Laparoscopic cholecystectomy: a continuing plea for routine cholangiography

The purpose of this clinical study was to demonstrate the usefulness of routine intraoperative cholangiography (IOC) and the safety of laparoscopic cholecystectomies (LC) in a community hospital. There were no ductal injuries and perioperative complications were extremely low. Patients (n = 236) with symptomatic gallstone disease, acalculus cholecystitis, or gallbladder polyps underwent LC from March 1991 to June 1993. During this period two patients were not considered appropriate candidates for this procedure. There were 172 women and 64 men ranging in age from 15 to 84 years. Four had preoperative endoscopic retrograde cholangiopancreatographies (ERCPs) for suspected choledocholithiasis. Elective LC was performed on 194 patients and emergency LC on 42 patients. The average operating time for elective LCs was 89 min and 97 min for emergency LCs. Thirty-six percent of patients had previous abdominal or pelvic surgery. IOC was attempted in 99% of patients and successful in 89%. Five percent had choledocholithiasis. Laparoscopic duct exploration was performed on four patients. Six patients had postoperative ERCP with stone extraction. Three percent of elective patients had additional surgery. One patient had LC during pregnancy (17 weeks), with a normal recovery and successful outcome of the pregnancy. Six elective and four emergency patients were converted to open cholecystectomy, a conversion rate of 4%. There were no ductal or vascular injuries, intraoperative haemorrhages or deaths. There were one small bowel laceration (0.4%). Postoperative complications included seven wound infections (3%), four bile leaks (2%), three trocar site haemorrhages (1%), one intraabdominal haemorrhage (0.4%), one suspected halothane hepatitis (0.4%), one drug-induced cholestatic jaundice (0.4%), and one subcutaneous emphysema (0.4%).(ABSTRACT TRUNCATED AT 250 WORDS)