Coelioscopic cholecystectomy: experience with 201 initial patients.

Over a 20-month period, 201 patients underwent laparoscopic cholecystectomy, including 159 women and 42 men (mean age, 44.2 years). Indications included symptomatic cholelithiasis (181 cases), acute cholecystitis (15 cases), gallstone pancreatitis (two cases), and cholangitis (three cases). Mean operating time was 78 min. Overall conversion rate was 5.4% (11 cases). Conversion to open procedure was elective in nine patients and enforced in two because of uncontrollable bleeding from the cystic artery. Three of the former nine patients who were converted subsequently had acute cholecystitis. One case of cellulitis at the umbilical stab wound and one case of bile leak, which drained spontaneously, occurred in patients operated on for acute cholecystitis. Laparotomy was performed on the 7th postoperative day for a liver bed hemorrhage in a patient presenting with cholecystitis. One common bile duct injury occurred in a patient with cholecystitis necessitating a biliary reconstruction. No perioperative deaths occurred. Mean hospital stay was 3.4 days. Despite several advantages, laparoscopic cholecystectomy must be performed by surgeons experienced in biliary tract surgery.