Complications of laparoscopic cholecystectomy: a prospective review of an initial 100 consecutive cases

In order to identify problems in concept or technique with laparoscopic cholecystectomy, a prospective analysis of the initial consecutive 100 procedures was accomplished. Ongoing review of the results led to modifications in order to improve operative outcome. Minor complications such as nausea for more than 12 h (20%) and right shoulder pain (29%) were self-limiting. There were no deaths, two bile duct injuries, two abscesses, two retained common duct stones, and one case requiring transfusion, totaling a 7% major complication rate. In the subsequent 200 laparoscopic cholecystectomies, there was a 1.5% rate of major complications. Specific measures and modifications in technique that account for this improvement are detailed. Complications of laparoscopic cholecystectomy are more frequent in initial cases but can be minimized by observing specific intraoperative principles.