Laparoscopic cholecystectomy: experience in 500 consecutive cases.

Between April 1989 and November 1991, 500 consecutive patients (393 women and 107 men, aged 17 to 87 years) underwent laparoscopic cholecystectomy at our institution. The most common indication for surgery was chronic calculous cholecystitis. Twelve (2.4%) patients underwent emergency surgery, and the rest had elective operations. The average operative time was 36 minutes. In all but 72 cases, dissection was performed with a laser. In 4 instances (0.08%), the laparoscopic procedure was converted to an open cholecystectomy because acute cholecystitis made the gallbladder hard to grasp (2 cases) or faulty insufflation equipment afforded poor visualization of the operative field (2 cases). Three patients (0.06%) underwent reoperation for posterior cystic artery bleeding, cystic duct leakage, and common-bile-duct injury (1 case each). Minor complaints during the immediate postoperative period included nausea and shoulder pain. Patients were discharged from the hospital an average of 20 hours after surgery and resumed full activity within 3 to 8 days.