Laparoscopic cholecystectomy in The Netherlands: early national results]

The results of laparoscopic cholecystectomy in 58 of the 66 hospitals in which surgeons introduced this method after attending a practical course are evaluated. Data of 546 patients were collected. The indication for laparoscopic surgery was symptomatic gallstone disease without evidence of common bile duct stones, cholecystitis or previous upper abdominal surgery. In 70% of the 58 hospitals fewer than 10 laparoscopic cholecystectomies were performed nine months after the first practical course because of shortage of equipment. The mean age was 50 years (range 20-80) with a male:female ratio of 1:4. The average operation time was 95 minutes. In 8.2% of the patients the laparoscopic procedure was converted to laparotomy. Adhesions, cholecystitis or difficulty in recognition of the anatomy was responsible for the conversion in 31 of the 45 patients. In the remaining 14 patients bleeding or bile leakage during the procedure compelled the surgeon to perform a laparotomy. One patient died because of bleeding from the cystic artery. Eleven patients underwent laparotomy postoperatively because of bleeding (3), bile leakage (6) and lesion of the ductus choledochus (2). Minor complications occurred in 30 patients. Laparoscopic cholecystectomy is expanding rapidly in the Netherlands. The early results are encouraging, although the experience is limited. Further registration is necessary to be able to compare the results of laparoscopic cholecystectomy more critically with those of conventional cholecystectomy.