title: Experience of laparoscopic cholecystectomy during a steep learning curve at a university hospital.
abstract: BACKGROUND
  Cholelithiasis is the most common disease of alimentary tract affecting the adult population globally and our country in particular is no exception to it as a cause of hospitalization. Surgical removal of gall bladder is the main stay of symptomatic cholelithiasis ensuring a permanent cure. The minimally invasive technique of laparoscopic cholecystectomy has gained wide acceptance as a Gold Standard treatment ever since its introduction. The purpose of this prospective observational study was to document our experience of laparoscopic Cholecystectomy during a learning curve in a single unit of a university hospital and compare it with other available data in the literature.
  
  
  METHODS
  Total 94 patients underwent laparoscopic cholecystectomy during the learning curve from Jan 2009 to Dec 2010 in the Department of Surgery Liaquat University Hospital Jamshoro.
  
  
  RESULTS
  Mean age was 42 years with females (88.29%) preponderance. Majority of the cases were operated by consultants (85.10%) within 25-60 minutes. Postoperative hospital stay was 3 days with return to work in 7 days. Only 6 (6.38%) cases were converted to open technique. Intra-peritoneal drains and Foley's catheter were kept in selected cases only. Eleven patients (11.70%) had intra-operative complications including complete transaction of CBD in only one (1.06%) male patient. Five patients (5.31%) had postoperative complications with two patients having iatrogenic duodenal injury which was not identified during surgery and pseudo cyst pancreas. Four patients (4.25%) died due to multiple organ failure.
  
  
  CONCLUSIONS
  We conclude that Laparoscopic Cholecystectomy is a gold standard procedure and should be learned on virtual simulated models before starting this procedure on human patients.
authors.affiliation: Department of Surgery, Liaquat University of Medical and Health Sciences, Jamshoro Sindh, Pakistan. sasadalishah@gmail.com
authors.forename: Syed Asad
authors.initials: SA
authors.lastname: Ali
authors.forename: Abdul Ghani
authors.initials: AG
authors.lastname: Soomro
authors.forename: Agha Taj
authors.initials: AT
authors.lastname: Mohammad
authors.forename: Mohammad
authors.initials: M
authors.lastname: Jarwar
authors.forename: Akmal Jamal
authors.initials: AJ
authors.lastname: Siddique
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017081:Cholecystectomy, Laparoscopic / Q000193:education*; D002769:Cholelithiasis / Q000601:surgery; D002983:Clinical Competence; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010154:Pakistan; D011446:Prospective Studies; D055815:Young Adult