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.
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Similar content being viewed by others Explore related subjectsDiscover the latest articles and news from researchers in related subjects, suggested using machine learning. Author information Authors and AffiliationsDepartment of Surgery, Klinikum Grosshadern, University of Munich, Marchioninistrasse 15, 81366 Munich, Germany
Thomas P. Hüttl, Christian Hrdina, Hans-Jörg Krämling, Friedrich Wilhelm Schildberg & Günther Meyer
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About this article Cite this articleHüttl, T.P., Hrdina, C., Krämling, HJ. et al. Gallstone surgery in German university hospitals. Langenbeck's Arch Surg 386, 410–417 (2001). https://doi.org/10.1007/s004230100249
Received: 02 January 2001
Accepted: 26 July 2001
Published: 05 October 2001
Issue Date: November 2001
DOI: https://doi.org/10.1007/s004230100249
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