This study analyzes the first 100 cases of laparoscopic cholecystecomies (L. C) performed at Yeungnam university hospital during seven months from May 1991 to January 1992.
Patients were mostly female (63%), with average age of 46.9 years old. There were 68 cases of cholecystitis with stones (acute 13, chronic 55), 5 case of gall stones associated with common bile duct stones, 6 cases of acalculous cholecystitis,
and
1
case of polyp.
Preoperative upper abdominal sonogram was done in all patients. Oral cholecystograms were performed in 19 cases who demonstrated no evidence of stone on sonogram. ERCP evalutions were done for 20 patients who showed either a dilated common blie
duct
(CBD) or presence of stone in CBD on songram, or elevated serum bilirubin. CBD stones proven by ERCP in 5 patietns were removed by papillotomies before L. C.
Authors preferred to dissect the gall bladder starting from the fundus toward hilum instead of beginning from hilum. both a contact Laser and an electric cautery were equally effective for the dissections. Routine operative cholangiogram was not
performed.
The operation time ranged between 18-200 minutes. with average 70.4 minutes. But it had been reduced to 53 minutes for the last 10 cases. Only 59 patients required analgesics after L. C (31 for day, 10 for 2 day, 18 for 3 day).
In 5 cases L. C had to be converted to O. C because of extremely hard contracted gall bladder in 2 cases and mistakes from poor operation skills in 3 cases. Operative complications developed in 13 cases (12.3%) and which included a mesenteric
teat
by a
trocar trauma in one case. Richter's hernia though infraumbilical puncture site in one, CBD injuries in two, misinsertion of laparoscope into falciform ligament in one, bleeding in two, bile leaks in two, prologed ileus in two and wound seroma in
two.
Almost all patients were able to take fluid diets on the first postoperative day and were to be discharged from hospital by the 4 th postoperative day.
These results suggeted that laparoscopic cholecytostomy 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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