ORIGINAL ARTICLES   

Minerva Chirurgica 2000 October;55(10):673-80

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: Italian

Evolution of indications and techniques of minimally invasive surgery in gallstones management

Di Stefano A., Fisichella P., Randazzo V., La Greca G., Di Carlo I., Russello D.

Background. A review of the experience with laparoscopic cholecystectomy to evaulate the impact of the efficacy, safety, and complications on the learning curve. Study design: Retrospective study.
Methods. Between 1993 and 1998, 415 patients, 123 males and 292 females, median age 52.1 years (range 23-96 years), with symptomatic cholelithiasis, underwent laparoscopic cholecystectomy. On the basis of different selection criteria and surgical techniques adopted, our experience was divided into two periods (93-95 and 96-98).
Results. The success rate was 89.4% (371 patients) with a conversion rate of 10.6% (44 patients). Overall complications rate was 2.9% (12 patients): 7 major complications (2 biliary tract injuries, 2 hemorrhages, 1 subphrenic abscess, 1 gastric perforation and 1 choleperitoneum) and 3 minor complications (1 biliary leakage and 2 wound infections) with 2 long-term sequela (umbelical site eventration). Median hospital stay was 3.3 days, 2.2 days for uncomplicated cases and 5.6 in those converted or complicated. Comparison between the two groups showed a conversion rate of 10.6 vs 10.4% (23 vs 21 patients), with a complication rate of 4.2% vs 2.2%.
Conclusions. Laparoscopic cholecystectomy can be considered a safe and effective procedure for the treatement of simple or complicated cholelithiasis. French surgical technique seems to be easier in the management of acute cholecistitis or lithiasis occurring after acute pancreatitis. Specific training in laparoscopy surgery is mandatory to avoid major complications.