D Collet1. 1. Service de Chirurgie Générale et Digestive, Maison du Haut-Levêque, Pessac, France.
Abstract
BACKGROUND: In 1996, laparoscopic cholecystectomy is the gold standard for symptomatic cholelithiasis. The results of this operation as published so far include data on the learning curve of the method. The aim of this study is to evaluate the results of laparoscopic cholecystectomy when performed by a large number of surgeons during the year 1994, not taking into account the beginning years in which the technique was being used. METHODS: This study has been carried out prospectively and anonymously among members of SFCERO. All the patients who underwent a cholecystectomy started laparoscopically during 1994 have been included. RESULTS: Some 4,624 cholecystectomies were performed by 150 surgeons. There were 3,310 females (42.5 +/- 19.8 years old) and 1,314 males (56.3 +/- 1.61 years old). The conversion rate was 6.9%: 320 operations had to be converted into laparotomy (group II) while 4,261 were performed entirely by laparoscopy (group I). Morbidity was 5% (N = 230)-4.7% in group I (N = 203) and 8.4% in group II (N = 27). Mortality was 0.2% (N = 9)--namely four intraabdominal complications (three cases of peritonitis and one biliary re-operation), two cardiac failures, and one brain infarction. The causes of death were not specified in two patients. CONCLUSIONS: These results show that morbidity and mortality have not changed dramatically since the beginnings of this technique, whereas the frequency of common bile duct (CBD) injuries has decreased. However, the conversion rate has increased slightly. These results make it possible to calculate the risk of conversion and postoperative complication according to the age of the patient and the biliary symptoms.
BACKGROUND: In 1996, laparoscopic cholecystectomy is the gold standard for symptomatic cholelithiasis. The results of this operation as published so far include data on the learning curve of the method. The aim of this study is to evaluate the results of laparoscopic cholecystectomy when performed by a large number of surgeons during the year 1994, not taking into account the beginning years in which the technique was being used. METHODS: This study has been carried out prospectively and anonymously among members of SFCERO. All the patients who underwent a cholecystectomy started laparoscopically during 1994 have been included. RESULTS: Some 4,624 cholecystectomies were performed by 150 surgeons. There were 3,310 females (42.5 +/- 19.8 years old) and 1,314 males (56.3 +/- 1.61 years old). The conversion rate was 6.9%: 320 operations had to be converted into laparotomy (group II) while 4,261 were performed entirely by laparoscopy (group I). Morbidity was 5% (N = 230)-4.7% in group I (N = 203) and 8.4% in group II (N = 27). Mortality was 0.2% (N = 9)--namely four intraabdominal complications (three cases of peritonitis and one biliary re-operation), two cardiac failures, and one brain infarction. The causes of death were not specified in two patients. CONCLUSIONS: These results show that morbidity and mortality have not changed dramatically since the beginnings of this technique, whereas the frequency of common bile duct (CBD) injuries has decreased. However, the conversion rate has increased slightly. These results make it possible to calculate the risk of conversion and postoperative complication according to the age of the patient and the biliary symptoms.