Long operation and the risk of complications from laparoscopic cholecystectomy

Data collected prospectively from patients undergoing laparoscopic cholecystectomy under one consultant surgical team were analysed to examine the influence of duration of operation on postoperative complications.

Between June 1990 and March 1994, 411 consecutive patients underwent laparoscopic cholecystectomy, of which nine (2.2 per cent) were converted to open operation. Patients whose laparoscopic operation took 3 h or more (32 patients) were compared with those whose operation took less than 3 h (370 patients) with respect to postoperative complications.

There was a higher incidence of acute biliary disease (28 versus 7.0 per cent), upper abdominal adhesions (16 versus 3.2 per cent), significant gallbladder adhesions (69 versus 25.4 per cent) and common bile duct exploration (16 versus 1.4 per cent) in patients having a long operation. Complications were divided into "surgical' and "general', and included cardiovascular, respiratory and thromboembolic events. The overall complication rate was 9 per cent in the long operation group and 3.8 per cent in the short operation group (P not significant) (4.2 per cent for both groups combined). No general complications occurred in those having a longer operation.

The duration of operation does not affect the risk of general complications after laparoscopic cholecystectomy, so enabling the advantages of the minimally invasive approach to be realized in patients with more advanced biliary disease.