Mini-laparotomy cholecystectomy: technique, outcomes: a prospective study.
BACKGROUND
The last decades have been characterized by a rapid growth in minimally invasive techniques for acute and chronic cholecystitis. The aim of our study was to analyze 10 years of experience with the mini-laparotomy cholecystectomy.


METHODS
From 1994 to 2004, we performed 2295 mini-laparotomy cholecystectomies, including 1028 patients with acute and 1267 patients with chronic cholecystitis. There were 1780 women and 515 men. We utilized a special surgical tool kit with a system of circular and small hook-retractors incorporating an illuminator and long surgical instruments. Our surgical approach was carried out using a 3-5 cm longitudinal incision located immediately above the gallbladder with a muscle splitting technique.


RESULTS
The mean time of operation was 64.5+/-24.5 min and the conversion rate was 3.7%. Intraoperative complications occurred in 25 cases (1.1%), including 4 cases (0.17%) of biliary tract injury. Cholecystectomy was combined with intervention on the choledochus and the papilla of Vater in 133 patients with choledocholithiasis. Postoperative complications developed in 4.1%. Five hundred and five patients (22%) required opioid analgesics on the first postoperative day. The mortality rate was 0.17%. The mortalities involved patients who had severe concomitant diseases and required urgent surgery for acute cholecystitis. Patients operated for acute cholecystitis had significantly higher rates of postoperative complications (5.8% vs. 2.8%), need for opioids (25.5% vs. 19.2%) and mortality (0.39% vs. 0%).


CONCLUSIONS
Mini-laparotomy cholecystectomy is an alternative to laparoscopic approach in the surgical treatment of acute and chronic cholecystitis.
Shulutko
Alexander M
AM
Department of Faculty Surgery N 2, I.M. Sechenov Moscow Medical Academy, Moscow, Russia.
Kazaryan
Airazat M
AM
Agadzhanov
Vadim G
VG
D002763:Cholecystectomy / Q000379:methods*; D002764:Cholecystitis / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D011446:Prospective Studies; D016896:Treatment Outcome