Laparoscopically guided cholecystectomy: a detailed report of the first 453 cases performed by one surgical team.

This study reports outcome data from a diverse population undergoing laparoscopic cholecystectomy. Our technique differs from other laparoscopic methods in its use of electrocautery, blunt hilar dissection, and routine intraoperative cholangiography. This study includes 453 consecutive surgeries performed between August 1989 and March 1991. Only the first 20 patients were screened to exclude those with common bile duct stones, prior upper abdominal surgery, pregnancy, or acute cholecystitis. Patients had the following conditions: current acute cholecystitis (9%), a history of acute cholecystitis (16%), jaundice (5%), pancreatitis (4%), and prior abdominal surgery (38%). Nine per cent had common bile duct stones which were treated with either laparoscopic transcystic common bile duct exploration (69%), laparoscopic choledochotomy (5%), open choledochotomy (10%), endoscopic retrograde cholangiopancreatography (10%), or observation (7%). Operative time averaged 78 minutes. One patient died, and 6% developed complications. Seventy-one per cent were discharged on the first postoperative day. Our experience demonstrates that LC can be performed safely, even in difficult cases, although considerable endoscopic experience and skill are required.