Comparison of laparoscopic and open cholecystectomy - adapted from the Journal of the American Colle

Date: May 15, 1995

Laparoscopic cholecystectomy has been associated with shorter periods of hospitalization and recovery. Despite the need for specialized training and equipment, the procedure has been widely adopted. Kane and associates describe the outcomes of elective laparoscopic and open cholecystectomy.

Consecutive cases of elective cholecystectomy from 35 hospitals were included in the study. Patients were interviewed to identify clinical symptoms, functional status and risk factors. Medical records were reviewed to determine any complications of the procedure. To establish outcomes, patients were sent a questionnaire about their symptoms and functional status six months after surgery. Included in analysis of intrahospital complications were records for 3,448 patients; functional and symptomatic baseline data and outcome data were available for 2,481 patients.

Patients who underwent laparoscopic P cholecystectomy had lower severity scores and shorter durations of symptoms. They were also younger, better educated and were less likely to be receiving Medicaid. Although the rate of severe and moderate operative complications did not differ according to type of operative technique, laparoscopic procedure was associated with significantly more mild operative complications, such as pain in the shoulder.

With the exception of the recovery of usual activities, functional outcome did not differ significantly by type of procedure performed. More patients who underwent laparoscopy reported a return to all or most of their usual activities at the time of follow-up evaluation six months after surgery. Also, these patients had shorter lengths of hospital stay and returned to work sooner (1.6 days and 15 days, respectively) than patients who had open cholecystectomy (4.3 days and 31 days, respectively).

Although most patients' symptoms improved after the procedure, the number of patients who experienced postoperative pain six months after discharge did not change significantly.

A learning curve was apparent for both procedures. The more laparoscopic procedures a surgeon performed, the fewer the operative. and general complications. The availability of laparoscopic operation was not found to be associated with a tendency to perform the operation more frequently.

The authors conclude that laparoscopic technique has decreased surgical recovery times and has not been associated with an increase in complications, increased demand or overuse by surgeons. This new procedure represents a significant advance in returning patients to normal activities. (Journal of the American College of Surgeons, February 1995, vol. 180, p. 136.)

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