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PubMed1999

Value of magnetic resonance cholangiopancreatography in demonstrating major bile duct injuries following laparoscopic cholecystectomy.

BACKGROUND: Conventionally, recognition of bile duct injuries after laparoscopic cholecystectomy largely relies on endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC). However, these invasive procedures are not without risk. Preliminary experience with use of magnetic resonance cholangiopancreatography (MRCP) to identify these injuries is reported. METHODS: The medical records of five patients who had undergone laparoscopic cholecystectomy and had suspected major bile duct injuries were reviewed. All five patients underwent MRCP, followed by conventional cholangiography: either ERCP or PTC, or both. The findings of MRCP and conventional cholangiography were compared. RESULTS: Four patients had proven bile duct injuries. The remaining patient had gallstones dislodged into the common bile duct (CBD) during laparoscopic cholecystectomy, which presented as transient jaundice mimicking a bile duct injury. The MRCP images were of higher diagnostic value than conventional cholangiographic images in four patients with frank bile duct injury. For these patients, ERCP showed only the cut-off sign of the CBD, and PTC was needed to visualize the upper biliary system. MRCP, however, demonstrated the entire biliary system proximal and distal to the amputated or stenotic sites simultaneously. In the remaining patient with dislodged gallstones, the two techniques yielded similar diagnostic information. CONCLUSION: This preliminary study suggests that MRCP is an ideal diagnostic test whenever bile duct injury following laparoscopic cholecystectomy is suspected.

Adult↗
PubMed1999

Emergency cholecystostomy and subsequent cholecystectomy for acute gallstone cholecystitis in the elderly.

BACKGROUND: The morbidity and mortality rates associated with acute cholecystitis are higher in the elderly. This study reports the results of treatment of acute cholecystitis in the elderly with emergency ultrasonographically guided percutaneous cholecystostomy followed by elective cholecystectomy after endoscopic treatment of any common bile duct stones diagnosed by percutaneous cholangiography. METHODS: From January 1989 to December 1998, 92 patients aged over 70 years were treated for acute gallstone cholecystitis. A group of 84 patients with ultrasonographic signs of severe cholecystitis or an American Society of Anesthesiologists score of II to IV were submitted to ultrasonographically guided percutaneous cholecystostomy. Transcatheter cholangiography was performed in all patients and endoscopic sphincterotomy was performed before operation in patients with common bile duct stones. After resolution of the acute phase and treatment of any associated diseases, patients were submitted to cholecystectomy. RESULTS: Cholecystostomy was performed successfully in 83 patients and permitted resolution of the acute attack in all after a mean period of 1.8 days. Cholangiography yielded a diagnosis of non-gallstone obstruction in one patient and common bile duct stones in 19 patients; preoperative endoscopic sphincterotomy and stone extraction was performed in 18 patients. Elective cholecystectomy was then performed in 70 patients with no deaths and a morbidity rate of 24 per cent. CONCLUSION: Combining emergency ultrasonographically guided percutaneous cholecystostomy, preoperative endoscopic treatment of common bile duct stones and subsequent elective cholecystectomy constitutes an optimal treatment regimen for acute gallstone cholecystitis in selected elderly patients with a mortality rate of zero in the authors' experience.

Acute Disease↗
PubMed2000

Cholecystectomy, peptic ulcer disease and the risk of adenocarcinoma of the oesophagus and gastric cardia.

BACKGROUND: Gastro-oesophageal reflux is a strong risk factor for oesophageal adenocarcinoma. Bile and pancreatic enzymes may be particularly carcinogenic. Cholecystectomy causes an increased gastric level of these constituents. A decreased risk of oesophageal adenocarcinoma has been observed in persons infected with cagA-positive Helicobacter pylori. There is a strong correlation between ulcer disease and Helicobacter pylori infection. The aim of this study was to determine whether previous cholecystectomy or peptic ulcer disease affects the risk of oesophageal carcinoma. METHODS: Data were collected as a nationwide population-based case-control study in Sweden between 1995 and 1997. Multivariate adjusted odds ratios (ORs) were calculated with logistic regression. RESULTS: There was no statistically significant association between cholecystectomy and the risk of oesophageal carcinoma. Among persons with previous peptic ulcer, the adjusted OR for oesophageal adenocarcinoma was below unity (OR = 0.6, 95 per cent confidence interval 0.3-1.1). The relative risk estimates for cardia adenocarcinoma and oesophageal squamous cell carcinoma were close to unity. CONCLUSION: Cholecystectomy, despite its effect on the composition of gastric juice, does not appear to increase the risk of adenocarcinoma of the oesophagus or gastric cardia. While the data do not contradict a protective effect of H. pylori, the results are also consistent with absence of such an effect.

