Laparoscopic cholecystectomy: a multicenter study of 17 hospitals.

A study of 1,254 laparoscopic cholecystectomies performed at 17 hospitals affiliated with the Liver, Gallbladder, and Pancreas Research Group of the First Department of Surgery at Okayama University was undertaken to assess the current status and safety of this procedure. The data for 336 patients, comprising the initial 20 laparoscopic cholecystectomies performed at each institution, were compared with the data from the remaining 918 patients. Comparison of the two groups revealed the following: 1. the rates of intraoperative conversion to open cholecystectomy were 11.3% and 5.1% (P < 0.05), 2. the complication rates were 5.7% and 3.4%, and 3. the rates of bile duct injury were 2.4% and 1.1%, respectively. Compared with the first group, the bile duct injuries resulting from a lack of experience decreased in the second group, however, the incidence of these injuries occurring during avulsion of the gallbladder in difficult cases increased. These results suggest that the experience acquired during the initial 20 laparoscopic cholecystectomies led to a reduction in the rate of intraoperative conversion to open cholecystectomy, but it did not reduce the rate of complications, and that the risk of bile duct injury was always present.