Risks and benefits of laparoscopic cholecystectomy in the community hospital setting

Laparoscopic cholecystectomy has rapidly become more popular than open cholecystectomy. To further evaluate the safety and efficacy of laparoscopic cholecystectomy in the community setting, the first 190 patients to undergo the procedure in Saginaw, Michigan were studied. There were 159 females and 31 males. The mean age was 47.8 years. All patients had symptoms consistent with biliary tract disease and most had gallstones proven by preoperative ultrasound. The mean operative time was 84 minutes but decreased from 161 minutes the first month of the study to 74 minutes by the seventh month. Eighty-seven percent of patients were tolerating a regular diet by postoperative day 1. Ninety-six percent of patients were requiring only oral pain medications by postoperative day 1. Seventy percent of patients were discharged by postoperative day one while 91% were discharged by postoperative day 2. Six patients were converted to open cholecystectomy due to acute inflammation, significant bleeding or extensive adhesions. There were no deaths and the morbidity rate was 9.5%. The most significant complication was postoperative bile leak which occurred in two patients. Patients returned to work a mean of 16.1 days following surgery and to their normal daily activities at home a mean of 12.9 days postoperatively. This study of the first 190 laparoscopic cholecystectomies in Saginaw affirms the safety and feasibility of this procedure in the community setting in selected patients.