LAPAROSCOPIC CHOLECYSTECTOMY - A STATEWIDE EXPERIENCE

The explosion in laparoscopic cholecystectomy has posed many questions about its safety compared with the ''gold standard'' of open cholecys tectomy. A statewide database was established in Connecticut to study these issues. Thirty-three (97%) of 34 hospitals in Connecticut partic ipated in the study, which began at the inception of the laparoscopic procedure. Four thousand six hundred forty laparoscopic cholecystectom ies were performed between May 1, 1990, and September 30, 1991. The ov erall conversion rate to open cholecystectomy was 6.9%. Conversions we re more frequent with acute cholecystitis, in the elderly, and early i n a surgeon's experience. The overall technical complication rate was 4.7%; common bile duct injuries occurred in 15 patients (0.3%). Compli cations decreased with increasing experience, to 0.98% after a surgeon 's 75th procedure. Six patients (0.13%) died following laparoscopic ch olecystectomy. The overall mortality rate associated with cholecystect omy fell during the study period. The frequency of cholecystectomy in Connecticut increased 29% with the advent of the laparoscopic procedur e. The introduction of laparoscopic cholecystectomy has resulted in an increased frequency of surgery without an increase in surgical mortal ity. The incidence of common bile duct injuries was low. The decreasin g incidence of technical complications demonstrates the learning curve for the procedure.