This study analyzes the first 50 cases of laparoscopic cholecystectmies(L.C) performed at Seoul Adventist Hospital during twenty nine months from September 1993 to January 1996.
The patients were mostly female(68%), with an average age of 50.06 years old. There were 48 cases of cholecystitis with stones (acute 3 cases, chronic 45 cases) and 2 cases of polyps.
Preoperative upper abdominal sonogram was done on all patients. Oral cholecystgrams were performed on 19 cases to rule out frozen gall bladder.
The authors preferred to dissect the gall bladder starting from the hilum to the fundus. Electric cautery were effective for the dissections. Routine intraoperative cholangiogram was not performed.
The operation time ranged from 43~260 minutes with an average of 82.4 minutes. But it was been reduced to 73.3 minutes in the last 10 cases. Only 37 patients(74%) required analgesics after L.C (27 cases for 1 day, 9 cases for 2 days, 1 case for 3
days).
In 4 cases, L.C had to be converted to open cholecystectomy because of extremely packed cholelithiasis in 1 case and the necessity to change the operative approach in 3 cases. Operative complications developed in 10 cases(20%), include a CBD
perforation
in 1 case, jejunal perforation in 1 case, duodenal perforation in 1 case, subcutaneous emphysema. in 2 cases, prolonged ileus in 4 cases and bleeding of liver bed in case.
Almost all patients were able to take fluid diet on the first postoperative day and were to be discharged from hospital by the 4th postoperative day. And mortality rate of L.C was none(0%).
These results suggested that laparoscopic cholecytectomy is an effective alternative method for the removal of gall bladder, but operative skills have to be improved to reduce complications.
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