LAPAROSCOPIC CHOLECYSTECTOMY: EXPERIENCE OF A SINGLE SURGEON IN 1000 CASES

Abstract

Laparoscopic cholecystectomy (LC) has undoubtedly standardized the treatment of gallbladder stones. One of the first surgeons to perform LC in Turkey, the author now has nearly 5 years of clinical experience with this procedure. The present article describes his results in 1000 consecutive cases of LC performed between September 1991 and October 1996.

LC was attempted in 1000 patients. The procedure was completed in 984 cases and converted to open operation in 16 cases (1.6 percent) owing to dense adhesions, bleeding, biliary complications and intrahepatic gallbladder. On the basis of preoperative investigations, 20 patients (2%) underwent ERCP-ERS. Cystic duct cholangiograms were obtained selectivety in 43 patients (4.3%). Biliary complication occured in 6 patients, including 2 patients with cystic duct leakage (0.2%) and 4 patients with common bile duct injury (0.4%). One patient required reoperation for small bowel obstruction due to spilled gallstones. Prolonged follow-up has revealed 3 cases of retained common bile duct stones (0.3%) and 2 cases of subumblical trocar site hernia. There was one mortality (0.1%).

The increased incidence of bile duct injury with the laparoscopic technique compared with open cholecystectomy will decrease as surgeons gain experience.