[Laparoscopic cholecystectomy--a meta-analysis of 23,700 cases and status of a personal patient sample]

Abstract

Meta-analysis of 23,700 laparoscopic cholecystectomies of 27 authors shows an intraoperative complication rate of 1.35% and a postoperative complication rate of 3%, including injuries of the bile duct in 0.48% and of the intestine in 0.19%. A second operation was necessary in 1.26%. In 0.43% retained common bile duct stones were observed. The conversion rate was 4.1% and the mortality rate was 0.08%. Our own experience in laparoscopic cholecystectomy as a standard procedure on 455 out of 574 unselected patients (50 acute, 405 elective) resulted in 9 (2.2%) intraoperative and 5 (1.2%) postoperative complications. In 4 cases (0.9%) the complications necessitated a second operation. The conversion rate was 11.6% and the mortality rate was zero. It is concluded that the results of laparoscopic cholecystectomy appear equivalent the "gold standard" of open cholecystectomy up to certain pathomorphological limits. Using an exact preoperative diagnostic regimen (sonography, cholangiography, ERCP if indicated) the place of routine intraoperative cholaniography is discussed critically.