STRATIFICATION FOR ELECTIVE LAPAROSCOPIC CHOLECYSTECTOMY

Background: In a former retrospective study in our clinic, an improvem ent in patient care was observed after the introduction of laparoscopi c cholecystectomy. The aim of this study was to verify whether this im provement could be maintained or even be further improved. Methods: Re trospective evaluation of all patients who underwent an elective chole cystectomy due to symptomatic cholelithiasis. We compared the results of 1992 the year of the introduction of laparoscopic cholecystectomy w ith 1993, the year that laparoscopic cholecystectomy became standard p rocedure, Also we compared specialized with general surgeons. Results: In comparison with 1992 more elective cholecystectomies were performe d in 1993 (162 vs 211). In 1993 there were more primary laparoscopic p rocedures (86 vs 93%) but due to an increase in conversion rate in 199 3 (2.5 vs 10%) the overall number of open procedures remained comparab le (17 vs 16%). In 1993 there was an increase in cholecystectomies by general surgeons (56 vs 72%). The general surgeons almost doubled thei r conversion rate in 1993 (6 vs 13%) while that of the specialized sur geons remained comparable (0 vs 2%). Morbidity and mortality remained comparable between 1992 and 1993 and between specialized and general s urgeons. Conclusions: The quality of patient care has not significantl y been altered. An improvement could be made if more laparoscopic oper ations were performed by specialized surgeons, but this would negative ly interfere with the working methods of a general hospital, Therefore we suggest stratification: Certain patients, as high-risk patients, p referably should be operated on by specialized surgeons, while routine operations could be performed by general surgeons.