Laparoscopic cholecystectomy in the rural setting

Laparoscopic cholecystectomy was introduced into the United States in the last 2 years following a lengthy evolutionary process of laparoscopic techniques abroad. Work done in major centers in Nashville, Los Angeles, Salt Lake City, and Chicago has quickly extended to other areas of the country. This report attempts to evaluate the applicability of laparoscopic cholecystectomy to rural portions of the United States by analyzing the early experience of laparoscopic cholecystectomy by two rural surgeons. Seventy-three patients with cholecystitis were treated consecutively. Three of these were relatively emergent cases. In 69 patients, the Veress needle insufflation technique was used, and in 4 patients the Hasson open laparoscopic technique was used. Electrocautery dissection was employed in 55 of these patients, and in 15 patients the KTP-532 laser, set at 20 W, was used. Three patients required open surgery due to adhesions or inadequate scope visualization. Twenty-five patients underwent intraoperative cholangiography. Between 1 and 2 weeks postoperatively, 2 of the 73 patients developed retrograde bile leak and peritoneal bile soilage, leading to open common bile duct exploration. Three patients were discharged from the hospital in less than 24 h, 56 within 36 h, 9 within 48 h, and 2 patients went home after more than 48 h in the hospital. The 3 patients who had converted to open cholecystectomy required the usual hospitalization for that procedure. Over half the patients returned to full activity in less than 2 weeks. The surgeons noticed a gradual decrease in operative time as their experience increased. The rural experience of these two surgeons was consistent with statistics identified within the university setting.