Laparoscopic cholecystectomy: results of first 300 cases in Hong Kong

Prospective analysis of the first three hundred patients who underwent laparoscopic cholecystectomy was carried out in three surgical centres of Hong Kong. Over a 20-month period, 300 consecutive patients were recruited, including elective and emergency cases. The indications for laparoscopic cholecystectomy were symptomatic gallstones (78%), cholangitis (6%), pancreatitis (5%) and cholecystitis (11%). Patients with common duct stones (12) had preoperative endoscopic sphincterotomy and stone extraction prior to cholecystectomy. Laparoscopic cholecystectomy was accomplished successfully in 287 patients. Thirteen patients (4.3%) required conversion to open cholecystectomy. The reasons for conversion were: inability to identify cystic duct and common bile duct clearly (6); bleeding (5); Mirizzi syndrome (1); and slippage of cystic duct clip (1). The median operation time was 80 min with a range of 28-270 min. The median hospital stay was 3 days. Seventy-five per cent of patients required only a single dose of pethidine injection. None of the patients required blood transfusion. The overall complication rate was 7%. These included mild cellulitis of the subumbilical wound (3%) and postoperative chest infection (3%). One patient developed subphrenic abscess which resolved on percutaneous drainage under ultrasound guidance. Iatrogenic injury to the common bile duct was seen in one patient who had an impacted stone at Hartmann's pouch. With adequate training laparoscopic cholecystectomy can be performed safely. The advantages over open cholecystectomy are less wound pain, better cosmesis and shorter convalescence.