MONITORING THE INTRODUCTION OF LAPAROSCOPIC CHOLECYSTECTOMY IN A DISTRICT GENERAL-HOSPITAL

There has been recent concern regarding the widespread introduction of laparoscopic procedures without adequate training. We report a 2 year prospective series of 229 consecutive open and laparoscopic cholecyst ectomies, following the introduction of laparoscopic surgery at a dist rict general. hospital. All laparoscopic cholecystectomies were perfor med by surgeons without formal training in this procedure. The proport ion of laparoscopic cholecystectomies rose from 27% in 1992 to 62% in 1993, with a conversion rate of 14%. An overall complication rate of 2 3% was recorded, 29% for open cholecystectomy and 16% for laparoscopic cholecystectomy. Procedure specific complication rates were 6% and 3% respectively. No major bile duct injuries occurred and the 30-day mor tality was 0.9%. We conclude that laparoscopic cholecystectomy has bee n introduced as a safe procedure in this hospital, as compared to open cholecystectomy. It is recommended that new techniques should be intr oduced carefully and monitored by means of prospective audit.