Adenocarcinoma↗
PubMed1999

Assessment of ondansetron and droperidol for the prevention of post-operative nausea and vomiting after cholecystectomy and minor gynaecological surgery performed by laparoscopy.

The anti-emetic effects of ondansetron and droperidol were evaluated in 134 ASA Grade I and II female patients, scheduled for laparoscopic cholecystectomy and minor gynaecological laparoscopic surgery, who were randomly assigned to receive ondansetron 4 mg or droperidol 75 micrograms kg-1 intravenously immediately after induction of anaesthesia. The patients were assessed 1, 6, 12 and 24 h after surgery for intensity of nausea and number of vomiting episodes. In the case of the patients undergoing laparoscopy, vomiting episodes occurred in a similar proportion in patients treated with ondansetron or droperidol, with the probability of the Type I error of 0.05 and the Type error II of 0.1. Although there was no difference between the two groups in emetic episodes following all laparoscopic procedures and gynaecological laparoscopic surgery, there was a significant difference between these parameters after laparoscopic cholecystectomy. The patients treated with ondansetron experienced a lower intensity of nausea (P = 0.04) after laparoscopic cholecystectomy, less frequent severe nausea (P = 0.02) and episodes of vomiting (P = 0.04) when compared with those in the droperidol group. We conclude, that despite the result the droperidol prophylaxis appears to be an effective alternative to ondansetron in all patients undergoing laparoscopy, the ondansetron prophylaxis is superior to droperidol in patients undergoing laparoscopic cholecystectomy.

Adult↗
PubMed1999

The blood supply of the biliary ductal system and its relevance to vasculobiliary injuries following cholecystectomy.

BACKGROUND: Cholecystectomy remains the only satisfactory treatment for symptomatic gall bladder stones. Unfortunately, in some cases the operation is complicated by vasculobiliary injury. The present study was undertaken to investigate the blood supply of the normal biliary system, to simulate vasculobiliary injuries described after cholecystectomy, and to determine the possible effects of the vascular injury on biliary reconstruction. METHODS: The blood supply of the biliary system in nine normal livers was investigated by injection of the coeliac axis and superior mesenteric arteries with coloured gelatin. The specimens were dissected under magnification and drawings prepared. Injection dissection studies were also carried out in eight specimens in which various vasculobiliary injuries encountered after cholecystectomy were simulated. RESULTS: The bile ducts possess an arterial plexus on their surface which is supplied from below by ascending marginal vessels derived from the postero-superior pancreaticoduodenal artery. These marginal vessels end above in the right hepatic artery or its branches. The right and left hepatic ductal systems are supplied by the right and left hepatic arteries and their sectoral or segmental branches. The right and left hepatic arteries communicate freely via the hilar plate arterial plexus. This collateral system allows the blood supply to the right hepatic duct to be maintained after ligation of the right hepatic artery and interruption of the common hepatic duct or excision of the confluence. CONCLUSION: A knowledge of the blood supply of the normal biliary system and the collateral hilar plate arterial plexus forms the anatomical foundation for successful reconstructive surgery, not only in vasculobiliary injuries following cholecystectomy, but also for a wide range of hepatobiliary procedures.

Aorta↗
PubMed2003

Recognition and management of biliary complications after laparoscopic cholecystectomy.

INTRODUCTION: Injuries to the extrahepatic biliary tree at laparoscopic cholecystectomy cause major morbidity and are a major source of litigation. Injuries are often diagnosed late, leading to further complications and decreasing the chance of a successful repair. METHODS: A prospective study was carried out of all patients with extrahepatic biliary injuries from cholecystectomy who were referred to the surgeons of the Universities of Melbourne Hepatobiliary Group between 1997 and 1999. RESULTS: Twenty-seven patients sustained biliary injuries to the extrahepatic biliary tree. Twenty patients (74%) had unrecognized injuries at the time of cholecystectomy. The median time to referral was 9 days. Only two of 11 operative cholangiograms were interpreted as showing a biliary injury. CONCLUSION: Biliary injuries are still occurring at laparoscopic cholecystectomy. Guidelines about the management of a suspected biliary injury are discussed. Clinical, radiological and pathological assessment should enable prompt diagnosis and management should be instituted early, preferably with the involvement of a hepatobiliary specialist.

