[Surgical therapy in cholecysto-/choledocholithiasis. Results of a Germany-wide questionnaire sent to 859 clinics with 123,090 cases of cholecystectomy].
BACKGROUND
With the advent of laparoscopic cholecystectomy, the choice of procedure (laparoscopic vs open) and surgical management in gallstone disease are of interest. The purpose of this study was to examine the current approach and various strategies for cholecystectomy in Germany.


METHODS
A retrospective survey at 859 (of 1,200, 67.6%) hospitals in Germany was conducted. Data from 123,090 patients that had undergone cholecystectomy were analyzed.


RESULTS
71.9% of the procedures were finished laparoscopically (LC: 88.537), whereas 22.5% (27.727) were done in the open technique (KC). Conversion to open surgery was required in 7.1% of the laparoscopically started operations, mainly in cases of adhesions and unclear anatomic situations (64.3%). When common bile duct (CBD) stones were diagnosed preoperatively, 74.4% of the participants favored primary endoscopic extraction (ERC), followed by LC. In cases of intraoperative diagnoses, the LC was finished and postoperative ERC and extraction were carried out in more than half of the hospitals (58.4%). Sixteen percent were converted to an open operation with simultaneous exploration of the CBD. Laparoscopic desobstruction of the CBD was extremely rare (4.4%). The intraoperative cholangiography (IOC) was the most strongly recommended approach for intraoperative diagnostics, but was generally routine practice in only 6% of the hospitals conducting LCs. Forty-nine percent of the respondents reported the use of IOC in selected cases and 43% of the hospitals did not perform any intraoperative diagnostics in LC. Compared with OC, the results show a lower incidence of postoperative reinterventions (0.9 vs 1.8%) and fatal outcomes (0.04 vs 0.53%) for LC. In contrast, CBD injuries were more frequent in the LC group (0.32 vs 0.12%). The median duration of hospitalization was 6.1 days (range 2.8-12) in the LC group compared with 10.4 days (range 3-28) in the OC group.


CONCLUSIONS
LC is the standard procedure for the treatment of uncomplicated gallstone disease. Even after adjustment for differences in patient comorbidities, there are logical differences between the hospitals as to the type of cholecystectomy used for acute cholecystitis, the management of CBD stones, and the intraoperative diagnostics in LC.
Ludwig
K
K
Abteilung Allgemein- und Visceralchirurgie Chirurgische Klinik Klinikum Südstadt Rostock, Südring 81 18059 Rostock.
Köckerling
F
F
Hohenberger
W
W
Lorenz
D
D
D002758:Cholangiography; D002763:Cholecystectomy; D017081:Cholecystectomy, Laparoscopic; D002769:Cholelithiasis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D003627:Data Interpretation, Statistical; D004724:Endoscopy; D042882:Gallstones / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D005858:Germany; D006801:Humans; D007813:Laparotomy; D007902:Length of Stay; D012086:Reoperation; D012189:Retrospective Studies; D011795:Surveys and Questionnaires