Experience in laparoscopic cholecystectomy

Laparoscopic cholecystectomy is accepted as the procedure of choice for gallstone diseases but like all other procedure it is also not free from unwanted events. In this study, the authors have analyzed their experience in laparoscopic cholecystectomy (LC) and its complications and their management. Amongst the total 4957 laparoscopic cholecystectomy (LC) performed by the authors between April 1995 to May 2005 the male, female ratio was 1:5.6 (744 and 4213). 15.33%(760) of LC were carried out for the patients with acute cholecystitis. The age ranged from 9 years to 98 years. Mean operating time was 37 minutes (7 m to 187 m). Average hospital stay was 2.23 days (20 h to 7d). Peri-cholecystic adhesions including cholecysto-enteric fistulae and acute inflammation were the main reason for difficult dissection. This could be anticipated from the history of recurrent attack, high fever, severe pain and thick walled gall bladder (GB) on ultrasonography (USG). The main per-operative problem the authors came across was hemorrhage 5.2%(258), iatrogenic perforation of the gallbladder 15.12%(755) and common bile duct (CBD) injuries 0.12%(7). Conversion to open procedure was necessary in 0.68%(36) cases, most commonly due to obscure anatomy as a result of chronic inflammatory adhesions 0.56%(28), the other reasons for conversion were to deal with the CBD injury 0.04%(2), cholecysto-colic fistula 0.02%(1), unsuspected malignancy 0.06%(3) and uncontrolled bleeding 0.04%(2). The postoperative complications were port site infection and stitch granuloma 0.75%(37), bile leakage 0.08%(4), hemorrhage 0.06%(3), sub-hepatic abscess 0.02%(1), peritonitis due to gut perforation 0.04%(2) and retained bile duct stones 0.06%(3). Two deaths were due to septicemia resulting from gut perforation. Laparoscopic cholecystectomy is a safe procedure in the hands of a surgeon with adequate exposure to open surgery and properly oriented in minimally invasive surgery. Complications can be reduced to minimum if meticulous principle of dissection is followed. The unwanted events can mostly be managed laparoscopically without conversion. But decision for conversion should be taken early if there is any confusion and thus mortality and morbidity could be minimized.