Adult↗
PubMed2003

Incidental finding of gallbladder carcinoma detected during or after laparoscopic cholecystectomy.

AIM: Carcinoma of the gallbladder is a rare neoplasm with a dismal prognosis. With the increase of cholecystectomies due to the wide acceptance of laparoscopic cholecystectomy, the incidental diagnosis of gallbladder carcinoma is more frequent. We report our experience with gallbladder cancer diagnosed during or after the performance of laparoscopic cholecystectomy. METHODS: We evaluated 11 patients with gallbladder cancer out of 5539 patients who underwent laparoscopic cholecystectomy. Patient clinical and demographic characteristics were reviewed. RESULTS: Intraoperatively in 297 patients there was the suspicion of adenocarcinoma and frozen sections were performed. In four of them the diagnosis of adenocarcinoma was confirmed. In two of them the procedure was converted to open with gallbladder liver bed resection and regional lymph node dissection while the other two were considered inoperable. Of the remaining 5242 patients, seven were diagnosed postoperatively at the pathologic examination. Of these, five patients refused to undergo a repeat operation. We did not observe port site metastasis in any of our patients. Survival was low and ranged from 3-14 months. CONCLUSION: Gallbladder cancer runs a short course, with a poor prognosis. The use of a meticulous laparoscopic technique seems to be important for the diagnosis and the avoidance of early complications of the disease.

Adenocarcinoma↗
PubMed2001

Association between cholecystectomy and adenocarcinoma of the esophagus.

BACKGROUND & AIMS: Barrett's esophagus, which is linked to adenocarcinoma of the esophagus, is associated with reflux of bile. Duodenogastric reflux is increased after cholecystectomy. This study aims to evaluate if cholecystectomy is associated with an increased risk of adenocarcinoma of the esophagus. METHODS: A population-based cohort study of cholecystectomized patients in Sweden between 1965 and 1997 cross-linked with the Swedish Cancer Register. RESULTS: Cholecystectomized patients had an increased risk of adenocarcinoma of the esophagus (standardized incidence ratio [SIR], 1.3; 95% confidence interval [CI], 1.0-1.8). Esophageal squamous-cell carcinoma was not found to be associated with cholecystectomy (SIR, 0.9; 95% CI, 0.7-1.1). Patients with gallstone disease on whom surgery was not performed did not have an increased risk of adenocarcinoma or squamous-cell carcinoma of the esophagus. CONCLUSIONS: Cholecystectomy is associated with a moderately increased risk of adenocarcinoma of the esophagus, possibly by the toxic effect of refluxed duodenal juice on the esophageal mucosa. Further studies are needed regarding the link between bile reflux and esophageal carcinogenesis.

Adenocarcinoma↗
PubMed2005

Glycemic load, glycemic index, and carbohydrate intake in relation to risk of cholecystectomy in women.

BACKGROUND & AIMS: High-carbohydrate diets with a high glycemic response may exacerbate the metabolic consequences of the insulin-resistance syndrome. The effect on the incidence of gallstone disease is not clear. METHODS: We examined the associations between high-carbohydrate diets with a high glycemic response and the risk of cholecystectomy in a cohort of women who were aged from 35 to 61 years in 1984 and had no history of gallstone disease. As part of the Nurses' Health Study, the women reported on questionnaires mailed to them every 2 years both their carbohydrate intake and whether they had undergone cholecystectomy. RESULTS: During 16 years of follow-up, we ascertained 5771 new cases of cholecystectomy. After adjusting for age and other known or suspected risk factors in a multivariate model, the relative risk for the highest compared with the lowest quintile of dietary carbohydrate was 1.35 (95% CI: 1.17-1.55, P for trend < .0001). The relative risks for the highest compared with the lowest quintile were 1.50 for glycemic load (95% CI: 1.32-1.71, P for trend < .0001) and 1.32 for glycemic index (95% CI: 1.20-1.45, P for trend < .0001). Independent positive associations were also seen for intakes of starch and sucrose. CONCLUSIONS: Our findings suggest that a higher intake of carbohydrate, dietary glycemic load, and glycemic index may enhance risk of cholecystectomy in women.

Adult↗
PubMed2002

Management and outcome of major bile duct injuries after laparoscopic cholecystectomy: from therapeutic endoscopy to liver transplantation.

