Indication and Contraindication of Laparoscopic Cholecystectomy

Shigeru Sakai, Tatsuo Yamakawa, Yasuro Ishikawa

Department of Surgery, Teikyo University Hospital at Mizonokuchi

During the 10 months from May 29, 1990 to the end of February 1991, 91 patients in the Department of Surgery, Teikyo University Hospital at Mizonokuchi required cholecystectomy, and 56 patients (61.5%) were considered to be candidates for laparoscopic cholecystectomy. In 52 of these 56 patients (92.9%) laparoscopic cholecystectomy was successfully completed. In the remaining 4 cases (7.1%) the operation was converted to open cholecystectomy. These 4 failures were attributed to acute cholecystitis in 1 case, inability of exposure of the cystic duct and the cystic artery at the Calot triangle in 1, and extensive omental adhesion around the gallbladder in 2. In the patients with acute cholecystitis whose treatments were converted to surgery, the cystic duct was easily desected with the clip applier unloaded. On the other hand, patients in whom laparoscopic cholecystectomy was not indicated included those with choledocholithiasis, acute cholecystitis, a previous history of upper abdominal surgery, cystic duct occlusion, Mirrizi syndrome, biliary tract anomalies, and bilio-enteric fistula. It is strongly advocated that surgeons who attempt to perform laparoscopic cholecystectomy should have a low threshold of conversion to open surgery whenever any difficult problems in management occur during laparoscopic surgery to prevent major complications.

Key words
laparoscopic cholecystectomy, indication, contraindication

Reprint requests
Shigeru Sakai Department of Surgery, Teikyo University Hospital at Mizonokuchi
74 Mizonokuchi, Takatsu-ku, Kawasaki, 213 JAPAN

Accepted
July 3, 1991

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