LAPAROSCOPIC CHOLECYSTECTOMY IN THE NETHERLANDS

Laparoscopic cholecystectomy was introduced into the Netherlands in th e Spring of 1990. The aim of this study was to evaluate the results of the procedure in Dutch hospitals over the first 2 years to obtain som e insight into its safety and efficacy in general surgical practice. A written questionnaire was sent to all 138 Dutch surgical institutions enquiring about conversion rate, complications (with emphasis on mort ality rate and common bile duct injuries), operating time and hospital stay. The surgeons' opinions were also sought on possible contraindic ations such as previous operation, bile duct stones and cholecystitis, as were their estimations of the percentage of patients in their prac tice eligible for laparoscopic cholecystectomy. Data were obtained for 6076 laparoscopic cholecystectomies; the response rate was 100 per ce nt. Conversion to open cholecystectomy was necessary in 413 patients ( 6.8 per cent), mostly because of adhesions, cholecystitis, haemorrhage and unclear anatomy. Postoperative complications were reported in 260 patients (4.3 per cent). There were seven deaths (0.12 per cent) and 52 (0.86 per cent) bile duct injuries, of which 20 were recognized dur ing laparoscopy. The mean operating time for the ten most recent patie nts in each institute was 70 (range 30-180) min and the mean hospital stay 4.5 (range 2-8) days. Previous lower abdominal operations were no t considered to be a contraindication by 96 per cent of surgeons, wher eas previous upper abdominal procedures were regarded as a contraindic ation by 66 per cent. After successful clearance of the bile duct at e ndoscopic retrograde cholangiopancreatography, only 12 per cent would perform an open procedure. Moderate cholecystitis was not considered a contraindication to laparoscopic cholecystectomy by 71 per cent of su rgeons, but severe cholecystitis was a reason for open cholecystectomy for 83 per cent. In most surgical practices 70-80 per cent of patient s were considered to be eligible for the laparoscopic procedure. In co nclusion, laparoscopic cholecystectomy has gained rapid acceptance in the Netherlands. Although the number of bile duct injuries is high, th e findings of this general survey are similar to those from highly spe cialized centres and match the overall results of conventional cholecy stectomy.