D H Wallace1, P J O'Dwyer. 1. University Department of Surgery, Western Infirmary, Glasgow, UK.
Abstract
BACKGROUND: One of the potential drawbacks of laparoscopic cholecystectomy is lack of experience with open cholecystectomy. The aim of this study was to examine the effect of a no-conversion policy on patient outcome following laparoscopic cholecystectomy. METHODS: One hundred and sixty-one patients underwent laparoscopic cholecystectomy in the no-conversion period and were compared with 127 operated on during a period in which there was a low threshold for conversion from laparoscopic to open cholecystectomy. All operations in the no-conversion period were performed by surgeons in training assisted by one consultant. RESULTS: One patient in the no-conversion group had a gallbladder carcinoma and the operation was converted to open surgery. All others underwent total cholecystectomy except for one patient who had part of a severely diseased gallbladder left in situ. Operating time was significantly lower, median 65 versus 50 min (P = 0.004), as was postoperative hospital stay, 3 versus 2 days (P = 0.001), in favour of the no-conversion group. There was no bile duct injury and postoperative complications were similar in both groups (6 versus 8 per cent; P not significant). CONCLUSION: Laparoscopic cholecystectomy can be performed safely without converting to open cholecystectomy. As surgeons become more experienced with laparoscopic cholecystectomy, the need to perform open cholecystectomy in an elective setting may disappear.
BACKGROUND: One of the potential drawbacks of laparoscopic cholecystectomy is lack of experience with open cholecystectomy. The aim of this study was to examine the effect of a no-conversion policy on patient outcome following laparoscopic cholecystectomy. METHODS: One hundred and sixty-one patients underwent laparoscopic cholecystectomy in the no-conversion period and were compared with 127 operated on during a period in which there was a low threshold for conversion from laparoscopic to open cholecystectomy. All operations in the no-conversion period were performed by surgeons in training assisted by one consultant. RESULTS: One patient in the no-conversion group had a gallbladder carcinoma and the operation was converted to open surgery. All others underwent total cholecystectomy except for one patient who had part of a severely diseased gallbladder left in situ. Operating time was significantly lower, median 65 versus 50 min (P = 0.004), as was postoperative hospital stay, 3 versus 2 days (P = 0.001), in favour of the no-conversion group. There was no bile duct injury and postoperative complications were similar in both groups (6 versus 8 per cent; P not significant). CONCLUSION: Laparoscopic cholecystectomy can be performed safely without converting to open cholecystectomy. As surgeons become more experienced with laparoscopic cholecystectomy, the need to perform open cholecystectomy in an elective setting may disappear.
Authors: Juliane Bingener-Casey; Melanie L Richards; William E Strodel; Wayne H Schwesinger; Kenneth R Sirinek Journal: J Gastrointest Surg Date: 2002 Nov-Dec Impact factor: 3.452