How I do it: Laparoscopic cholecystectomy

Laparoscopic cholecystectomy, although new, has enjoyed a rapid acceptance around the world. This article describes our initial experience with this procedure. Training and credentialing, including attending of courses, are important to ensure competency in this technique prior to independent performance of this operation; our guidelines are outlined. Our indications for laparoscopic chlecystectomy are no different from those for open surgery and some previously considered contraindications to laparoscopic cholecystectomy have now been dropped. Our preoperative work up and operative technique are discussed. From June 1991 to December 1992, we performed and analyzed 304 laparoscopic cholecystectomies, including 66 cases of inflamed gallbladders in our department. Preoperative endoscopic retrograde cholangiopancreatography (ERCP) was done only in patients suspected of having bile duct stones. This resulted in 0.9% needing postoperative ERCP stone extraction. The procedure was completed in 91.4% of patients, with a conversion rate of 3% for elective and 28% for emergency patients. Bile duct injury occurred in 1.4% of patients and minor complications in 4%. The use of laparoscopic cholecystectomy is growing in our region. As experience increases and more emergency cholecystectomies are done, the proportion of all cholecystectomies done laparoscopically will increase rapidly. Offprint requests to: P. Goh