A Clinical Review of Laparoscopic Cholecystectomy

Yang, Woo Suck; Ghu, Hoi Dong; Cho, Cheol Kyoon; Kim, Hyun Jong

Abstract

Laparoscopic cholecystectomy was tried in one hundred fifty three patients from March 1992 to March 1996 at Chonnam University Hospital. These 153 patients were 36.5% of all cholecystectomy cases including the open cholecystectomy and the rate of the laparoscopic cholecystectomy is increasing with time. The most prevalent age group was 4th. decades, male to female ration was 1:1.4, mean age was 47.7 years old. Previous abdominal operations(N=17) were appendectomy(9), T.A.H(4), C-section(3), and herniorraphy(1). The disease distribution of 153 cases were as follows: 148 chronic cholecystitis, 2 cholesterolosis, 2 GB polyp, and 1 GB cancer. There was no death and total postoperative complications were 12 cases(7.8%) including postoperative bleeding, bile duct injury, jaundice, decreased hepatic function, subcutaneous emphysema, and wound infection. Bile duct injury were treated with Roux-en-Y hepaticojejunostomy(N=2) and primary repair of leaked sites(N=3), but other complicated patients were treated with conservative therapy. Total twelve cases were converted to open cholecystectomy because of anatomically structural abnormality(N=3), acute inflammation(N=2), adhesion due to previous operation(N=2), Bile duct injury(N=2), bleeding(N=1), and others(N=2). The mean duration of successful operation was 59.5 minutes and mean duration of postoperative hospital stay was 4.7 days. These data suggested that the laparoscopic cholecystectomy was a useful and safe alternative procedure of open cholecystectomy, however, preoperative bile duct evaluation and the selection of a suitable patient for laparoscopic cholecystectomy are important to avoid of bile duct injuries. And laparoscopic cholecystectomy should be done in no hurry and when the operative maneuver is anticipated difficult on viewing laparoscopic image, prompt conversion to open method is important to avoid of bile injuris.