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Laparoscopic cholecystectomy has become the treatment of
choice for gallbladder stones. As a matter of fact, the advantages
related to the significant reduction of postoperative
pain and the early mobilization of the patient, with a
decrease of general surgical risk, have been well demonstrated.
Also the complications of the surgical wound have
been drastically reduced. On the contrary, iatrogenic trocarrelated
injuries represent specific complications of laparoscopic
technique. However, the incidence of these complications,
mostly the more severe ones, may be significantly reduced
with routine use of the “open” technique. The increased
incidence of common bile duct (CBD) injuries in laparoscopic
cholecystectomy compared with the conventional
technique may be partly explained with the learning curve
related to the rapid diffusion of this new approach. An
appropriate training, a meticulous operative technique and
an early conversion to open procedure in case of intraoperative
difficulties may reduce the risk of a CBD injury.
In this work the authors’ experience of 400 laparoscopic
cholecystectomies without CBD injury and major complications
is presented. Conversion rate was 5.2% in patients
with simple symptomatic cholelithiasis and 37.5% in
patients with acute or subacute cholecystitis.