Alternative(nonresective) therapies of symptomatic cholelithiasis have been followed by frequent recurrence of gallstones. Great interest has been generated by the recent development of laparoscopic cholecystectomy, which in addition to
preventing
recurrence, may be associated with less discomfort to sorter hospital stays and more rapid return to work than standard cholecystectomy. We retrospecively reviewed our experience with 135 consecutive laparoscopic cholecystectomies performed at
Soonchunhyang University Hospital from January 1992 to February 1994. Most patients had a preoperative history consistent with symptomatic biliarytract disease, and most had proved gallstones by sonography. One hundred three patients underwent
preoperative ERCP. Eleven patients(11%) were found to have choledocholithiasis, and clearance of common bile duct with preoperative endoscopic sphincterotomy was achieved in 10 patients (91%). Of the 135 attempted laparoscopic procedure, 118
(87%)
were
completed successfully. The procedures to an open cholecystectomy for a variety of reasons, the most common being inflammation and adhesions in the triangle of Calot. Postoperative complications occurred in 7 patients(5.8%), including common bile
duct
injury in one, subphrenic abscess in one, bile leakage in one, pneumothorax in one and some other minor complications. Postoperative complications leading to immediate or delayed laparotomy include common bile duct injury and subphrenic abscess.
The
mean operative time for al 120 patients undergoing laparoscopic cholecystectomy was 85 minutes(range, 40 to 245 minutes). But it had been reduced to 65 minutes for the last 20 cases. Almost all patients were able to take liquid diets on the first
postoperative day and were to be discharged from hospital by the 4th postoperative day. Laparoscopic cholecystectomy should be performed by surgeons who are trained in biliary surgery and knowledgeable in biliary anatomy, and as with all
operations, it
should be performed with meticulous attention to technique. The results of our experience confirm the safety and efficacy of laparoscopic cholecystectomy for the treatment of symptomatic gallstones. (Korean J Gastroenterol 1994 ; 26 : 971-980)
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