Laparoscopic cholecystectomy is associated with a higher rate of bile duct injuries than an open cholecystectomy. The annual incidence of bile duct injuries has remained almost constant and these injuries tend to be more serious, making demands on the method of repair. We wanted to report the management and outcome of major bile duct injuries after laparoscopic cholecystectomy in patients referred to a hepatobiliary and liver transplantation unit. Eighteen patients (14 women), with a median age of 53.5 years were referred to the liver surgery unit with a major bile duct injury after laparoscopic cholecystectomy. The injury was identified after a median of 3 days (range, 0 to 25 days) after operation and the median time interval to referral was 79 days (0 to 2270 days). Fourteen patients had undergone surgery before referral. By the time of referral, four patients had developed end-stage cirrhosis, necessitating liver transplantation. Three of them had undergone bilioenteric drainage operations at the referring institute. Of the remaining 14 patients, three were managed by therapeutic endoscopic procedures. Ten patients were managed with Roux-en-Y hepaticojejunostomy. One died of septic complications before the repair. A median time for hospitalization in our unit was 33 days (range, 10 to 164 days). At present, 16 patients are alive. One patient died of Kaposi's sarcoma 7 months after liver transplantation. A long interval between bile duct injury and referral was associated with the development of end-stage liver disease. Surgery of biliary lesions is demanding, and surgical experience with multidisciplinary approach, including therapeutic endoscopy and liver transplantation, is necessary for successful outcome.

Adult↗
PubMed2001

Laparoscopic cholecystectomy: effective treatment for chronic abdominal pain in children with acalculous biliary pain.

BACKGROUND/PURPOSE: Acalcular biliary pain is a term used to identify patients who have significant abdominal pain related to an abnormally low gallbladder ejection fraction in the absence of cholelithiasis. Little is known about this disease in the pediatric population. The aim of this study was to determine whether laparoscopic cholecystectomy is an effective method for treatment of children with abdominal pain in the setting of acalcular biliary pain and whether one can predict the outcome preoperatively. METHODS: The charts of all children who underwent laparoscopic cholecystectomy for acalcular biliary pain in our institution from January 1991 through April 1998 were reviewed. Sixty-three patients were identified as children with acalcular biliary pain who underwent laparoscopic cholecystectomy. Forty-eight patients were contacted successfully and they all completed the questionnaire. Complete resolution of abdominal pain occurred in 72%, and another 18% had near-complete resolution of pain. Some improvement was noted by 8%, and only 2% had no improvement. In a multiple logistic model, none of the variables were significant predictors of response outcome. CONCLUSIONS: Laparoscopic cholecystectomy is an effective means of therapy for children with abdominal pain and low gallbladder ejection fraction. It is difficult to predict patients with complete response based on the preoperative clinical findings.

Abdominal Pain↗
PubMed2000

Laparoscopic cholecystectomy and cirrhosis: a case-control study of outcomes.

The incidence of gallstone disease in patients with cirrhosis is greater than that in healthy patients. Previous surgical literature reported greater morbidity and mortality in patients with cirrhosis with both open and laparoscopic cholecystectomy (LC). We compared our recent experience with LC in patients with cirrhosis and controls. A retrospective review was performed using the search terms, "cirrhosis" and "laparoscopic cholecystectomy." Forty-eight patients with cirrhosis were identified and randomly matched with healthy controls by age and sex. Four controls were assigned per patient with cirrhosis. Outcomes assessed included mortality, duration of surgery, length of hospital stay, blood transfusion requirement, postoperative complications, and need for conversion to open cholecystectomy. Forty-eight patients with cirrhosis and 187 healthy controls underwent LC. Child-Pugh classification of severity of liver disease was as follows: Child's class A, 38 of 48 patients; Child's class B, 10 of 48 patients; and Child's class C, 0 of 48 patients. Patients with cirrhosis had statistically significantly lower albumin levels (P =.0001) and prolonged prothrombin times (P =. 05). Average duration of surgery for patients with cirrhosis was 1. 71 versus 1.57 hours (P =.57) for controls. Average length of hospital stay for patients with cirrhosis was 6.47 versus 4.77 days (P =.152) for controls. Average number of units of blood transfused in patients with cirrhosis was 0.156 versus 0.0 units (P =.025) in controls. Complications occurred in 6 of 48 patients with cirrhosis (12.5%) and 8 of 187 controls (4.2%; P <.05). No child's class C patient underwent LC. Four patients with cirrhosis (8.3%) and no controls were converted to open cholecystectomy. No postoperative infections were noted. There was no mortality in either group. LC in patients with Child's class A and B cirrhosis is reasonably safe and shows no increase in morbidity or mortality or worsening of outcome. Further studies are required to evaluate the management of acute gallbladder disease in Child's class C patients.

