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[How safe is laparoscopic cholecystectomy?]
R Kube1, H Lippert, I Gastinger
1Klinik für Allgemein-, Viszeral- und Gefässchirurgie Universitätsklinikum A. ö. R. Magdeburg. rainer.kube@med.ovgu.de
Introduction:
Laparoscopic cholecystectomy (LCE) is the standard treatment for symptomatic non-complicated cholecystolithiasis. However, there is still an ongoing debate about the appropriate surgical approach in cases with complicated cholecystolithiasis. As a result, an initial decision whether to use the open or laparoscopic approach must be primarily based on patient safety. Additional indications favouring the use of LCE must not lead to an increase in the rate of serious complications.
Methods:
All patients who underwent operations for cholecystolithiasis performed in a single surgical centre, from 1 / 1 / 1994 to 12 / 31 / 2007, were considered in this analysis. Parameters for the characterisation of the results were intervention-associated hospital mortality and iatrogenic transsection of the common bile duct.
Results:
5 084 cholecystectomies were performed during the study period, 84 % (n = 4 272) intended as laparoscopic and 16 % (n = 812) as open procedures. The LCE operations were done by 36 surgeons. The conversion rate to open surgery was 6.2 % (n = 265), in cases of acute cholecystitis, however, it was 26.3 % (n = 86). One LCE procedure involved an iatrogenic bile duct transsection (0.02 %). The in-hospital mortality rate for LCE was 0.05 % (n = 2).
Conclusions:
In the hands of experienced surgeons LCE is a safe procedure for the treatment of symptomatic, non-complicated cholecystolithiasis. Associated with complicated cholecystolithiasis however are an increase in conversion rate and thus the risk of severe complications.
