Complications after laparoscopic cholecystectomy. An appraisal's attempt.

Laparoscopic cholecystectomy has been considered as a safe and effective procedure without randomised prospective triaL Two physician insurers assocations (in France and in USA) have shown an important increase of the lawsuits after laparoscopic cholecystectomy, especially concerning common bile duct injuries. An exhaustive study of the litterature demonstrates that in the rare prospective studies collecting all of the laparoscopic cholecystectomies realised in one country or one state, the percentage of biliary tract injuries is from twice to five times as big as with open surgery, and bigger in case of acute cholecystitis. It seems that diffusion of the monopolar current can explain a good number of them. These injuries are difficult for repairing because of their high localisation and the associated tissular burn. Their long term morbidity is important and their cost is huge. Three recent prospective studies comparing laparoscopic versus minilaparotomy approach demonstrate that the advantages of laparoscopic approach according to the cost and the recovery's speed are, except for the obese patients, less evident than one could believe.