Treatment of biliary lithiasis; laparoscopic approach

This paper reports the experience of 1,000 laparoscopic cholecystectomies in our hospital between January 1991 and June 1996. Thirty- five patients (3.5%) required conversion to the open cholecystectomy. Twenty- six patients had technical difficulties (e.g. dense adhesion) and 8 patients were converted because of intraoperative complications. Seventy-one patients were diagnosed acute cholecystitis preoperatively and 14 patients (19.7%) were converted to the open surgery. However, after percutaneous transhepatic gallbladder drainage (PTGBD) was performed routinely in the case of acute cholecystitis, the rate of conversion was reduced to 5.9%. There were 44 patients of cholecysto-choledocholithiasis. Endoscopic sphincterotomy was performed in 37 patients before laparoscopic cholecystectomy and laparoscopic choledocholithotomy was performed in 7 patients.