Endoscopic Cholecystectomy

Abstract

We analyzed our initial 381 endoscopic cholecystectomies with particular emphasis on postoperative complications. The rate of conversion to open cholecystectomy was 3%. A technical complication occurred in 2% and a non-technical complication in 4%, for a total complication incidence of 6%. There were three postoperative fatalities (0.9%). Two fatal technical complications consisted of unrecognized intestinal injuries at the time of endoscopic cholecystectomy that were obvious when the abdomen was opened. One patient died of a cerebrovascular accident. Nonfatal technical complications included five bile leaks that required treatment. There were no common bile duct injuries, but excessive caution to prevent common bile duct injury may have contributed to the high incidence of bile leaks. Examination of the case numbers of the technical complications and conversion to open cholecystectomy suggests that the learning curve is real and somewhat prolonged, and that a willingness to convert to open cholecystectomy is necessary if technical complications are to be avoided.

Laparoscopic or open conventional cholecystectomy: clinical and economic considerations

“…For those studies selected for their similarities to the method used in our own analysis, the mean postoperative stay for an open conventional cholecystectomy was 8 days compared with the 3 days recorded for laparoscopy (8,17,23,38,50). In the present study, the mean number of postoperative days in hospital was similar-8 and 3 days, respectively.…”

Laparoscopic cholecystectomy: incidents and complications. A retrospective analysis of 9542 consecutive laparoscopic operations

“…Lesions of the extrahepatic bile ducts can occur at any level as follows. Detachment of the gallbladder may open any accessory bile ducts present in the gallbladder bed [10][11][12][13]; postmortem studies demonstrate their presence in 3-5% of individuals [11]. However, accessory bile ducts were only recognised in three patients immediately after detachment of the gallbladder.…”

Management of Descending Duodenal Injuries Secondary to Laparoscopic Cholecystectomy

“…A delay in diagnosis may result in sepsis and peritonitis, contributing to the relatively high associated mortality [8, 9]. The overall mortality rate of duodenal perforation secondary to laparoscopic cholecystectomy ranges from 8.3% [4] to 16% [10], but mortality varies from 30 to 75% when sepsis results in a multiorgan failure [2, 11, 12].…”