Gallstone surgery in German university hospitals. Development, complications and changing strategies.
A representative anonymous questionnaire was sent to all German university hospitals ( n=45) to address the development and outcome of laparoscopic gallstone surgery between 1991 and 1998. The response rate was 64%, and 28,753 operations for gallstone disease were analysed. Two-thirds of the procedures (67%) were performed laparoscopically. While a significant decrease of surgical complications (1991 vs 1998: 5.4% vs 3.4%; P<0.001) and re-laparotomy rate (1.0% vs 0.5%, P<0.05) was observed, no significant changes were detected with regard to the mortality rate. A learning curve regarding common bile duct (CBD) injuries was detected, showing a significant increase between 1991 and 1994 (0.3% and 0.7%, respectively, P<0.05) and a decrease to 0.2% in 1995 and 1996 ( P<0.05). The use of intraoperative cholangiography is compulsory in 10%, selective in 52%, while 38% of the university hospitals never use it. Most institutions use the Veress needle for pneumoperitoneum installation, and 93% use hook cautery for dissection. Since 1998, 45% of all institutions have also used the harmonic scalpel. The spectrum of indications for laparoscopic procedures has increased with time since acute cholecystitis, CBD stones and adhesions are not considered a general reason for a primary open approach. Our findings confirm a learning curve with regard to postoperative morbidity after laparoscopic cholecystectomy. This observation may be due to better training as well as surgical experience.
Hüttl
T P
TP
Department of Surgery, Klinikum Grosshadern, University of Munich, Marchioninistrasse 15, 81366 Munich, Germany. thomas.huettl@gch.med.uni-muenchen.de
Hrdina
C
C
Krämling
H J
HJ
Schildberg
F W
FW
Meyer
G
G
D017081:Cholecystectomy, Laparoscopic / Q000706:statistics & numerical data*; D002769:Cholelithiasis / Q000601:surgery*; D042882:Gallstones / Q000601:surgery; D005858:Germany; D006785:Hospitals, University / Q000706:statistics & numerical data*; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology; D011300:Preoperative Care; D011795:Surveys and Questionnaires