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Laparoscopic cholecystectomy: a report of 409 consecutive cases and its future outlook
N Kano1, T Yamakawa, Y Ishikawa
1Department of Surgery, Teikyo University Hospital, Kawasaki, Japan.
Insights
Laparoscopic cholecystectomy is a safe procedure when patients are carefully selected. Experience has expanded indications, making it comparable to open surgery for gallbladder removal.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Minimally Invasive Surgery
Background:
- Laparoscopic cholecystectomy (LC) has become a standard procedure for gallbladder removal.
- Early adoption of LC involved strict patient selection criteria.
Purpose of the Study:
- To evaluate the safety and feasibility of LC in a large patient cohort.
- To assess the evolving indications and outcomes of LC over time.
Main Methods:
- Retrospective analysis of 409 patients undergoing LC between May 1990 and October 1992.
- Documentation of conversion rates, reasons for conversion, operative times, and postoperative complications.
Main Results:
- Ten out of 409 patients (2.4%) required conversion to open cholecystectomy due to bleeding or adhesions.
- Average operative time was 81 minutes, with an average hospital stay of 6.5 days.
- Eleven patients (2.7%) experienced complications, including bile duct injury and bile leaks.
Conclusions:
- Laparoscopic cholecystectomy is a safe and effective procedure with acceptable complication rates.
- Expanded indications, including common bile duct stones and prior gastrectomy, are feasible with careful patient selection and surgical expertise.
Abstract:
A retrospective study was conducted on 409 patients who underwent laparoscopic cholecystectomy at Teikyo University Hospital between May, 1990 and October, 1992. The operation had to be converted to an open cholecystectomy in ten of these patients because of uncontrollable bleeding from the cystic artery in one, venous bleeding due to portal hypertension in one, extensive adhesions of the omentum and the duodenum to the gallbladder in two, extensive adhesions around the gallbladder in four, and extensive adhesions between the gallbladder and the common bile duct (CBD) in two. The time taken to complete the procedure ranged from 30 to 235 min, the average time being 81 min, and the postoperative hospital stay ranged from 3 to 56 days, the average stay being 6.5 days. Eleven patients developed complications intra- or postoperatively: bile duct injury which became manifest after the operation and required laparotomy in three patients; injury to the right hemidiaphragm resulting in a right pneumothorax in one; periumbilical subcutaneous emphysema in one; mild bile leaks which resolved in a few days in two; and a severe bile leak which resolved after 6 days in one. The indications for laparoscopic cholecystectomy have widened with experience and now, CBD stones and a history of previous gastrectomy are no longer contraindications for laparoscopic cholecystectomy. Thus, it seems that laparoscopic cholecystectomy can be performed as safely as a standard cholecystectomy, provided the patients are selected properly and appropriate caution is exercised.