Surgical practices during cholecystectomy in Algeria: results of a survey




Middle income country, Best practice, Gallbladder, Laparoscopy, Surgery, North Africa


Background: The cholecystectomy is one of the most practiced surgeries; the learned societies published guidelines to improve surgical practices. Guidelines are sometimes not followed, either by negligence, by lack of means or adequate professional environment. So, to know the real practices of surgeons, a survey was conducted.

Methods: An anonymous national survey involving all practicing Algerian surgeons was conducted. At the end of the survey, all data were captured and processed using the SPSS v20 software; χ2 tests were used to compare different groups of surgeons.

Results: Only 122 responses were retained, twenty-two percent of surgeons perform open cholecystectomy. No surgeon performed routinely cholangiography, 43% extracted the gallbladder using extraction disposal, 18% performed systematic abdominal cavity drainage, all surgeons send the gallbladder to histology for examination and postoperative antibiotic prophylaxis was routinely prescribed by 69% of surgeons. The average postoperative hospitalisation recommended by surgeons was 1.65 days (0-5) days. The experience of the surgeon or his position was associated with lower rates of systematic prescription of antibiotic prophylaxis, and with a lower duration of postoperative hospitalisation.

Conclusions: We recommend publication of guidelines of good practices adapted to the socio-professional and economic context of countries. 


Urbach DR, Stukel TA. Rate of elective cholecystectomy and the incidence of severe gallstone disease. CMAJ. 2005;172(8):1015‑9.

Traverso LW. Langenbuch and the first cholecystectomy. Am J Surg. 1976;132(1):81-2.

Strosberg DS, Nguyen MC, Muscarella P, Narula VK. A retrospective comparison of robotic cholecystectomy versus laparoscopic cholecystectomy: operative outcomes and cost analysis. Surg Endosc. 2017;31(3):1436-41.

Overby DW, Apelgren KN, Richardson W, Fanelli R. Society of American Gastrointestinal and Endoscopic Surgeons. SAGES guidelines for the clinical application of laparoscopic biliary tract surgery. Surg Endosc. 2010;24(10):2368‑86.

Tazuma S, Kanno K, Kubota K, Tsuyuguchi T, Kamisawa T, Isayama H, et al. Report on the 2013 national cholelithiasis survey in Japan. J Hepato Biliary Pancreat Sci. 2015;22(5):392‑5.

Majbar MA, Benkabbou A, Souadka A. Comparison of early outcomes and costs between laparoscopic and open cholecystectomy for mild and moderate cases of cholelithiasis in rural Morocco: a retrospective comparative study. J Minim Invasive Surg Sci. 2015;4(4):88-9.

Sun S, Yang K, Gao M, He X, Tian J, Ma B. Three-port versus four-port laparoscopic cholecystectomy: meta-analysis of randomized clinical trials. World J Surg. 2009;33(9):1904‑8.

Kumar M, Agrawal CS, Gupta RK. Three-port versus standard four-port laparoscopic cholecystectomy: a randomized controlled clinical trial in a community-based teaching hospital in eastern Nepal. JSLS. 2007;11(3):358‑62.

Ahmad G, Duffy JMN, Phillips K, Watson A. Laparoscopic entry techniques. Cochrane Database Syst Rev. 2008;(2):CD006583.

Buddingh KT, Hofker HS, Hoedemaker HO, Dam GM, Ploeg RJ, Nieuwenhuijs VB. Safety measures during cholecystectomy: results of a nationwide survey. World J Surg. 2011;35(6):1235-41.

Comajuncosas J, Hermoso J, Jimeno J, Gris P, Orbeal R, Cruz A, et al. Effect of bag extraction to prevent wound infection on umbilical port site wound on elective laparoscopic cholecystectomy: a prospective randomised clinical trial. Surg Endosc. 2017;31(1):249‑54.

Sarli L, Contini S, Sansebastiano G, Gobbi S, Costi R, Roncoroni L. Does laparoscopic cholecystectomy worsen the prognosis of unsuspected gallbladder cancer? Arch Surg. 2000;135(11):1340-4.

Agarwal AK, Kalayarasan R, Singh S, Javed A, Sakhuja P. All cholecystectomy specimens must be sent for histopathology to detect inapparent gallbladder cancer. HPB. avr 2012;14(4):269‑73.

Picchio M, Angelis FD, Zazza S, Filippo AD, Mancini R, Pattaro G, et al. Drain after elective laparoscopic cholecystectomy a randomized multicentre controlled trial. Surg Endosc. 2012;26(10):2817‑22.

El-labban G, Hokkam E, El-labban M, Saber A, Heissam K, El-Kammash S. Laparoscopic elective cholecystectomy with and without drain: A controlled randomised trial. J Minimal Access Surg. 2012;8(3):90‑2.

Tidjane A, Tabeti B, Serradj BN, Bensafir S, Ikhlef N, Benmaarouf N. Laparoscopic management of a drain site evisceration of the vermiform appendix, a case report. Int J Surg. 2017;42:29‑33.

Chang WT, Lee KT, Chuang SC, Wang SN, Kuo K-K, Chen JS, et al. The impact of prophylactic antibiotics on postoperative infection complication in elective laparoscopic cholecystectomy: a prospective randomized study. Am J Surg. 2006;191(6):721-5.

Pasquali S, Boal M, Griffiths EA, Alderson D, Vohra RS. Meta‐analysis of perioperative antibiotics in patients undergoing laparoscopic cholecystectomy. BJS. 2016;103(1):27‑34.

Sato A, Terashita Y, Mori Y, Okubo T. Ambulatory laparoscopic cholecystectomy: an audit of day case vs overnight surgery at a community hospital in Japan. World J Gastrointest Surg. 2012;4(12):296‑300.






Original Research Articles