EXPERIENCE OF LAPAROSCOPIC CHOLECYSTECTOMY DURING A STEEP LEARNING CURVE AT A UNIVERSITY HOSPITAL

Abstract

Background: Cholelithiasis is the most common disease of alimentary tract affecting the adultpopulation globally and our country in particular is no exception to it as a cause of hospitalization.Surgical removal of gall bladder is the main stay of symptomatic cholelithiasis ensuring a permanentcure. The minimally invasive technique of laparoscopic cholecystectomy has gained wide acceptanceas a Gold Standard treatment ever since its introduction. The purpose of this prospective observationalstudy was to document our experience of laparoscopic Cholecystectomy during a learning curve in asingle unit of a university hospital and compare it with other available data in the literature. Methods:Total 94 patients underwent laparoscopic cholecystectomy during the learning curve from Jan 2009 toDec 2010 in the Department of Surgery Liaquat University Hospital Jamshoro. Results: Mean age was42 years with females (88.29%) preponderance. Majority of the cases were operated by consultants(85.10%) within 25–60 minutes. Postoperative hospital stay was 3 days with return to work in 7 days.Only 6 (6.38%) cases were converted to open technique. Intra-peritoneal drains and Foley’s catheterwere kept in selected cases only. Eleven patients (11.70%) had intra-operative complications includingcomplete transaction of CBD in only one (1.06%) male patient. Five patients (5.31%) had postoperativecomplications with two patients having iatrogenic duodenal injury which was not identified duringsurgery and pseudo cyst pancreas. Four patients (4.25%) died due to multiple organ failure.Conclusion: We conclude that Laparoscopic Cholecystectomy is a gold standard procedure and shouldbe learned on virtual simulated models before starting this procedure on human patients.Keywords: Laparoscopic Cholecystectomy, Learning curve, experience.