LAPAROSCOPIC CHOLECYSTECTOMY IN ENGLAND AND WALES - RESULTS OF AN AUDIT BY THE ROYAL-COLLEGE-OF-SURGEONS-OF-ENGLAND

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.