Adult↗
PubMed2002

Latent adenocarcinoma of the colon discovered during or after laparoscopic cholecystectomy.

BACKGROUND: The wide acceptance of laparoscopic cholecystectomy has resulted in the performance of increased numbers of cholecystectomies, hence increasing the number of patients discovered with concomitant malignancy or other pathological states. PATIENTS AND METHODS: A total of 3751 patients who underwent laparoscopic cholecystectomy between January 1995 and December 2000 were included in this study. Nine cases of coexisting malignant colonic neoplasm were discovered. All of these patients but one underwent therapeutic resection. RESULTS: The survival rate of these nine patients was the same as that of 62 consecutive colonic cancer patients who were treated in our department over the same period. The rate of postoperative complications in the study group was higher than in the control group (21 % vs. 9.5 %). The hospital stay in these patients was also greater (17 days vs. 10 days). CONCLUSION: The rate of incidental discovery of colorectal carcinomas during laparoscopic cholecystectomy in our department was 0.24 %. These patients had higher complication rates and a longer hospital stay.

Adenocarcinoma↗
PubMed2002

Changes in hemodynamics and autonomic nervous activity in patients undergoing laparoscopic cholecystectomy: differences between the pneumoperitoneum and abdominal wall-lifting method.

BACKGROUND AND STUDY AIMS: Intraoperative changes in circulatory hemodynamics and autonomic nervous activity were evaluated in 33 patients with cholelithiasis who underwent laparoscopic cholecystectomy. PATIENTS AND METHODS: Of these patients, 18 were treated using a pneumoperitoneum (group G) and 15 using the abdominal wall-lifting method (group WL). Their ECG, blood pressure, arterial oxygen saturation, and expiratory carbon dioxide partial pressure were monitored. Autonomic nervous function was evaluated by spectral analysis of the heart rate. RESULTS: Mean blood pressure increased significantly in group G during surgery, but did not vary in group WL during any stage of surgery. The high-frequency (HF) power, an index of parasympathetic activity, decreased significantly in group G after pneumoperitoneum. However, the HF power did not decrease significantly in group WL. The LF/HF ratio, an index of sympathetic activity, increased significantly in group G after pneumoperitoneum, but did not vary in group WL. In addition, the incidence of ventricular or supraventricular arrhythmias and the severity of the arrhythmias as determined by Lown's classification were higher in group G than in group WL. These findings suggest that intraoperative changes in autonomic nervous activity, due to increased intra-abdominal pressure, were smaller in patients undergoing laparoscopic cholecystectomy using the abdominal wall-lifting method than in those undergoing laparoscopic cholecystectomy using pneumoperitoneum. The results also demonstrated that hemodynamic changes were smaller in patients undergoing the abdominal wall-lifting method than in those undergoing pneumoperitoneum. CONCLUSIONS: It was concluded that hemodynamics should be carefully monitored during pneumoperitoneum, and that the abdominal wall-lifting approach in laparoscopic cholecystectomy is a method worthy of consideration for elderly patients or those with cardiopulmonary complications.

Abdominal Muscles↗
PubMed2006

Ultrasound examination shows disturbed proximal gastric function in symptomatic gallstone patients with dyspepsia and improvement after cholecystectomy--gallstones and gastric emptying.

AIM: The aim of our study was to examine gastric function, gallbladder emptying, and dyspepsia in symptomatic gallbladder stone patients (SGBS) to see if a motility disorder, expressed by gastric function and gallbladder emptying, may cause dyspepsia in SBGS. MATERIALS AND METHODS: Gastric function and gallbladder emptying in 21 SGBS referred for surgical treatment were measured by ultrasound after ingestion of 500 ml of a meat soup (bouillon). Dyspeptic symptoms were simultaneously recorded on a Visual Analog Scale (VAS). The patients were re-examined 10 months after cholecystectomy. Hospital staff (n = 14) served as control subjects (C). RESULTS: In SGBS, the frontal diameter of the proximal stomach was wider than in C at both 10 minutes (55.7 vs. 48.3 mm; p = 0.053) and 20 minutes (49.3 vs. 39.5 mm; p = 0.002), and the sagittal area of the proximal stomach was larger at 10 minutes (25.0 vs. 20.9 cm (2); p = 0.03). The postprandial frontal diameter decreased significantly after cholecystectomy (immediately after the meal: 51.3 mm; p = 0.03, at 10 minutes: 47.6 mm; p = 0.05, and at 20 minutes: 39.1 mm; p = 0.004). Twenty minutes after meal ingestion, gallbladder emptying was significantly less in SGBS than in C with a mean (SD) emptying of 20 % (17) versus 33 % (18); p < 0.04. In the fasting state, SGBS felt more hunger than C (VAS 67 mm vs. 39 mm; p = 0.03). After cholecystectomy, the feeling of hunger decreased (VAS 27 mm; p = 0.01). CONCLUSION: SGBS had a wider proximal stomach and more hunger in the fasting state than C. After cholecystectomy the proximal stomach function and the hunger score improved. Our results suggest a physiological link between symptomatic gallstone disease and dyspepsia expressed by impaired proximal gastric function.

