Affiliation:
1. Department of Surgery, Westeinde Hospital, The Hague, The Netherlands
Abstract
To compare the results of laparoscopic cholecystectomy (LC) and open cholecystectomy (OC)
for symptomatic cholelithiasis in elective surgery we performed a prospective matched-cohort
study. Hundred consecutive patients who underwent LC in the period Sept. 1990-June 1992,
and 100 patients who were age and sex matched and underwent an elective OC in the foregoing
two years (1989-1990) were studied. The median operation time for LC (75, 40-180 min) was
significantly longer than for OC (55, 20-155 min; p < 0.001). Postoperative hospitalization was
significantly shorter after LC (3, 1-16 days), compared with OC (7, 4-22 days; p<0.001).
Conversion of LC to OC occurred in 12 (12%) patients initially scheduled to undergo LC.
Complications occurred in 5 patients (5%) after LC and in 5 patients (5%) after OC. The
calculated expenses (operation and postoperative hospitalization, 3rd class) were approximately
fl. 3740,- for LC (excl. investments for pieces of apparatus) and fl. 6725,- for OC. This
study demonstrates that LC can be performed safely with the number of complications
comparable to those for OC. Bile duct injury is a serious potential threat. The main advantages
ofLC are the minimal trauma, with more rapid recovery. Insurers seem to benefit from reduced
postoperative disability and earlier discharge.
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