COMPLICATIONS DURING THE INTRODUCTION OF LAPAROSCOPIC CHOLECYSTECTOMY IN NORWAY - A PROSPECTIVE MULTICENTER STUDY IN 7 HOSPITALS

Objective: To assess the morbidity of laparoscopic cholecystectomy since its introduction in Norway in the Autumn of 1990. Design: Postal collection of prospectively collected data. Setting: Practices of 26 surgeons in 7 district and university hospitals. Subjects: 527 patients who underwent laparoscopic cholecystectomy. Interventions: 133 patients (25.5%) had endoscopic retrograde cholangiopancreatography before operation, and two had cholangiograms during operation; dissection was by electrocautery in 490 patients and by laser in 37. Main outcome measures: Morbidity, number converted to open operation, and number who required reoperation. Results: There were no deaths and a total of 70 complications (13.3%), 8 of which were after laser dissection. There were 59 local complications (11.2%) and 11 general (2.1%); 12 patients (2.3%) required reoperation for bleeding (n = 5), biliary leak (n = 4), and incisional hernia (n = 3). One had a retained stone in the common duct. 42 were converted to open operation (8.0%), 11 because of complications (bleeding, n = 6; damage to the bile duct, n = 3; and bowel perforation, n = 2). Of the 28 patients with acute cholecystitis 5 (17.9%) had to be converted to open operations and 7 (25.0%) developed complications. 2 of these patients had bile duct injury. Conclusion: The morbidity during the introductory period of laparoscopic cholecystectomy in Norway is higher than that reported elsewhere, indicating that the risk of complications is increased during the learning period.