Laparoscopic Cholecystectomy - Two-Decade Experience of over 3000 Cases from a Tertiary Care Center

Abstract

Introduction: Laparoscopic Cholecystectomy (LC) remains the gold standard for benign gall bladder diseases. It is associated with higher risk of biliary injury (0.1%-1.5%) resulting in prolonged morbidity, decreased overall survival. This complication counterpoises the benefit of minimal invasive surgery. If we adopt the principle of safe cholecystectomy under supervision, laparoscopic cholecystectomy can be done safely even in difficult situations. Methods: Retrospective review of the data of patients who underwent LC in a single surgical unit from January 2003 - December 2018 at a tertiary care center was done. 5 consultants and 12 residents (operating ratio of 70:30) conducted the surgeries. Demographic variables, intra operative findings, conversion rate, morbidity and mortality were evaluated. Results: A total of 3095 patients underwent LC in the mentioned period, 75.05% females and 24.95% males. Difficult calot's triangle anatomy was identified in - 66 (2.132%) patients. 30 (0.969%) were converted to open procedure with one major bile duct injury (CBD transection), one accessory duct injury and one lateral CBD injury. 31 (1.01%) patients developed post operative bile leak. 15 (48.3%) patients were managed by ERCP and 10 (32.2%) underwent re-laparoscopy. 6 (19.35%) patients required pig tail drainage. None of the patients developed bile duct stricture in long term follow up. Conclusion: LC offers shorter hospital stay and low morbidity. Procedure is safe and effective both for uncomplicated and complicated cholelithiasis. The incidence of major Bile Duct Injury can be kept to minimum with proper training and supervision in a tertiary care centre.