LONGITUDINAL CHOLECYSTECTOMY STUDY - PATTERNS OF CARE IN A TOTAL COMMUNITY EXPERIENCE

The purpose of this study was to determine outcomes and safety of lapa roscopic cholecystectomy (LC) versus open cholecystectomy (OC) in a co mmunity setting at multiple open staff hospitals with multiple surgeon s. This second-year study retrospectively examined all cholecystectomy records in one city at each of five hospitals over a 1-year period be ginning in April 1991 through March 1992. All charts were examined for type of surgery, rate of conversion to open procedure, sex, weight, p revious abdominal surgery, surgeon, hospital, preoperative workup, ope rative time, antibiotic prophylaxis, cholangiograms, concurrent proced ures, drains, hospital stay, common duct stones and their follow-up, p athology, reoperations, complications, and mortality. One thousand eig ht hundred one gallbladders were removed. One thousand three hundred f our (72.4%) were successfully removed at LC. One hundred eighty-three (10.2%) others were attempted laparoscopically and converted to open c holecystectomy (CC), which represented 12.3% of the attempted LCs. Thr ee hundred fourteen (17.4%) were removed via a standard OC. The mean o perative times were 72.3 minutes for LC, 100.1 minutes for CC, and 86. 2 minutes for OC. Cholangiography was attempted in 916 (70.3%) LCs, 14 4 (78.7%) CCs, and 250 (79.6%) OCs, with similar operative times, exce pt in LC, when done via the GB, operative time was 65.2 versus 73.4 mi nutes when done via the cystic duct. Diagnosis of acute cholecystitis occurred in 306 (23.5%) LCs, 119 (65.0%) CCs, and 145 (46.2%) OCs. Com plications requiring reoperation occurred in 30 (2.3%) LCs, 5 (2.7%) C Cs, and 5 (1.6%) OCs. Common bile duct (CBD) injuries occurred in 5 (3 4%) LCs, with 4 converted to CC and 1 repaired 5 days later. Trocar si te hernias occurred in 11 (0.8%) LCs. Thirty-nine surgeons participate d in the study with mean numbers of 33.4 LC cases, 5.5 CC cases, and 7 .2 OC cases, with ranges of 1 to 165 LC cases, 1 to 17 CC cases, and 1 to 24 OC cases. Death occurred in 12 (0.9%) LC cases, 4 (2.2%) CC cas es, and 25 (8.0%) OC cases. The mean hospital stay was 39.6 hours for LC, 156.5 hours for CC, and 198.3 hours for OC.