience was defined by 50 LCs performed and the overall complication rate presented a statistically significant relation to surgeon experience (P < 0.001).

[Laparoscopic cholecystectomy in Spain: multicentric study of 2,432 patients]. / La colecistectomía laparoscópica en España: estudio multicéntrico de 2.432 enfermos.

OBJECTIVES: To evaluate the efficiency of laparoscopic cholecystectomy for the treatment of gallstones. DESIGN: Retrospective/prospective multicentric study undertaken by the Department of Surgical Endoscopy of the Spanish Association of Surgeons. Data were introduced into a computerized protocol. Statistical analysis with SPSS 4.0 applying the Student's T test and Pearson's chi square. PARTICIPANTS: 69 surgeons from 40 Hospitals who have performed laparoscopic cholecystectomies in 2432 patients, diagnosed of gallstones, with an average age of 49 years (9-91) and 80% in women. RESULTS: The operation was completed in 94% of the cases and lasted on an average of 75 minutes (20-120). Surgical findings were 2380 non complicated gallstones, 185 acute cholecystitis (7.6%) and 265 scleroatrophic gallbladders (11%). Intraoperative cholangiography was performed in 9% and gallstones in the common bile duct were diagnosed in 2%, of which 0.3% were treated by laparoscopy and 1% by post-operative endoscopic sphinterotomy Five per cent were converted to laparotomy, of which 29% (1.5% of total patients) were obligatory conversions. Among postoperative complications there were 0.4% lesions due to abdominal puncture, 0.4% lesions of the common bile duct and 2.5% hemorrhages. Post-operative complications were seen in 7.5% of patients. The most frequent complications affected the surgical wounds (3%), whereas bile duct complications represented 0.6% and were most frequent in the series of less than 50 patients. Mortality was 0.12%. Average post-operative hospital stay was 2.5 days (0.5-5). CONCLUSIONS: In Spain, laparoscopic cholecystectomy is an effective and safe procedure with results which are comparable to other multicentric studies published in other countries, with a morbidity-morbility index similar to open cholecystectomy and the great added advantage is the avoidance of laparotomy and its inconveniences (pain, longer hospital stay...) and complications.