D. Dunn et al., LAPAROSCOPIC CHOLECYSTECTOMY IN ENGLAND AND WALES - RESULTS OF AN AUDIT BY THE ROYAL-COLLEGE-OF-SURGEONS-OF-ENGLAND, Annals of the Royal College of Surgeons of England, 76(4), 1994, pp. 269-275
The results of an audit of open and laparoscopic cholecystectomy condu
cted by the Comparative Audit Service of The Royal College of Surgeons
of England are presented. Data were submitted by 124 consultant surge
ons on 3319 attempted laparoscopic and by 227 consultant surgeons on 8
035 open cholecystectomies performed in England and Wales during the 2
years 1990 and 1991. These were contrasted with 9322 attempted laparo
scopic cholecystectomies reported in 21 series reported in the world l
iterature between 1991 and 1992, and with five other nations' audit st
udies. Among attempted laparoscopic cases, conversion to an open proce
dure was necessary in 175/ 3319 (5.2%) of cases and overall mortality
was 0.15% (5/3319). Major complications were reported in 2.1% and mino
r complications in 5.9% of cases. Bile duct injury was reported to be
significantly more common after attempted laparoscopic cholecystectomy
(11/3319, 0.33%) than after open cholecystectomy (4/8035, 0.06%) (95%
confidence intervals -0.48 to 0.08), but it was not significantly dif
ferent from that reported for laparoscopic cholecystectomy in the comb
ined world literature (28/9322, 0.3%) (95% confidence intervals -0.19
to 0.25). Most systemic complications were significantly more common a
fter open cholecystectomy. For open cholecystectomy, the mortality was
55/8035 (0.76%), with major complications reported in 3.2% and minor
complications in 9.8% of patients. Adoption of the laparoscopic approa
ch was associated with a four-fifths reduction in the mortality of cho
lecystectomy, and a 40% reduction in the overall complication rate whe
n compared with the open operation. While laparoscopic cholecystectomy
has an impressively low mortality and morbidity profile during the fi
rst 2 years of its introduction into the UK, prevention of bile duct i
njury is the most important issue to be addressed in all laparoscopic
cholecystectomy training programmes.