LAPAROSCOPIC CHOLECYSTECTOMY - A REPORT ON THE COMMUNITY-HOSPITAL EXPERIENCE IN HOKKAIDO

We analyzed the outcome of 1408 patients who underwent laparoscopic ch olecystectomy (LC) between February 1991 and October 1993 in affiliate d community hospitals around Hokkaido, Japan. LC was performed for sym ptomatic gallstones (68%) and asymptomatic gallstones (29%) using the pneumoperitoneum (96%) or abdominal wall lift (4%) techniques, Intraop erative and postoperative complications occurred in 105 patients (10%) , including bile duct injuries in 9 patients (0.9%). Conversion to ope n surgery or reoperation was required in 89 patients (8%) mainly becau se of unclear anatomy difficulties with hemostasis, or bile duct injur y. One patient died of congestive heart failure, resulting in a mortal ity rate of 0.07%, The patients were discharged after an average of 8 days, and returned to work after an average of 14 days. The complicati on and conversion rates were high; however, the incidences of reoperat ion, bile duct injuries, postoperative bile leaks, and deaths were low . In conclusion, LC was performed with acceptable safety in our commun ity hospitals, The reason for this is most likely that conventional ch olecystectomy was preferred to LC in difficult cases during this early period.