Comparison of laparoscopic cholecystectomy with open cholecystectomy in a single center.

In this retrospective study, we compared the results of 1,283 open cholecystectomies (OCs) performed at our medical center during the pre-laparoscopic era with 1,107 laparoscopic cholecystectomies (LCs) performed from 1990 to 1992. There was no difference in the percentage of cases of acute and chronic cholecystitis in each time period (16.8% in each), nor were there differences in the patient characteristics for each group. The percentage of patients undergoing intraoperative cholangiography was similar for patients with chronic cholecystitis for each period, although the incidence of abnormal cholangiograms was lower in the laparoscopic era (5.8% versus 15.2%, p < 0.001). There was one bile duct injury in the OC group and three in the LC group (although one of these occurred after conversion ot an open procedure), but this difference was not statistically significant. However, there was a higher mortality rate in the patients with acute cholecystitis treated with OC (2.3% versus 0%, p = 0.03) and an increase in the overall complications in the patients with chronic cholecystitis in the OC group (7.5% versus 3.1%, p < 0.001) compared with the LC group. The increase in overall complications appeared to be primarily related to the increased rate of wound-related complications (3.6% versus 0%, p < 0.001) in the patients with chronic cholecystitis in the OC group. LC appears to be a safe procedure with a low incidence of complications including bile duct injury when performed by adequately trained surgeons.

[1]  R. Lefering,et al.  Conventional Versus laparoscopic cholecystectomy and the randomized controlled trial , 1991, The British journal of surgery.

[2]  J. B. Ganey,et al.  Cholecystectomy: clinical experience with a large series. , 1986, American journal of surgery.

[3]  K. Zucker,et al.  Laparoscopie Cholangiography: Results and Indications , 1992, Annals of surgery.

[4]  Gilliland Tm,et al.  Modern standards for comparison of cholecystectomy with alternative treatments for symptomatic cholelithiasis with emphasis on long-term relief of symptoms. , 1990 .

[5]  J. Monson,et al.  Cholecystectomy is safer without drainage: the results of a prospective, randomized clinical trial. , 1991, Surgery.

[6]  J. Folkman.  Is there a field of wound pharmacology? , 1992, Annals of surgery.

[7]  D. Easter,et al.  Laparoscopie Injuries to the Bile Duct: A Cause for Concern , 1992, Annals of surgery.

[8]  G. E. Newman,et al.  Mechanisms of major biliary injury during laparoscopic cholecystectomy. , 1992, Annals of surgery.

[9]  G. Berci,et al.  Twelve hundred open cholecystectomies before the laparoscopic era. A standard for comparison. , 1992, Archives of surgery.

[10]  L W Way,et al.  Bile duct injury during laparoscopic cholecystectomy. , 1992 .

[11]  R. Symmonds,et al.  Open versus laparoscopic cholecystectomy. A comparison of postoperative pulmonary function. , 1991, Annals of surgery.

[12]  M. Talamini,et al.  Traditional versus laparoscopic cholecystectomy. , 1991, American journal of surgery.

[13]  K A Zucker,et al.  Laparoscopic cholecystectomy. Experience with 375 consecutive patients. , 1991, Annals of surgery.

[14]  C. Mcsherry.  Cholecystectomy: the gold standard. , 1989, American journal of surgery.

[15]  G. Mcentee,et al.  Reduced postoperative hospitalization after laparoscopic cholecystectomy , 1991, British Journal of Surgery.

[16]  S. Ashley,et al.  Comparison of early postoperative results for laparoscopic versus standard open cholecystectomy. , 1992, Surgery, gynecology & obstetrics.