LAPAROSCOPIC CHOLECYSTECTOMY: DIFFICULTIES & COMPLICATIONS IN 300 CASES
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Laparoscopic cholecystectomy (LC) was attempted in 300 consecutive patients. 292 patients (97.3%) presented on an elective basis for symptomatic chronic calcular cholecystitis, and the remaining 8 patients (2.7%) were admitted for acute cholecystitis. 26 (8.6%) were obese and 6 patients had upper or right paramedian scars after previous abdominal operations. These difficulties required some precautions during insertion of trocars and a meticulous technique for acute cases. Careful identification of cystic artery anomalies and the combination of sharp and blunt dissection reduced the frequency of bile duct injuries which were recorded in two patients (0.7%). These two patients were among the the 19 patients (6.3%) that required conversion to open cholecystectomy. No mortality was reported, while the morbidity rate reached to 5.7% (17patients). It is concluded that LC can be performed safely even in some difficult cases, and its complications can be avoided by proper patient selection, increasing surgeon's experience and by the election to convert to open cholecystectomy than to be forced to do so.