Three Decades of Laparoscopic Cholecystectomy: Standardized Protocols and Surgical Outcomes

Objectives: The primary aim of this study was to present our 30 years of experience with laparoscopic cholecystectomy (LC) procedures conducted in tertiary care institutions, focusing on patient outcomes, complications, and the efficacy of standardized management protocols.
Methods: This retrospective cohort study analyzed 4,572 LC procedures conducted over a 30-year period in a tertiary medical center. All patients were managed according to a standardized protocol encompassing preoperative, intraoperative, and postoperative care, which was regularly reviewed and updated. Data on demographic characteristics, surgical indications, complications, and patient outcomes were collected and analyzed.
Results: A total of 4,572 patients (3,246 female [71%], 1,326 male [29%]) underwent LC, with a mean age of 41.0 ± 1.3 years (range 14–91). The most common indication for surgery was symptomatic or complicated gallstones, observed in 4,453 patients (97.4%). Of these, 1,966 patients (43%) had gallstone-related complications, including cholecystitis (985 patients [21.5%]), choledocholithiasis (736 patients [16.1%]), and biliary pancreatitis (247 patients [5.4%]). Simultaneous laparoscopic procedures were performed in 342 patients (7.5%), with common surgical interventions such as choledochal exploration (104 patients [2.3%]), hysterectomy (71 patients [1.5%]), and umbilical hernia repair (45 patients [1.0%]). Perioperative morbidity occurred in 361 patients (7.9%), with no reported mortality. According to the Clavien-Dindo classification, 349 patients (96.7%) experienced minor complications (grades I and II), while 12 patients (3.3%) had major complications (grades III and IV), including biliary injury (3 patients [0.07%]), intestinal injury (3 patients [0.07%]), bleeding (3 patients [0.07%]), thromboembolism (2 patients [0.05%]), myocardial infarction (1 patient [0.02%]), and pneumonia (1 patient [0.02%]). Conversion to open surgery was required in 3 patients (0.07%).
Conclusion: The adherence to a unified management protocol for LC, with periodic reviews and updates, significantly reduces postoperative mortality and the incidence of major complications, including biliary injury. Furthermore, this approach enables the safe performance of simultaneous laparoscopic procedures in patients with comorbidities, contributing to improved surgical outcomes in tertiary care settings.

Keywords: Biliary injury, conversion to open surgery, laparoscopic cholecystectomy, surgical outcomes, standardized protocols, perioperative morbidity, simultaneous laparoscopic procedures