[Laparoscopic cholecystectomy. Initial experiences and results in 278 patients]

Of 467 cholecystectomies (performed between 13. 6. 1990 and 12. 9. 1991) 278 were done by laparoscopy (196 women, 82 men; mean age 53 [18-86] years). Contraindications to a laparoscopic procedure were acute cholecystitis, severe chronic cholecystitis with adhesions, abnormal clotting and suspected gallbladder carcinoma. In 31 patients (11.1%) the initial laparoscopic cholecystectomy was continued as a conventional cholecystectomy, usually because of unclear conditions in severe chronic cholecystitis. Mean duration of hospital stay was 6.3 days for the laparoscopic procedure compared with 11.5 days for the conventional one. Complications occurred in four patients (in 12 with the conventional method): one occlusion (by clip) of the common bile duct, one bile leak, one bleeding and one pneumothorax, requiring re-operation in three patients. There were no deaths (compared with two in the conventional group). Assuming correct indications, laparoscopic cholecystectomy is a sparing method for the treatment of cholecystolithiasis.