SAFETY, EFFICACY, COST, AND MORBIDITY OF LAPAROSCOPIC VERSUS OPEN CHOLECYSTECTOMY - A PROSPECTIVE ANALYSIS OF 228 CONSECUTIVE PATIENTS

Laparoscopic cholecystectomy has become the procedure of choice in most hospitals for the resolution of surgically treatable gallbladder disease. Few reports address the results of laparoscopic cholecystectomy in comparison to open cholecystectomy during the same time interval within the same institution. One hundred ninety-six laparoscopic cholecystectomies were performed from April 1990 through February 1991. Initial patient selection was restricted to elective procedures for chronic cholecystitis with expanded indications as experience was gained. Of the 196 cases, 11 required conversion to open cholecystectomy, leaving 185 laparoscopic cholecystectomies for. comparison. During the same period, 82 open cholecystectomies were performed. Thirty-nine of these were complicated cases and would not have been considered for laparoscopic cholecystectomy early in the study, leaving 43 routine open cholecystectomies for comparative purposes. In the laparoscopic group, 1.1 per cent of the patients had major operative complications as opposed to the open group, which had none. There were no common bile duct injuries in either group. To provide a true cost-benefit analysis, a group of patients was identified that would qualify for elective, same-day admission for either an open or laparoscopic procedure. Laparoscopic cholecystectomy (LC) was performed on 70 patients, and open cholecystectomy (OC) was performed on 26 patients. A comparison of data from these groups showed no significant difference in age or sex. Hospitalization costs averaged $5,390 for the LC group versus $5,392 for the OC group. Postoperative hospital stay averaged 1.3 days for the LC group versus 3.7 days for the OC group (P < 0.0001). The mean time of return to work and regular activities was 8.2 days for the LC group and 42.8 days for the OC group (P < 0.0001). Patient satisfaction was evaluated by an independent, postoperative, nonbiased phone interview at 6 weeks. In the LC group, 96 per cent were very satisfied and 4 per cent were satisfied. In the OC group, 14% were very satisfied, 67% were satisfied, and 19% were not satisfied. This study indicates that laparoscopic cholecystectomy offers significant advantages for patient recovery and satisfaction while providing a safe, cost-effective method for the treatment of gallbladder disease.