Laparoscopic cholecystectomy in a private community setting

In order to evaluate early results and safety of laparoscopic cholecystectomy in community hospitals, the charts of 380 consecutive patients, scheduled between February 8 and November 28, 1990, were reviewed. There were 294 women and 86 men, with a mean age of 48 years. Forty-one patients required conversion to open cholecystectomy, for reasons including adhesions in 18 patients, intraductal filling defects in 11, marked inflammation in 6, excessive bleeding in 3, poor visualization of the operative field in 2, and gangrenous gallbladder in 1. Hospital stay (excluding patients converted to laparotomy) ranged from 0.29-18 days, with a mean of 1.4 days. Operative time ranged from 29-280 min, with a mean of 114 min. Cystic duct operative cholangiography was performed in 71% of patients. In 29%, operative cholangiography was either not performed at all or was attempted and unsuccessful, due to inability to cannulate the cystic duct. Procedure-related morbidity was 2.6%, which includes three common bile duct injuries, three intraabdominal abscesses requiring drainage, and one pneumonia. There was one death resulting from respiratory failure. Our results compare favorably with those reported in the literature. We conclude that laparoscopic cholecystectomy in community hospitals is a safe procedure in properly selected patients.