Laparoscopic Cholecystectomy : Experience with 150 consecutive patients in Kurashiki

One hundred and fifty consecutive patients who underwent laparoscopic cholecystectomy (LC) in Kurashiki between March 1991 and December 1997 were studied in order to examine intraoperative procedures, and complications, especially with regard to bile duct injuries and acute cholecystitis, furthermore postoperative management. Nine out of the 150 cases were converted to open cholecystectomy, so that the overall success rate was 94%. One hundred and forty-six patients (97%) presented on an elective basis, and the remaining four patients were admitted as acute cholecystitis. One hundred and forty-four patients had gallbladder stones. All of seven patients had adenomyomatosis with stones (4 cases) and without stones (3 cases). Nine patients had benign polyps of the gallbladder with stones (6 cases) and without stones (3 cases). Seven patients with choledocholithiasis were treated successfully with endoscopic sphincterotomy preoperatively. In six out of eight patients with acute cholecystitis, among whom 4 were treated preoperatively with percutaneous transhepatic gallbladder aspiration (PTGBA), LC was conducted.　　

Major complications included 3 cases of bile duct injuries (2%). Twenty cases (14) of bleeding encountered during operation were controlled easily under laparoscopy. Postoperative oral feeding was started in nearly all cases on the 1st postoperative day.　　

In conclusion, LC seems to offer significant advantages to patient recovery but attention to bile duct injury and the judgement for the timing of conversion to open cholecystectomy is considered necessary for a successful LC.