Laparoscopic cholecystectomy: quality of care and benchmarking. Results of a single-institution specialized in laparoscopy compared with those of a nationwide study in Switzerland.

BACKGROUND: Quality control is an important issue in surgery. Therefore, we assessed the outcome of laparoscopic cholecystectomies (LC) performed at our institution specialized in laparoscopic surgery in order to do a benchmarking. METHODS: The perioperative courses of the first 1000 LCs performed in Aarberg hospital were recorded, analyzed, and compared with the results of a recent study including 10, 174 patients published by the Swiss Association of Laparoscopic and Thoracoscopic Surgery (SALTS). RESULTS: The following quality indicators were compared with the corresponding SALTS rates: primary conversion rate 1.5% (SALTS 8.2%; p <0.01); conversion rate for intraoperative complications 6.5% (63.8%; p <0.01); intraoperative complication rate 22.2% (34.4%; p <0.01); postoperative morbidity rate 8.1% (10.4%; n.s.); in-hospital mortality rate 0.1% (0.2%; n.s.); and reoperation rate 0.8% (1.7%; n.s.). CONCLUSIONS: LC has reached a high quality level in its widespread use, but in a small specialized center even a higher quality level can be achieved. Favorable results seem to depend on structural advantages of a surveyable unit in association with a continuously motivated surgical team.

[Acute cholecystitis: indication for emergency laparoscopic cholecystectomy?]. / Akute Cholezystitis: Indikation zur notfallmässigen laparoskopischen Cholezystektomie?

Between 1989 and 1992, 43 patients underwent laparoscopic cholecystectomy for acute cholecystitis. Conversion to open cholecystectomy was necessary in one case (2.3%). Morbidity was 14%, i.e. 7% local complications and 7% systemic complications. No lesions of the CBD occurred and no reoperations or reinterventions were required. Mortality was 0%. The main determining factor for the technical difficulty of laparoscopic cholecystectomy was the lapse of time between onset of symptoms and operation. We show the duration of laparoscopic cholecystectomy during the first 6 days of acute cholecystitis (mean 104 min) is statistically different in the following groups of patients (7-14 days p = 0.0049; 15-21 days p = 0.0037; Mann-Whitney-U-test). We therefore conclude that laparoscopic cholecystectomy is a safe method in acute cholecystitis and that the ideal time of operation is as soon as possible within the first 6 days after onset of illness. Performance of laparoscopic cholecystectomy should not be delayed during this period of acute cholecystitis. If the procedure is carried out by well trained laparoscopic surgeons the risks and complications are equal to those of open cholecystectomy.

[Ambulatory laparoscopic cholecystectomy?]. / Ambulante laparoskopische Cholezystektomie?

Commonly, after laparoscopic cholecystectomy, patients will be discharged from the hospital on the second or the third postoperative day and return to full activities about a week after surgery. Some reports from the USA demonstrate that laparoscopic cholecystectomy can be done on an outpatient basis. But these as well as all operative procedures are not without risk, and we prefer a short hospitalization. Outpatient laparoscopic cholecystectomy is performed because cost containment has become a major issue in American medicine.

[Laparoscopic cholecystectomy--results of the first 100 cases]. / Die laparoskopische Cholezystektomie--Resultate der ersten 100 Fälle.

100 patients underwent laparoscopic cholecystectomy for symptomatic gallbladder stones. In seven cases the laparoscopic procedure had to be converted into an open cholecystectomy due to bleeding, choledochus injury and acute cholecystitis. There were no complications postoperatively. We feel that the indication of this method is advantageous. Independent of the size, the number and the chemical composition, this method is used for symptomatic gallbladder stones. All together the main advantages are higher comfort for the patient, better cosmetic results, shortening of hospital stay and sooner return to full activity.

[Laparoscopic cholecystectomy: 100 consecutive cases without postoperative morbidity]. / Die laparoskopische Cholezystektomie: 100 konsekutive Fälle ohne postoperative Morbidität.

100 consecutive patients underwent laparoscopic cholecystectomy for symptomatic gallbladder stones. We report our results and the management of choledocholithiasis. In two cases the laparoscopic procedure had to be converted into open cholecystectomy due to bleeding. There were no complications postoperatively. The results show that laparoscopic cholecystectomy is a safe procedure with real benefits. The main advantages are greater comfort for the patient, better cosmetic results, shortening of hospital stay and earlier return to full activity. We feel that, with a proper indication, laparoscopic removal of the gallbladder will establish itself as the procedure of choice in stone disease.

[From diagnostic laparoscopy to laparoscopic surgery]. / Von der diagnostischen Laparoskopie zur laparoskopischen Chirurgie.

The analysis of 135 laparoscopic procedures since 1987 shows the possible indications of this new method. 77 cases were emergencies, mainly suspicion of acute appendicitis. 28 laparoscopic appendectomies were performed. Of the 58 elective operations 42 were laparoscopic cholecystectomies without complications. We believe that these minimally invasive procedures have many advantages compared to open surgery.

[Laparoscopic cholecystectomy. Personal experiences in 20 cases]. / Die laparoskopische Cholezystektomie. Unsere Erfahrungen in 20 Fällen.

20 patients underwent laparoscopic cholecystectomy for symptomatic gallbladder stones. Only in one case the laparoscopic procedure had to be converted into an open cholecystectomy due to cystic arterial bleeding. There were no complications postoperatively. We feel that in selected cases laparoscopic cholecystectomy is a real alternative to the standard operation. The main advantages are higher comfort for the patient, better cosmetic results, shortening of hospital stay and sooner return to full activity.