Videolaparoscopic cholecystectomy: Personal experience

Abstract

AIM: Laparoscopic cholecystecomy (LC) is now the gold standard for the treatment of gallstones. In this report were analyzed 153 LC performed by a single surgical team and, according to results, elaborated any technical recommendation.

MATERIALS AND METHODS: 153 LC has been performed in Section of General and Thoracic Surgery of University of Palermo, Sicily, by a single surgical team, since 2000. Indications for LC were all forms of calculous cholecystitis (biliary colic in 73.2%, acute cholecystitis in 4.5%, gallbladder polyps in 5.8%) or colecystocoledochal lithiasis (9.8%). The mean age of patients was 49.46 years (range 18-78) and 62.7% were female. The patients were studied in our Section with hematochemical routine, plane chest roentgram, ECG, abdominal ultrasound (the day before the operation) and ASA classification (ASA I: 9.8%, ASA II: 67.3%, ASA III: 22.9%).

RESULTS: All cases (153) were uneventful in terms of either serious intraoperative complications or necessity in relaparoscopy. In operatory room we adopted the French position, with mean operatory time of 65.03 minutes (range 30180 minutes) and we also used the French technique of exposure of the cystic pedicle. The grade of difficulty of LC was analysed according 4 variables (approach to peritoneum, approach to gallbladder, pedicle dissection, cholecystectomy).

There were 10 cases (6.5%) of convertions in total. Subhepatic space drainage was performed in 60.1% of cases. No postoperative biloma or subhepatic infiltration were observed. No port site infections were diagnosed, no port site hernias observed and no mortality observed. The mean postoperative bedstay was 2.21 days.

CONCLUSIONS: LC is the treatment of choice for symptomatic gallstone disease. When performed by experienced surgeons, it is safe and effective.