Small-incision (mini-laparotomy) versus laparoscopic cholecystectomy: a retrospective study in a university hospital.
OBJECTIVE
Since the introduction of laparoscopic cholecystectomy into general practice in 1990, it has rapidly become the dominant procedure for gallbladder surgery. The aim of this study was to compare the results of the laparoscopic, open and mini-laparotomy approaches to cholecystectomy.


METHODS
Our study covers a period of 6 years. A total of 1,276 patients underwent cholecystectomy for calculous biliary disease. The laparoscopic procedure was applied to 952 (74.6%) patients, while 210 (16.5%) underwent the traditional open cholecystectomy and the remaining 114 (8.9%) patients underwent mini-laparotomy cholecystectomy.


RESULTS
Thirty-seven patients (3.9%) from the laparoscopic group required conversion to open cholecystectomy. Morbidity was similar in the open and laparoscopic groups (3.8%), while it was significantly lower in the mini-laparotomy group (0.8%). No major bile duct injuries occurred after the open or mini-laparotomy approaches. The median operation time was significantly shorter in the mini-laparotomy group than in the laparoscopic group (46 min vs 61 min). Hospital stay was significantly longer for the open cholecystectomy group (mean value 5.1 days) compared with the laparoscopic and mini-laparotomy groups (mean values 2.5 days and 2.7 days, respectively). Hospital expenses showed a saving of 786 Euro for each patient who underwent the open procedure and 980 Euro for each patient who underwent the mini-laparotomy approach compared with the laparoscopic one.


CONCLUSIONS
We believe that commissioners of healthcare should question whether the benefits of laparoscopic cholecystectomy justify the additional cost after the introduction of the mini-laparotomy approach.
Syrakos
Theodoros
T
A' Surgical Clinic, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece. antonits@otenet.gr
Antonitsis
Polichronis
P
Zacharakis
Emmanouil
E
Takis
Athanasios
A
Manousari
Antonia
A
Bakogiannis
Konstantinos
K
Efthimiopoulos
George
G
Achoulias
Ignatios
I
Trikoupi
Anastasia
A
Kiskinis
Dimitrios
D
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002763:Cholecystectomy / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D017081:Cholecystectomy, Laparoscopic; D006115:Greece; D006801:Humans; D007431:Intraoperative Complications; D007813:Laparotomy / Q000379:methods; D008875:Middle Aged; D012189:Retrospective Studies