Our Experience of 4360 Laparoscopic Cholecystectomy for Cholelithiasis

Abstract

Objective: Analysis of our own experience in performing laparoscopic cholecystectomy (LCE) for cholelithiasis (CHL). Methods: The study is based on the results of 4360 LCE in patients with cholelithiasis. Among the patients, women predominated – 3732 (85.6%), the average age of patients was 52.0±3.5 years. The structure of nosologies: chronic calculous cholecystitis – 3310 (75.9%), acute calculous cholecystitis – 1050 (24.1%). The operations were performed under general endotracheal anaesthesia with carbon dioxide insufflations; the location of the operating team was of the «American» type. Results: LCE was performed in 96.5% of patients, access conversion to open surgery was required in 3.5% of cases. The most common causes of conversion were the presence of a massive adhesive process (59.6%) and destructive changes in the walls of the gallbladder (9.93%). In the ICU, the operated patients were observed on average for 4±2.5 hours, the postoperative stay of patients in the hospital ward was 1.7±1.2 days. Immediate postoperative complications were noted in 1.63% of cases, mortality was 0.13%. Conclusions: Based on their own experience, the authors agree with the postulate that the LCE is the «gold standard» in gallbladder surgery in patients with gallstone disease. At the same time, purposeful preoperative preparation, careful selection of patients, high qualification of the surgeon, as well as adequate postoperative management of patients are the main factors in achieving good outcome. The complexity of surgical techniques can be reduced by collectively addressing complex situations of general somatic status by the active involvement of associated professionals. Keywords: Gallstone disease, laparoscopic cholecystectomy, conversion, early postoperative complications.