Endoscopic cholecystectomy. An analysis of complications
B. M. Wolfe, B. N. Gardiner, B. F. Leary and C. F. Frey
Department of Surgery, University of California, Davis, Sacramento 95817.
We analyzed our initial 381 endoscopic cholecystectomies with particular
emphasis on postoperative complications. The rate of conversion to open
cholecystectomy was 3%. A technical complication occurred in 2% and a
non-technical complication in 4%, for a total complication incidence of 6%.
There were three postoperative fatalities (0.9%). Two fatal technical
complications consisted of unrecognized intestinal injuries at the time of
endoscopic cholecystectomy that were obvious when the abdomen was opened.
One patient died of a cerebrovascular accident. Nonfatal technical
complications included five bile leaks that required treatment. There were
no common bile duct injuries, but excessive caution to prevent common bile
duct injury may have contributed to the high incidence of bile leaks.
Examination of the case numbers of the technical complications and
conversion to open cholecystectomy suggests that the learning curve is real
and somewhat prolonged, and that a willingness to convert to open
cholecystectomy is necessary if technical complications are to be avoided.
