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Complications during the introduction of laparoscopic cholecystectomy in Norway. A prospective multicentre study in
E Trondsen1, T E Ruud, B H Nilsen
1Surgical Department of Central Hospital of Akershus, Nordbyhagen, Norway.
Objective:
To assess the morbidity of laparoscopic cholecystectomy since its introduction in Norway in the Autumn of 1990.
Design:
Postal collection of prospectively collected data.
Setting:
Practices of 26 surgeons in 7 district and university hospitals.
Subjects:
527 patients who underwent laparoscopic cholecystectomy.
Interventions:
133 patients (25.5%) had endoscopic retrograde cholangiopancreatography before operation, and two had cholangiograms during operation; dissection was by electrocautery in 490 patients and by laser in 37.
Main Outcome Measures:
Morbidity, number converted to open operation, and number who required reoperation.
Results:
There were no deaths and a total of 70 complications (13.3%), 8 of which were after laser dissection. There were 59 local complications (11.2%) and 11 general (2.1%); 12 patients (2.3%) required reoperation for bleeding (n = 5), biliary leak (n = 4), and incisional hernia (n = 3). One had a retained stone in the common duct. 42 were converted to open operation (8.0%), 11 because of complications (bleeding, n = 6; damage to the bile duct, n = 3; and bowel perforation, n = 2). Of the 28 patients with acute cholecystitis 5 (17.9%) had to be converted to open operations and 7 (25.0%) developed complications. 2 of these patients had bile duct injury.
Conclusion:
The morbidity during the introductory period of laparoscopic cholecystectomy in Norway is higher than that reported elsewhere, indicating that the risk of complications is increased during the learning period.