Laparoscopic cholecystectomy: A report of 409 consecutive cases and its future outlook

Abstract

A retrospective study was conducted on 409 patients who underwent laparoscopic cholecystectomy at Teikyo University Hospital between May, 1990 and October, 1992. The operation had to be converted to an open cholecystectomy in ten of these patients because of uncontrollable bleeding from the cystic artery in one, venous bleeding due to portal hypertension in one, extensive adhesions of the omentum and the duodenum to the gallbladder in two, extensive adhesions around the gallbladder in four, and extensive adhesions between the gallbladder and the common bile duct (CBD) in two. The time taken to complete the procedure ranged from 30 to 235 min, the average time being 81 min, and the postoperative hospital stay ranged from 3 to 56 days, the average stay being 6.5 days. Eleven patients developed complications intra- or postoperatively: bile duct injury which became manifest after the operation and required laparotomy in three patients; injury to the right hemidiaphragm resulting in a right pneumothorax in one; periumbilical subcutaneous emphysema in one; mild bile leaks which resolved in a few days in two; and a severe bile leak which resolved after 6 days in one. The indications for laparoscopic cholecystectomy have widened with experience and now, CBD stones and a history of previous gastrectomy are no longer contraindications for laparoscopic cholecystectomy. Thus, it seems that laparoscopic cholecystectomy can be performed as safely as a standard cholecystectomy, provided the patients are selected properly and appropriate caution is exercised.

Variations of the hepatobiliary vasculature including coexistence of accessory right hepatic artery with unusually arising double cystic arteries: case report and literature review

“…(1994) described that injury to the bile duct is the most common major complication of laparoscopic cholecystectomy. This usually stems from mistaken identification of the cystic duct or cystic artery.…”

“…They also stated that exposure of the cystic duct and cystic artery in the same field of vision is important for preventing such injury (Kano et al. 1994). …”

Successful laparoscopic cholecystectomy in a child with upper transverse scarring: Report of a case

“…[2][3][4] However, fewer publications are available on children, most of which deal with cases of minor surgery such as gastrostomy or ventriculoperitoneal shunt. 6 In fact, the impact of previous major abdominal surgery on LC has not been reviewed in pediatric patients.…”

“…1 However, according to some recent publications, previous abdominal surgery is no longer considered to be a contraindication of LC in adult patients whose scars are mostly located in upper midline portion. [2][3][4] In this paper we describe our initial experience of successfully performing LC in a 4-year-old boy with a long upper transverse surgical scar following surgery carried out during his neonatal period. The feasibility of LC for pediatric patients with previous major abdominal surgery is also discussed.…”

Techniques for difficult cases of laparoscopic cholecystectomy

“…Laparoscopic cholecystectomy (LC) has become the gold standard for removal of the gallbladder (GB) . Many of the early contraindications for this evolving procedure have now been abandoned.…”