Complications during the introduction of laparoscopic cholecystectomy in Norway. A prospective multicentre study in seven hospitals.

OBJECTIVE

To assess the morbidity of laparoscopic cholecystectomy since its introduction in Norway in the Autumn of 1990.

DESIGN

Postal collection of prospectively collected data.

SETTING

Practices of 26 surgeons in 7 district and university hospitals.

SUBJECTS

527 patients who underwent laparoscopic cholecystectomy.

INTERVENTIONS

133 patients (25.5%) had endoscopic retrograde cholangiopancreatography before operation, and two had cholangiograms during operation; dissection was by electrocautery in 490 patients and by laser in 37.

MAIN OUTCOME MEASURES

Morbidity, number converted to open operation, and number who required reoperation.

RESULTS

There were no deaths and a total of 70 complications (13.3%), 8 of which were after laser dissection. There were 59 local complications (11.2%) and 11 general (2.1%); 12 patients (2.3%) required reoperation for bleeding (n = 5), biliary leak (n = 4), and incisional hernia (n = 3). One had a retained stone in the common duct. 42 were converted to open operation (8.0%), 11 because of complications (bleeding, n = 6; damage to the bile duct, n = 3; and bowel perforation, n = 2). Of the 28 patients with acute cholecystitis 5 (17.9%) had to be converted to open operations and 7 (25.0%) developed complications. 2 of these patients had bile duct injury.

CONCLUSION

The morbidity during the introductory period of laparoscopic cholecystectomy in Norway is higher than that reported elsewhere, indicating that the risk of complications is increased during the learning period.