title: Laparoscopic cholecystectomy for acute cholecystitis should be performed by a laparoscopic surgeon.
abstract: BACKGROUND
  The aim of this study was to evaluate the impact of surgical subspecialization on the outcome of laparoscopic cholecystectomy.
  
  
  METHODS
  The retrospective cohort study included all consecutive patients who underwent laparoscopic cholecystectomy between June 2002 and June 2009 in a major teaching hospital. Patients were divided into two groups: those operated on by laparoscopy-oriented surgeons (more than 50 laparoscopic procedures annually) and those operated on by nonlaparoscopy surgeons. Surgeries were divided into two groups as well: elective surgery for cholelithiasis and emergency surgery for acute cholecystitis. Conversion rate, operating time, complications, and length of hospital stay were analyzed and compared between both groups.
  
  
  RESULTS
  During the study period 1509 patients underwent laparoscopic cholecystectomy for symptomatic gallstone disease. A laparoscopic surgeon performed the procedure on 893 patients, and 616 patients were operated on by nonlaparoscopy surgeons. For elective surgeries the laparoscopic interest of the surgeon had no influence on the outcome of the procedure. In patients with acute cholecystitis, a significant difference in conversion rate (3.6 vs. 15.6%, p = 0.003) and operating time (68 vs. 76 min, p = 0.02) favored the laparoscopic surgeons.
  
  
  CONCLUSIONS
  Patients who present with acute cholecystitis have a greater chance of a laparoscopically completed cholecystectomy if operated on by a laparoscopy-oriented surgeon.
authors.affiliation: Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Kortram
authors.forename: Jan Siert Kayitsinga
authors.initials: JS
authors.lastname: Reinders
authors.forename: Bert
authors.initials: B
authors.lastname: van Ramshorst
authors.forename: Marinus J
authors.initials: MJ
authors.lastname: Wiezer
authors.forename: Peter M N Y H
authors.initials: PM
authors.lastname: Go
authors.forename: Djamila
authors.initials: D
authors.lastname: Boerma
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D017081:Cholecystectomy, Laparoscopic / Q000592:standards*; D041881:Cholecystitis, Acute / Q000601:surgery*; D002983:Clinical Competence; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D016896:Treatment Outcome