Laparoscopic or open cholecystectomy: a prospective randomised trial to compare postoperative pain, pulmonary function, and stress response.
OBJECTIVE
Open cholecystectomy (OC) has been superseded by laparoscopic cholecystectomy (LC) for the treatment of cholelithiasis, although this fashion has not been validated by prospective studies. Our aim was to compare the two techniques.


METHODS
Prospective, randomised, open study.


METHODS
University hospital, Finland.


METHODS
49 patients who required cholecystectomy for cholelithiasis confirmed by ultrasound.


METHODS
49 patients were randomly allocated to LC (n = 27) or OC (n = 22): 25 and 22, respectively, eventually had the operation. LC was done using a four-trocar technique, and OC through a transverse right subcostal incision, as short as possible.


METHODS
Length of hospital stay and the duration of the sick leave were the primary outcome measures. Secondary outcome measures were: postoperative pain evaluated by visual analogue scale (VAS) and the need for opioids; pulmonary function measured by forced vital capacity (FVC), forced expiratory volume in one second (FEV1), peak flow velocity (PEFV), and arterial oxygen tension (PaO2), and endocrine stress measured by plasma catecholamines, cortisol and glucose concentrations.


RESULTS
The median (range) hospital stay was significantly shorter after LC than OC, being 2.0 (1-15) compared with 4.5 (2-19) days p < 0.01. The duration of sick leave was also significantly shorter after LC than OC, being 14 (7-17) compared with 29 (4-34), p < 0.01. Patients had significantly less postoperative pain after LC than OC as reflected by the need for opioids. Pulmonary function and arterial oxygen tension deteriorated significantly less after LC than OC. The stress response was equal. There were three documented complications, one pneumonia after LC and two wound infections after OC.


CONCLUSIONS
LC gives significantly better results in terms of less postoperative pain, better pulmonary function, better arterial oxygenation, and shorter hospital stay and duration of sick leave.
Hendolin
H I
HI
Department of Anaesthesia, Kuopio University Hospital, Finland.
Pääkönen
M E
ME
Alhava
E M
EM
Tarvainen
R
R
Kemppinen
T
T
Lahtinen
P
P
D002763:Cholecystectomy / Q000379:methods*; D017081:Cholecystectomy, Laparoscopic; D002769:Cholelithiasis / Q000601:surgery*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain; D011446:Prospective Studies; D012123:Pulmonary Ventilation; D013312:Stress, Physiological / Q000503:physiopathology