Impact of laparoscopic technique on the quality of cholecystectomy.
To compare the quality of cholecystectomy before and after the introduction of laparoscopic technique, a comparison was made between 463 consecutive patients undergoing open cholecystectomy (OC) during the 1985-1989 and 329 consecutive patients cholecystectomized during 1991-1993 after the introduction of laparoscopic cholecystectomy (LC) (i.e., open or laparoscopic cholecystectomies). The frequency of procedure-related complications was unchanged in the two periods [13 vs. 9% (NS)], but general complications were reduced from 17 to 9% (p < 0.001), mainly attributable to a reduced incidence of pulmonary complications. Mortality was 2.2 and 0.9%, respectively (NS). The frequency of bile duct injury was 0.2% in the first and 0.6% in the second period (NS). The frequency of reoperations was 2.8 and 1.8% (NS), and residual stones were later detected in 3.0 and 3.6%, respectively (NS). Hospital stay after elective surgery was reduced from 6 days in the first period to 4 days in the second (all cases) (p < 0.001). Thus the quality of cholecystectomy improved regarding general complications, while mortality and number of reoperations were unchanged. Further improvement is desirable to prevent general as well as procedure-related complications.
Bentzon
N
N
Department of Surgery, Hillerød Hospital, Denmark.
Adamsen
S
S
D000368:Aged; D000369:Aged, 80 and over; D002763:Cholecystectomy / Q000401:mortality / Q000592:standards*; D017081:Cholecystectomy, Laparoscopic / Q000592:standards*; D017558:Elective Surgical Procedures / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011787:Quality of Health Care; D012086:Reoperation