The advent of laparoscopic cholecystectomy has been a significant milestone not only in the treatment of gallstone disease, but in the evolution of surgical treatment toward the minimal access approach, the aim of which is intended to minimize
the
trauma of access without compromising the exposure of the surgical field. The aim of this study was to retrospectively assess the factors affecting the outcomes of the laparoscopic cholecysbecome the standard treatment for symptomatic gallbladder
diseases. But precise multivariate analysis on the factors that affect the course and result of this procedure has berely done, although a number of recent reports suggest that there should be few complications to a conventional procedure. All
patients
suggest that there should be few complications to a conventional procedure. All patients presenting with symptomatic or silent cholelithiasis from October 1991 until May 1993 were evaluated with intention of proceeding to a laparoscopic
cholecystectomy
and of helping practitioners to understand more on the various potential factors that may involve laparoscopic cholecystectomy. We evaluated five factors-intraoperative minor complications, postooperative complications, operation time,
postoperative
hospital stay, days for return to normal activity after operation-with sixteen variables. duration of symptoms, comorbid disease, grade of visualization of gallbladder on oral cholecystogram, degree of the contraction of the gallbladder on oral
cholecystogram, numbers of trocar, the location of incision for previous abdominal operation, degree of adhesion of those who had a history of previous abdominal operation, degree of adhesion around the gallbladder or on the inferior surface of
the
liver, color of the gallbladder on laparoscopy, gross morpohology of the liver, number of stones, size of stones, thickness of the wall of the gallbladder, with or without trial of intraoperative cholangiogram, pathologic findings and the
learning
curve, those may interact with former five factors. Two most common intraoperative complications are perforation of gallbladder and minor bleeding during dissection (30% and 15.3%, respectively). Occasionally grave complications lead to
conversion
to
the conventional cholecystectomy, but we have only 3 cases of conversion (2.0%) The most common postoperative complication is wound infection (8%), and overall morbidity is 15.3%. Mean operating time improved significantly from the thirtyfirst
patient
(average: 116.7 minutes, ranges from 30 minutes to 305 minutes), indicating a rapid learning curve. Mean postoperative hospital stay is 4.4 days (range: 1 to 13 days). The mean time for return to full physical activity after surgery is 8.2 days
(range :
0 to 20 days). According our investigation ; Comorbid diseases affect adversely on the postoperative hospital stay as we thought, well visualized gall bladder is feasible for dissection and brings less intraoperative minor complications, thus
requires
less operating time, shortens postoperative hospital stay and affects positively on the return to full activity after surgery. We think preoperative cholecystogram may be one of the good index to the feasibility of laparoscopic cholecystectomy.
Although
four-puncture technique has been widely used, we tried a number of cases by thrce-puncture technique and we got the excellent results and it may be worthy of consideration for further progress in the laparoscopic cholecystectomy. A number of
surgeons
recommend routine intraoperative cholangiography for further information in detail on the billary tree, but we have used various preoperative ealuations including intravenous cholangiography (IVC) and ERCP, and we didn't have trouble due to not
doing
intraoperative cholangiography. Instead, we have had better positive experiences by using IVC and ERCP, if needed, including suspected CBC stone or subtle visualization of CBD in IVC. Laparoscopic cholecystectomy for the various benign diseases
of
the
gallbladder is safe and associated with a significantly shorter postoeprative hospital stay compared to open surgery.
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