LAPAROSCOPIC CHOLECYSTECTOMY - A CONTINUING PLEA FOR ROUTINE CHOLANGIOGRAPHY

The purpose of this clinical study was to demonstrate the usefulness o f routine intraoperative cholangiography (IOC) and the safety of lapar oscopic cholecystectomies (LC) in a community hospital. There were no ductal injuries and perioperative complications were extremely low. Pa tients (n = 236) with symptomatic gallstone disease, acalculus cholecy stitis, or gallbladder polyps underwent LC from March 1991 to June 199 3. During this period two patients were not considered appropriate can didates for this procedure. There were 172 women and 64 men ranging in age from 15 to 84 years. Four had preoperative endoscopic retrograde cholangiopancreatographies (ERCPs) for suspected choledocholithiasis. Elective LC was performed on 194 patients and emergency LC on 42 patie nts. The average operating time for elective LCs was 89 min and 97 min for emergency LCs. Thirty-six percent of patients had previous abdomi nal or pelvic surgery. IOC was attempted in 99% of patients and succes sful in 89%. Five percent had choledocholithiasis. Laparoscopic duct e xploration was performed on four patients. Six patients had postoperat ive ERCP with stone extraction. Three percent of elective patients had additional surgery. One patient had LC during pregnancy (17 weeks), w ith a normal recovery and successful outcome of the pregnancy. Six ele ctive and four emergency patients were converted to open cholecystecto my, a conversion rate of 4%. There were no ductal or vascular injuries , intraoperative haemorrhages or deaths. There was one small bowel lac eration (0.4%). Postoperative complications included seven wound infec tions (3%), four bile leaks (2%), three trocar site haemorrhages (1%), one intraabdominal haemorrhage (0.4%), one suspected halothane hepati tis (0.4%), one drug-induced cholestatic jaundice (0.4%), and one subc utaneous emphysema (0.4%). Seventy-five percent of elective patients w ere discharged on the first or second postoperative day. Fifty-six per cent of emergency patients were discharged by the second postoperative day and 83% by the fourth day. This study demonstrates the importance of routine IOC in preventing ductal injuries and diagnosing choledoch olithiasis. The low complication rates demonstrate the safe applicatio n of this procedure in a community hospital.