Original article
State of gallstone videosurgery in Świętokrzyskie Voivodeship

Introduction: For over a dozen years laparoscopic cholecystectomy (LC) has gained recognition as a treatment method distinguished by many advantages. However, due to the specific surgical technique, it also carries the risk of complications.
Aim: The current state and assessment of laparoscopic surgery, including complications, in the Świętokrzyskie Voivodeship (SV).
Materials and methods: Intraoperative complications and difficulties in patients subjected to LC in SV surgical wards in the years 1993-2005 have been described based on a questionnaire survey.
Results: In the years 1993-2005, 9358 patients with symptomatic cholecystolithiasis were operated on in 15 SV wards of general surgery, of whom 7955 came from planned indications (73.5%) whereas 1403 underwent immediate surgery (26.5%). In 2504 (26.7%) patients there occurred intraoperative difficulties caused most frequently by adhesions preventing easy access to the surgical field – 1472 (15.7%). Gallbladder injury and concretion spill-out during surgery occurred in 722 (7.7%) patients. In 137 (1.4%) cases there occurred intrasurgical bleeding which was laparoscopically controlled. Other intraoperative difficulties such as inflammatory infiltration and postsurgical adhesions after previous operations were observed in 173 patients. Conversions were performed in 570 patients, of whom 471 (5.03%) were planned and 99 (1.05%) forced. The planned conversions were introduced due to identification difficulties and pericholecystic infiltration making it impossible to be dissected. Forced conversion was performed mainly due to bleeding from injured vessels of the cystic arteria in most cases [55 (0.58%) patients], lesion of the bile duct in 15 (0.16%) patients, and visceral injuries in 9 (0.09%) patients. In 20 (0.21%) cases it was caused by either difficulties in inducing a pneumoperitoneum or laparoscopic equipment failure. Trocar insertion complications occurred in 22 (0.23%) patients. The complications observed during primary surgery were laparoscopically fixed in 90 (0.9%) patients. Separate classic surgery was required in 57 (0.6%) patients, of whom 21 (0.22%) were operated on due to lesions of bile ducts (6 cases were diagnosed as having lesions based on postoperative endoscopic examination), 12 due to vascular injuries, 8 due to visceral injuries and 16 due to other causes (bile leak, haematoma, closure of Luschka’s duct). The number of LC performed in individual wards ranges from 46 to 1761.
Conclusions: Based on the analysis of 9358 LC performed in the SV surgical wards representing various levels of videosurgery experience, laparoscopic treatment of cholecystolithiasis is a safe method with a low risk of complications. An LC-related injury of the bile duct is a rare complication and can be avoided when special care is given. Complications concomitant with trocar placement are also avoidable by means of the microlaparotomic method when inserting the first trocar. Analysis of SV technical development and surgical complications is similar to that of the all-Polish data in this respect. The number of serious complications, e.g. injury of the bile duct, is equal to or even lower than that given in the Polish literature. No injury of large blood vessels was recorded either.