Safety and Efficacy of Laparoscopic Cholecystectomy

Abstract

Laparoscopic cholecystectomy quickly emerged as an alternative to open cholecystectomy. However its safety, efficacy, and morbidity have yet to be fully evaluated. During the first 6 months of 1990, we performed 100 consecutive laparoscopic cholecystectomies with no deaths and a morbidity rate of 8% (8 of 100 patients; 4 major, 4 minor). There were 81 women and 19 men, with a mean age of 46.1 years (range, 17 to 84 years). All patients had a preoperative history consistent with symptomatic biliary tract disease, and most had proved gallstones by sonography. This included four patients with acute cholecystitis. Mean operating time improved significantly from month 1 to month 6 (122 +/- 45.4 minutes versus 78.5 +/- 30 minutes, respectively), indicating a rapid learning curve. Mean hospital stay was 27.6 hours, reflecting a policy of overnight stay. Postoperative narcotic requirements were limited to oral or no medications in more than 70% of patients. A regular diet was tolerated by 83% of the patients by the morning following the procedure. Median time of return to full activity was 12.8 +/- 6.8 days after operation. In addition analysis of the hospital costs of these 100 cases demonstrates a modest cost advantage over standard open cholecystectomy (n = 58) (mean, $3620.25 +/- $1005.00 versus $4251.76 +/- $988.00). There was one minor bile duct injury requiring laparotomy and t-tube insertion, two postoperative bile collections, and one clinical diagnosis of a retained stone that passed spontaneously. Four patients required conversion to open cholecystectomy because of technical difficulties with the dissection. Although there is a significant learning curve, laparoscopic cholecystectomy is a safe and effective procedure that can be performed with minimal risk. Laparoscopic cholecystectomy should be performed by surgeons who are trained in biliary surgery and knowledgeable in biliary anatomy, and, as with all operations, it should be performed with meticulous attention to technique.

Perseverance pays: A complicated case of post laparoscopic cholecystectomy duodenal injury

“…In contrast, duodenal injuries usually result from thermal damage from energy devices, either contact or conductive. 9 This danger is potentiated by working in compromised conditions like in this case where the operating surgeon had problems with maintaining the pneumoperitoneum. Alternatively, they can arise during separation of duodenum when it is densely adherent to the gallbladder.…”

Bile duct disruption and biloma after laparoscopic cholecystectomy: imaging evaluation.

“…Bile duct injury and bile leaks are likely the most significant postoperative complications, and have been recently reported to occur in 0-7% of patients [1 , 2]. Bile extravasation is predominantly attributed to an anatomic variation of small biliary radicles entering directly into the gallbladder bed, or the bile ducts of Luschka, reported to be present in 25-35% of patients [1]. Bile extravasation also may occur from direct injury to the biliary tree, from larger accessory ducts, or from the cystic duct remnant.…”

Management and prevention of iatrogenic bile duct injury

“…Introduction of laparoscopic cholecystectomy in 1987 was associated with significantly increased rate of bile duct injury (15,16). This is certainly due in part to the 'learning curve' effect.…”