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Results of the Prospective Swiss Association of Laparoscopic and Thoracoscopic Surgery Study

Kaspar Z'graggen, MD; Dominik Aronsky, MD; Christoph A. Maurer, MD; Christian Klaiber, MD; Hans U. Baer, MD

Arch Surg. 1997;132(9):1026-1030.

Abstract
Background
The introduction of laparoscopic cholecystectomy (LC) changed the treatment strategies for patients undergoing biliary surgery. There is a lack of data about acute postoperative pancreatitis (APP) as a complication of LC.

Objectives
To determine the incidence, morbidity, and mortality of APP after LC and to analyze the possible intraoperative and pathogenic factors associated with APP.

Design
A prospective cohort study of 10 174 patients who underwent LC. The data for 32 patients with APP after the completion of LC and 8 patients with APP after an attempted LC that was converted to an open cholecystectomy were analyzed.

Setting
A multi-institutional study of the Swiss Association of Laparoscopic and Thoracoscopic Surgery. Eighty-one surgical services or surgeons in private practice participated.

Results
The incidence of APP after a completed LC was 0.34%. In comparison, the incidence of APP after conversion to an open procedure (0.96%) was significantly (P=.02) increased. A biliary origin of APP could be established in 4 (12.5%) of the 32 patients. No evidence for a causative role of intraoperative cholangiography or trauma to the pancreas was found. Factors shown to be associated with APP were the surgeon's experience level and a high morbidity of 31.3%. The mortality was 3%.

Conclusions
The incidence of APP after LC is low; the risk increases after conversion to an open procedure. In the rare event of an APP after LC, a biliary cause should be suspected. The mortality of patients with APP did decrease substantially compared with those undergoing open biliary surgery.

Arch Surg. 1997;132:1026-1030

Author Affiliations
From the Swiss Association of Laparoscopic and Thoracoscopic Surgery and the Department of Visceral and Transplantation Surgery, Inselspital, University of Bern, Bern (Drs Z'graggen, Maurer, and Baer); and the Department of Surgery, Spital Aarberg, Aarberg (Drs Aronsky and Klaiber), Switzerland. A complete listing of all participating institutions and surgeons in private practice appears in the box on page 1029.

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