COMPLICATIONS OF LAPAROSCOPIC CHOLECYSTECTOMY IN SWITZERLAND - A PROSPECTIVE 3-YEAR STUDY OF 10,174 PATIENTS

Background: We set out to analyze the technical aspects, intraoperativ e complications, morbidity, and mortality of laparoscopic cholecystect omy in a multi-institutional study representative of Switzerland. Meth ods: Data were collected from 10,174 patients from 82 surgical service s. A total of 353 different parameters per patient were included. Resu lts: We found intraoperative complications in 34.4% of patients and ha d a conversion rate of 8.2%. This rate was significantly increased in patients with complicated cholelithiasis and in those with previous up per-but not lower-abdominal surgery. In most cases, conversions to ope n procedures were required because of technical difficulties due to in flammatory changes and/or unclear anatomical findings at the time of o peration. Bleeding was a common intraoperative complication, that sign ificantly increased the risk of conversion. Patients with loss of gall stones in the peritoneal cavity had increased rates of abscesses. The rate of common bile duct injuries was 0.31%, but it decreased signific antly as the laparoscopic experience of the surgeon increased. The rat e of common bile duct injuries was not increased in patients with acut e cholecystitis or in the 1.32% of patients undergoing laparoscopic co mmon bile duct exploration. Intraoperative cholangiography did not red uce the risk of common bile duct injuries, but it allowed them to be d iagnosed intraoperatively in 75% of patients. Local complications were recorded in 4.79% of patients, and systemic complications were seen i n 5.59%. The mortality rate was 0.2%. Conclusions: Although laparoscop ic cholecystectomy is a safe procedure, the rate of conversion to open cholecystectomy is still substantial. The conversion rate depends bot h on the indication and intraoperative complications. There is still a 10.38% morbidity associated with the procedure; however, the incidenc e of common bile duct injuries, which decreases with growing laparosco pic experience, was relatively low.