[Laparoscopic Cholecystectomy at Landspítalinn, University Hospital of Iceland. The first 353 cases.]

Since the first laparoscopic cholecystectomy done at the Department of Surgery in November 1991, our aim has been to operate on all presenting patients by this method.

From November 17th 1991 until September 30th 1994, 384 cholecystectomies were performed. Open cholecystectomy was performed in 31 patients. The most frequent causes for open operation were; suspected stones in the choledochus, acute cholecystitis or biliary sepsis. The objective of this study was to determine the frequency of procedure-related complications and the frequency of conversion to open surgery. Furthermore, the operation time, the length of post-operative hospital stay, mortality and morbidity were studied.

A retrospective analysis of patients undergoing cholecystectomy during this period was performed. Post-operatively patients were also contacted by telephone. There were 121 males and 263 females, ranging between three and 91 year of age. Mean age was 53.2 years. Urgent operations (operation performed after emergency admission) were 43.9%, being highest in the last period of the study. Conversion to open surgery was needed in 63 cases (17.8%). The reasons were; adhesions (39.7%), unclear anatomy (17%) and bleeding (15.9%). Conversion rate was 13% for elective operations but 24% for acute cases. Reoperation was needed in 11 cases (3.8%). Seven patients were reoperated during the same hospital admission but four later on. The reasons were; bleeding (four), bile leakage (three), common duct stone (two), subphrenic abscess (one) and injury to the common bile duct (one). One patient (83 years old male) died of pulmonary embolus after a converted operation. The mean operation time for laparoscopic cholecystectomy was 94.9 minutes (30-210 minutes). For the first 100 operations the mean operative time was 99.3 minutes but 85.5 minutes for the last 100. The mean hospital stay after laparoscopic cholecystectomy was 3.1 days (ranging from just few hours to 60 days). Data on 257 patients after laparoscopic cholecystectomy showed that the mean loss of work or preoperative activity level was 17.6 days (2-87 days). There was a statistically significant difference between preoperative activity level in the emergency versus the elective group (21.4 or 15 days, p<0.05).

We conclude that laparoscopic cholecystectomy is a safe procedure and its safety will increase as surgeons gain more experience. Furthermore, this technique may be recommended for elective and emergency cases. Shorter hospital stay and fewer working days lost, followed by decreased expenses both for the patient as well as the community as a whole, must also be considered as a major advantage.