Tomoyuki Nagaoka, MD, Katuhiro Tomofuji, MD, Yusuke Nakagawa, MD, Tomoaki Okada, Tatsuo Yamauchi, Naoki Ishida, Yoshinori Imai, Taro Nakamura, Hidenori Kiyochi, Kenzo Okada, Shinsuke Kajiwara. Uwajima city hospital
Laparoscopic cholecystectomy (LC) has become a standard surgical technique for cholecystectomy owing to its relatively noninvasive nature. We aimed to examine the LC cases performed during the study period at our institute, which has a community emergency care department, and evaluate the historical changes.
This study included 3000 cases of LC performed from July 1991 through June 2014. The cases were divided into 3 groups based on the time of operation: oldest 1000 cases, the middle 1000 cases, and the most recent 1000 cases. The age, sex, operating time, hospitalization days after operation, original diseases, complications, and conversion rates were examined and compared among the 3 groups.
The mean age of all patients was 62.1 ± 14.8 years, ranging from 12 to 104 years. The overall sex ratio was 1616 females to 1384 males. The average operation time was 84.9 ± 41.6 min, ranging from 25 to 335 min. The mean duration of hospitalization after the operation was 9.0 ± 7.4 days. The frequencies of original disease among all patients were 60% for cholelithiasis, 29% for cholecystitis, 4% for gall bladder polyp, and 7% for others. The overall conversion rate of all patients was 8.0%. Major intraoperative complications included uncontrollable bleeding (1.3%), bile duct injury (0.5%), and intestine injury (0.3%). Major postoperative complications included surgical site infection (0.7%), bile leakage (0.6%), and bile duct stenosis (0.1%). The mean operating time was longest in the most recent 1000 cases among the 3 groups (81.4 vs. 76.0 vs. 96.4 min, respectively ). The main reasons for this recent increase in operating time are a gradual increase in the rate of cholecystitis (16.8 % vs. 28.7% vs. 41.1%, respectively) and introduction of reduced port surgery (3 ports or 1 port) for cholelithiasis in 2009. However, duration of hospitalization after operation, conversion rates, and postoperative complications decreased or remained nearly the same over time.
Indications for LC range from simple cholelithiasis to complicated acute cholecystitis, and advanced techniques have been required along with this change. However, improved outcomes have been achieved. LC has become an essential operative procedure for emergency care at our institute.