Laparoscopic cholecystectomy.

Abstract

Forty-one patients with uncomplicated gall stone disease were laparoscopied with the object of cholecystectomy. The procedure was accomplished in 36 patients, but the operation had to be transformed to a conventional open operation in five: Fibrosis made dissection of the gall bladder hazardous in four and bleeding during the procedure made immediate laparotomy necessary in one patient, whose postoperative course was uneventful. The median operating time was 100 minutes, range was 60-250 minutes. The only operative complication was bleeding from a trocar puncture hole on the first postoperative day which stopped spontaneously in one patient. Eighteen were sent home on the first postoperative day and 12 patients on the second day. Peroperative cholangiography was performed employing the Olsen-Reddick cholangiography forceps. We have designed a special catheter, which greatly facilitates the procedure. The procedure was accomplished in 27 of 32 planned cases. Two patients had common bile duct or common hepatic duct stones. A trans-sphincteric endoprosthesis was applied through the cholangiography forceps in both patients, to prevent postoperative bile duct outlet obstruction. The endoprosthesis made the following endoscopic sphincterotomy, which was performed at a convenient time rapid and safe. The stones were extracted and the prosthesis removed on the same occasion. A reliable flushing system was developed on the basis of the "Kidde" automatic tourniquet frequently used in orthopaedic surgery. All patients were seen in the outpatient clinic 1 month after the operation. Superficial infection in the trocar holes in ten patients were the only problem the patients had encountered and all had returned to their normal work.(ABSTRACT TRUNCATED AT 250 WORDS)