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KMID : 0978820080110020125
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Journal of the Korean Society of Endoscopic & Laparoscopic Surgeons
2008 Volume.11 No. 2 p.125 ~ p.129
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Clinical Review of 1,211 Cases of Laparoscopic Cholecystectomy in the Northwestern Province of Gangwon-do
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Chung Min-Sung
Kim Hae-Sung
Ryu Byoung-Yoon
Kim Hong-Ki
Hong Sung-Il
Lee Jeong-Hun
Kim Han-Joon
Jeon Jang-Yeong
Kim Jin-Bong
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Abstract
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Purpose: We have performed 1,211 cases of laparoscopic cholecystectomy in the northwest province of Gangwon-do since 1993. This study aims to analyze our cases of laparoscopic cholecystectomy that were performed over 16 years and to evaluate the proper current treatment for gallbladder disease.
Methods: A retrospective study was conducted on 1,211 patients who underwent laparoscopic cholecystectomy at Chuncheon Sacred Heart Hospital between February 1993 and February 2008. We analyzed the patients’ age, gender and chief complaints, the diagnostic methods, the preoperative diagnosis, the conversion rate, surgical complications, pathology and length of the hospital stay.
Results: The mean age was 51.7±15.8 years. The male-to-female ratio was 1:1.4. The chief complaints were right upper quadrant pain (47.6%), epigastric pain (13.1%) and abdominal pain (11.9%). Abdominal sonography and ERCP were performed in 91.9% and 82.2% of the patients, respectively, during the early ten years, but in the recent six years, MRCP often took place of these procedures (65.7%). Laparoscopic cholecystectomy was performed for gallbladder stone (69.6%), polyp (11.7%), acute cholecystitis and empyema (5.0%). Chronic cholecystitis was the leading pathologic diagnosis (76.9%) followed by acute cholecystitis (11.3%) and polyp (6.6%). The mean operation time was 453.1±24.6 minutes. The conversion rate was 10.9% with inflammatory adhesion being the most common cause of conversion. The postoperative complication rate was 1.8%, and bile leak was the leading cause of this. Overall, the length of the hospital stay was 4.1±2.0 days.
Conclusion: With the broad application of laparoscopic cholecystectomy, the conversion rate might not be reduced even as physicians’ experience with this procedure increases, but the proper selection of patients and the decision making for conversion when facing severe inflammation or adhesion during the laparoscopic approach is critical for safely managing patients and avoiding critical complications.
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KEYWORD
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Laparoscopic cholecystectomy, Gallbladder stone, Acute cholecystitis
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