Open Cholecystectomy in the Age of the Laparoscope

We reviewed our experience with open cholecystectomy since laparoscopic cholecystectomy became the treatment of choice for symptomatic gallstones. Over a 3 year period 35 open (6%) and 578 laparoscopic cholecystectomies (94%) were performed. Fourteen trainee surgeons performed only 16 open cholecystectomies and assisted at 19. The proportion of open cholecystectomies declined through the study period. Ten emergency cholecystectomies were performed for empyema, gallbladder perforation, severe acute cholecystitis, liver abscess, and cholangitis. In 12 patients, laparoscopic surgery was converted to an open procedure because of severe inflammation, empyema, dense adhesions, carcinoma of the gallbladder, cholecystoduodenal fistula, and perforated small bowel. Ten patients underwent open cholecystectomy and bile duct exploration after failure to clear duct stones endoscopically, and three patients had Mirizzi's syndrome. Open cholecystectomy is infrequently performed giving trainee surgeons little experience. However, such cases are occasionally inevitable and laparoscopic surgeons need to have the appropriate skills.