title: Ten years of laparoscopic cholecystectomy: a comparison between a developed and a less developed country.
abstract: OBJECTIVE
  To compare the specific features and outcomes of laparoscopic cholecystectomy in two university hospitals, one in a developing country, Bosnia-Herzegovina, and the other in a well developed country, Italy.
  
  
  METHODS
  Between January 1996 and December 2005, a total of 2018 patients underwent laparoscopic cholecystectomy in Mostar Clinical Hospital, Bosnia-Herzegovina (1066) and in Chieti University Hospital, Chieti, Italy (952). Differences in patients' presentations, diagnostic protocols, medication, surgical treatment, complications and outcomes were analyzed.
  
  
  RESULTS
  The number of patients with life-threatening conditions was lower in Italy (15 or 1.5% vs. 53 or 4.9%; P<0.001), as was the use of analgesia and antibiotics (131 or 13.96% vs. 873 or 81.97%; P<0.001). Open-access biliary surgery was rare in Italy, where the vast majority of patients were operated laparoscopically; only 44 (4.41%) patients had open-access surgery, including 35 (3.61%) conversion patients. In comparison, 1669 (61%) patients in Bosnia-Herzegovina underwent open-access operations. There was a significant difference, in favor of the Italian hospital, in the number of surgical complications (8 or 0.84% vs. 40 or 3.75%; P<0.002) and also in the number of postoperative infections following surgical incision (0 or 0.0% vs. 6 or 0.56%; P<0.033).
  
  
  CONCLUSIONS
  It is encouraging for surgeons in Bosnia-Herzegovina to find that satisfactory results can be achieved in a developing country. However, the number of complications encountered in the Mostar hospital emphasizes the need for further improvement of surgical technique through better structured training combined with strict supervision of junior staff. The finding of postoperative infections in the Bosnia-Herzegovina hospital, despite that their occurrence was relatively rare, highlights the necessity for further improvement of hospital infection control.
authors.affiliation: Mostar Clinical Hospital and School of Medicine, Mostar University, Mostar, Bosnia-Herzegovina.
authors.forename: Zdrinko
authors.initials: Z
authors.lastname: Brekalo
authors.forename: Paolo
authors.initials: P
authors.lastname: Innocenti
authors.forename: Goran
authors.initials: G
authors.lastname: Duzel
authors.forename: Guido
authors.initials: G
authors.lastname: Liddo
authors.forename: Enzo
authors.initials: E
authors.lastname: Ballone
authors.forename: Vladimir J
authors.initials: VJ
authors.lastname: Simunović
mesh_terms: D017522:Bosnia and Herzegovina / Q000453:epidemiology; D017081:Cholecystectomy, Laparoscopic / Q000706:statistics & numerical data*; D019049:Developed Countries / Q000706:statistics & numerical data*; D003906:Developing Countries / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008137:Longitudinal Studies; D011183:Postoperative Complications / Q000453:epidemiology*; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors