Initial experience with laparoscopic cholecystectomy at an Army community hospital

Laparoscopic cholecystectomy is associated with significantly less postoperative discomfort, a shorter hospital stay, and earlier return to normal activity compared with standard cholecystectomy. From February 1992 to January 1993, an initial 67 laparoscopic cholecystectomies were attempted at Irwin Army Community Hospital; 64 were completed, for a conversion rate of 4.5%. Average operative time was 127.3 minutes, but improved over the course of the series. Cholangiography was selectively performed for unclear biliary anatomy or possible choledocholithiasis, and was completed in 9 of 11 patients. Two procedure-related complications (3.1%) occurred. No biliary injuries or trocar injuries to intraabdominal contents occurred, and mortality was zero. Laparoscopic cholecystectomy can be safely performed at community hospitals by properly trained surgeons. Definitive identification of biliary anatomy, along with selective cholangiography and the Hasson method of trocar placement, can minimize the morbid injuries that are more common with this technique than with traditional cholecystectomy.