Adult↗
PubMed1994

Endoscopic treatment of biliary leakage after laparoscopic cholecystectomy.

Laparoscopic cholecystectomy is an effective and safe treatment for uncomplicated symptomatic cholelithiasis. However, biliary tract injury may be more common with this procedure than with open cholecystectomy. We have encountered 17 patients with a biliary leak among 465 patients undergoing laparoscopic cholecystectomy, the diagnosis being established by clinical and radiographic parameters. The most common site of leakage was the cystic duct stump. Patients underwent endoscopic sphincterotomy and biliary stent placement, with an overall success rate of 96%. No morbidity or mortality related to the endoscopic procedures was encountered. We conclude that biliary leakage after laparoscopic cholecystectomy is uncommon. When it occurs, it can be treated safely and efficaciously by endoscopic means.

Adult↗
PubMed1992

Laparoscopic cholecystectomy: technical performance, safety and patient's benefit.

Laparoscopic cholecystectomy seems to be the most promising new technique for the treatment of symptomatic gallstone disease. For different reasons, controlled clinical trials comparing comfort and trauma for the patient of conventional versus laparoscopic cholecystectomy are difficult to perform at our institution. We therefore report on the results of our first 400 laparoscopic cholecystectomies using a strict and detailed protocol on technical performance, safety and benefit for the patient. Data was obtained immediately after the operation and after a short-term follow-up. To analyze the technical performance and the safety of the procedure, we developed a new classification system (I-V) of adverse events, including both the patients' and the surgeons' viewpoints. Our results show that in nearly 80% of the cases an optimal result (no adverse events in any respect) was obtained. For different reasons, the surgical procedure had to be changed during the operation in 20 cases (5%). In 3 cases (0.8%), an injury of the common bile duct occurred; 2 patients died (mortality 0.5%). On the first post-operative day, vomiting occurred in only 8% and nausea in 19% of the patients. Pain intensity was always below the level where patients demand analgesic medication and declined near zero the day after the operation. Patients fatigue was measured on a scale from 0-10 and rose from 2.2 preoperatively to 3.3 postoperatively. Only a short hospital stay of 3 days median was required. At short-term follow-up 6 weeks after the operation, pain was only rarely reported, the patients were fit and only 20% avoided some kind of food. We conclude that laparoscopic cholecystectomy is the treatment of choice for this precisely defined patient population with symptomatic gallstone disease.

Cholecystectomy↗
PubMed1992

Prospective study of laparoscopic cholecystectomy in two hundred and fifty patients.

Two hundred and fifty consecutive patients (151 women, 99 men, age 49.3 years) with symptomatic gallstones as diagnosed on ultrasonography underwent elective laparoscopic cholecystectomy over a 12-month period. Preoperative intravenous cholangiography (IVC) and endoscopic retrograde cholangiography (ERC) were also performed in 203 and 200 patients, respectively. Laparoscopic cholecystectomy was successfully performed on 248 of the 250 patients (99.2%). Two patients required conversion to open cholecystectomy because of a pin hole injury to the portal vein in one case, and because of technical difficulties with the dissection due to severe adhesions in the other patient. Procedure time in the initial 100 cases decreased from an average of 216 minutes for the first ten cases to 87 minutes for the last 30 cases, including the time required for intraoperative cholangiography (IOC). Bile duct stones were found in 4 cases on IOC which were diagnosed by preoperative ultrasonography, IVC and ERC in 0, 2 and 3 cases respectively. An intraabdominal drain was inserted for two days in all cases. The mean hospital stay was 8.6 days (range 4 to 19 days) with no readmissions. No complications were seen at short-term follow-up one month after discharge. Although there was a significant learning period, the procedure was safe and effective and could be performed with minimal risk. The results show that physicians with experience in both endoscopy and laparoscopy are well qualified to perform laparoscopic cholecystectomy after appropriate training.

Cholangiography↗