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How I do it — Laparoscopic Cholecystectomy
Author(s) -
LEE SungGyu,
KIM MyungHwan,
SUNG GyuBo,
LEE SungKoo,
MIN PyungChul
Publication year - 1994
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/j.1443-1661.1994.tb00676.x
Subject(s) - medicine , surgery , common bile duct , cholecystectomy , complication , bile duct , dissection (medical) , laparoscopic cholecystectomy , general surgery , cholangiography , cystic duct , gallbladder
One thousand consecutive patients underwent a laparoscopic cholecystectomy from September 1990 to January 1993 at our institution. A total of 435 presented with complications acute cholecystitis (83), common bile duct stones (61), or previous abdominal surgery (321). Of the 1,000 patients, 37 (3.7%) were converted to an open cholecystectomy, usually because of marked inflammation and unclear anatomy. There were no deaths and the total postoperative complication rate was 91 of 1,000 (9.1%). Major complications (1.1%) included 3 bile duct injuries, 2 postoperative bleedings, 5 residual common duct stones and 1 case of peritonitis caused by stone spillage. All bile duct injuries were detected and suspected in the operating room and repaired by a Roux‐en‐Y hepaticojejunostomy. Minor complications occurred in the remaining 80 patients(8.0%). The most common complication encountered was urinary retention (6.1%). Intraoperatively, the two‐hand technique, electrosurgical dissection, selective cholangiography and selective use of closed drainage were used. When common bile duct stones were encountered during the performance of laparoscopic cholecystectomy, they were primarily managed by a simultaneous laparoscopic choledochotomy. These experiences suggested that the immediate detection of operative injury was very important to prevent later serious complications, and wider operative indications can be applied safely and carefully by trained general surgeons.