Laparoscopic cholecystectomy. The new 'gold standard'?
N. J. Soper, P. T. Stockmann, D. L. Dunnegan and S. W. Ashley
Department of Surgery, Washington University School of Medicine, St Louis, MO 63110.
Laparoscopic cholecystectomy has rapidly been adopted by surgeons, but
concerns remain about its safety, the management of common bile duct
stones, and the means of appropriate training. Of 647 patients referred for
cholecystectomy, preoperative endoscopic retrograde cholangiography was
performed in 49 (7.6%), with 27 patients (4%) undergoing sphincterotomy and
stone extraction. Traditional cholecystectomy was performed in 29 patients
(4.5%). Laparoscopic cholecystectomy was attempted in 618 patients and
completed successfully in 600 (97.1%). Surgical trainees functioned as the
primary surgeon in 70% of cases. Technical complications occurred in three
patients (0.5%), including one patient with a common bile duct laceration
(0.2%). Major complications occurred in 10 patients (1.6%), with no
perioperative mortality. Mean postoperative hospital stay was 1 day, with
return to work or full activity a mean of 8 days after surgery. Two cases
of retained common bile duct stones (0.3%) were identified. We now regard
laparoscopic cholecystectomy as the "gold standard" therapy for management
of symptomatic cholelithiasis.
