EXPERIENCE OF LAPAROSCOPIC CHOLECYSTECTOMY DURING A STEEP LEARNING CURVE AT A UNIVERSITY HOSPITAL
AbstractBackground: 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.
Sanjay KB, Langer JG. Laparoscopic Cholecystectomy: An
experience of 200 cases. JK Science 2004;6(2):73–6.
Shea JA, Berlin JA. Indications and outcome of
cholecystectomy: A comparison of pre and post-laparoscopic era.
Ann Surg 1998;227(3):343–50.
Thomas RG. US experience with laparoscopic cholecystectomy.
Am J Surg 1993;165:450–3.
Goco IR, Luciola G, Chamber RN. Mini-cholecystectomy and
operative cholangiography: A means of cost containment. Am
Andrus JV, Smiley GST, Sumi I. The tail of the learning curve for
Laparoscopic Cholecystectomy. Am J Surg 2001;182(3):250–3.
Mouret P. From the first laparoscopic cholecystectomy to the
frontier of laparoscopic surgery; the future prospective. Dig Surg
Mühe E. Laparoscopic cholecystectomy--late results
[German]. Langenbecks Arch Chir Suppl Kongressbd
Bruce DS, Stephen BE. Laparoscopic cholecystectomy:
Treatment of choice for symptomatic cholelithiasis. Ann Surg
Lim SH, Salleh I, Poh BK, Tay KH. Laparoscopic
Cholecystectomy. An audit of our learning programme. ANZ J
Royston CMS, Lansdown MRJ, Brough WA: Teaching
laparoscopic surgery: The need for guidelines. Br Med J
McDermott EWM, McGregor JR, O'Dwyer PJ, Mur-phy JJ,
O'Higgins NJ. Patient outcome following laparoscopic and
minilaparotomy cholecystectomy. Br J Surg 1991;78:1502.
Barkun JS, Barkun AN. Randomised controlled trial of
laparoscopic versus mini-cholecystectomy. Lancet
Supe AN, Bapat VN. Laparoscopic vs mini-lap cholecystectomy
for gallstone disease. Ind J Gastroenterol 1996;15(3):94–6.
McMahon AJ, Baxter JN, Anderson JR, Ramsay G, O'Dwyer PJ,
Russell IT, et al. Laparoscopic versus mini-cholecystectomy, a
randomized trial. Lancet 1994;343:135–8.
McGinn FP. Randomized trial of laparoscopic cholecystectomy
and mini-cholecystectomy. Br J Surg 1995;82(10):1374–77.
Hawasli A. To drain or not to drain in laparoscopic
cholecystectomy: rational and technique. Surg Lap Endosc
Liu SK, Rassai H. Urinary catheter in laparoscopic
cholecystectomy: Is it necessary? Surg Laparosc Endosc
Percutan Tech 1999;9(3):184–8.
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