Surgical therapy for cholecysto-/choledocholithiasis. Results of a Germany-wide questionnaire sent to 859 clinics including 123,090 cholecystectomies

Background: With the advent of laparoscopic cholecystectomy, the choice of procedure (laparoscopic vs open) and surgical management in gallstone disea se are of interest. The purpose of this study was to examine the current ap proach and various strategies for cholecystectomy in Germany. Methods: A re trospective survey at 859 (of 1,200, 67.6%) hospitals in Germany was conduc ted. Data from 123,090 patients that had undergone cholecystectomy were ana lyzed. Results: 71.9% of the procedures were finished laparoscopically (LC: 88.537), whereas 22.5% (27.727) were done in the open technique (KC). Conv ersion to open surgery was required in 7.1% of the laparoscopically started operations, mainly in cases of adhesions and unclear anatomic situations ( 64.3%). When common bile duct (CBD) stones were diagnosed preoperatively, 7 4.4% of the participants favored primary endoscopic extraction (ERC), follo wed by LC. In cases of intraoperative diagnoses, the LC was finished and po stoperative ERC and extraction were carried out in more than half of the ho spitals (58.4%). Sixteen percent were converted to an open operation with s imultaneous exploration of the CBD. Laparoscopic desobstruction of the CBD was extremely rare (4.4%). The intraoperative cholangiography (IOC) was the most strongly recommended approach for intraoperative diagnostics, but was generally routine practice in only 6% of the hospitals conducting LCs. For ty-nine percent of the respondents reported the use of IOC in selected case s and 43% of the hospitals did not perform any intraoperative diagnostics i n LC. Compared with OC, the results show a lower incidence of postoperative reinterventions (0.9 vs 1.8%) and fatal outcomes (0.04 vs 0.53%) for LC. I n contrast, CBD injuries were more frequent in the LC group (0.32 vs 0.12%) . The median duration of hospitalization was 6.1 days (range 2.8-12) in the LC group compared with 10.4 days (range 3-28) in the OC group. Conclusions : LC is the standard procedure for the treatment of uncomplicated gallstone disease. Even after adjustment for differences in patient comorbidities, t here are logical differences between the hospitals as to the type of cholec ystectomy used for acute cholecystitis, the management of CBD stones, and t he intraoperative diagnostics in LC.