[Laparoscopic cholecystectomy--experiences in a British district general hospital]

In the first year after the introduction of the new technique a complication rate of 3.3% was calculated from the evaluation of 118 laparoscopic cholecystectomies. The only severe complication noted was a perforation of the transverse colon following the insertion of a 10 mm port. Henceforth, open laparoscopy is performed in difficult cases. Hereby, to ensure a more secure sealing of the initial incision, an endotracheal tube can be used as the camera port. The conversion rate was found to be 9%, whereby in 50% of acute cholecystitis an open procedure had to be adopted. The use of a Nd-Yag-Laser in 24 cases proved to be of no apparent advantage. Intraoperative cholangiograms were carried out selectively to demonstrate the anatomical situation, or in cases where common bile duct stones were suspected. Within a year, it was possible to reduce the mean operating time from 130 min to 80 min. The postoperative stay was on average 3.7 days. From an economic point of view, the substantially shorter hospitalisation period outweighs the longer operating time. However, more stringent and precise standards with respect to an overall concept in diagnosing and treating common bile duct stones would be beneficial.