Evolution of laparoscopic cholecystectomy in the regional hospitals of Catalonia

OBJECTIVE: to assess the safety and effectiveness of laparoscopic cholecyst ectomy in the hands of surgeons with different amounts of experience in lap aroscopic surgery at 15 regional hospitals, and to analyze the evolution of the current performance in comparison with results published in 1993. METHODS: prospective study of 1168 laparoscopic cholecystectomies done in 1 996 in 15 regional hospitals in Catalonia. RESULTS: in 887 cases (76%) the indication was uncomplicated cholelithiasis , Preoperative cholangiography was done selectively in 12 of the 15 hospita ls. Preoperative endoscopic retrograde cholangiopancreatography was positiv e in only 50 cases (57.4%), with 9 complications (10.3%). In 87 patients (7 .4%) conversions to open surgery occurred. Postoperative complications (6.3 %), bile duct injury (0.4%), reintervention (0.4%) and postoperative stay ( 2.8 days) decreased in comparison with the year 1993. CONCLUSIONS: the current results suggest an overall improvement in comparis on with the 1993 findings, since the rate of complications and length of st ay decreased. However, the increasing number of conversions was notable; th is may be due to the increasing complexity of the indications and the rise in the number of surgeons dill on the learning curve, Laparoscopic cholecys tectomy is, in our setting and for many surgeons, a safe and effective proc edure that yields results similar to those in other multicenter studies.