Cholecystectomies: from laparotomy to laparoscopy

Retrospective study of a series of 397 consecutive cholecystectomies among which 289 by laparotomy, 100 by coelioscopy and 8 by coelioscopy first and laparotomy in a second time (conversion rate 8/108 = 7.4%). The results of the whole series are comparable to those of the literature (mortality: 0.7% and morbidity: 8.5%). The results of the first 100 cholecystectomies completely performed by laparoscopy are comparable to the last 100 cholecystectomies performed by laparotomy (no mortality and low morbidity). The coelioscopic approach can reasonably be proposed when indication for cholecystectomy exists, with the exception of undissectable adhesions, a Mirizzi's syndrome or a very acute cholecystitis, and providing a good preoperative imagery of the biliary ducts. In our series, we did not observed wounds of the main biliary duct. We recommend a systematic subhepatic drainage.