Original article
Laparoscopic cholecystectomy – is it a safe operation method? Our experiences

Laparoscopic cholecystectomy has been recognized as the gold standard in treating cholelithiasis, although not free from some intraoperative difficulties and complications typical of this method. Therefore it is still important to collect experience within laparoscopic cholecystectomy as this method has been present in Poland for as long as 15 years.
Aim of work: Evaluation of intraoperative complications and difficulties related to the laparoscopic method.
Materials and methods: Intraoperative difficulties and complications recorded in 1411 laparoscopic cholecystectomies (LCH) were analyzed. Symptomatic cholelithiasis indicated LCH in 1251 cases, acute cholecystitis in 160. Results: In 1411 LCH performed, intraoperative difficulties and complications occurred in 230 cases. In the whole group with intraoperative difficulties and complications were 177 female patients with the average age of 51.3 (18-78) and 53 male patients with the average age of 54.1 (22-79). Complications subjected to reoperation occurred in 10 cases as follows: haemorrhage from the gallbladder chamber – 3, punctual perforation of the common bile duct (CBD) – 1, punctual perforation of the duodenum – 1, perforation of the small bowel – 2, slipping of the clip from the cystic duct in a female patient with choledocholitiasis – 1, leakage of bile from the cystic duct below the clip – 1, subcapsular haematoma of the liver – 1. Intraoperative difficulties were recorded during 220 LCH; 160 of them were solved during the laparoscopic cholecystectomy: intraoperative haemorrhage (18), perforation of the gallbladder and subsequent spillage of concretions (117), liberation of the adhesions blocking access to the operating area (14), haemorrhage of the location of trocar (3), necessity to strike off additional trocar (2), single cases e.g. downfall of the gallbladder, slipping of the clip from the gallbladder, necessity to clip additional bile duct etc. (6); 60 cases required conversion of two types: *forced – due to haemorrhage from the stump of the vesicular artery and from the gallbladder-vacated chamber (10), spillage of numerous concretions into the peritoneal cavity (1), sudden increase of carbon dioxide concentration in blood (1); *programmed – due to unclear anatomic conditions (48). In 94 cases microlaparotomy was necessary for pneumoperitoneum.
Conclusions: The foregoing material showed that the number of complications that required a classic operation to be performed some other time and relevant treatment provided was low – 1.56 % (22/1411). No injuries to bile ducts and large blood vessels occurred during the operation. No deaths were recorded within the postoperative period.