title: Randomized clinical trial of small-incision and laparoscopic cholecystectomy in patients with symptomatic cholecystolithiasis: primary and clinical outcomes.
abstract: OBJECTIVE
  To evaluate the primary and clinical outcomes in laparoscopic and small-incision cholecystectomy.
  
  
  METHODS
  Blinded randomized single-center trial emphasizing methodologic quality and generalizability.
  
  
  METHODS
  General teaching hospital in the Netherlands.
  
  
  METHODS
  A total of 257 patients undergoing cholecystectomy for symptomatic cholecystolithiasis.
  
  
  METHODS
  Laparoscopic cholecystectomy and small-incision cholecystectomy, performed mainly by surgical residents.
  
  
  METHODS
  Complications and symptom relief were primary outcome measures; conversion rate, operative time, and hospital stay were secondary outcome measures. Feasibility of performing both procedures by residents was evaluated as well.
  
  
  RESULTS
  In the 257 patients, surgical residents performed 105 laparoscopic and 118 small-incision cholecystectomies. There were no significant differences in complications, conversion rates, and hospital stay. Operative time was significantly shorter with the small-incision technique.
  
  
  CONCLUSIONS
  No differences in primary clinical outcome measures were found between laparoscopic and small-incision cholecystectomy in this randomized trial with emphasis on methodologic quality and generalizability. The gold standard status of laparoscopic cholecystectomy is questionable. Trial Registration isrctn.org Identifier: ISRCTN67485658.
authors.affiliation: Department of Surgery, St Elisabeth Hospital, Tilburg, the Netherlands.
authors.forename: Frederik
authors.initials: F
authors.lastname: Keus
authors.forename: Johanna E M
authors.initials: JE
authors.lastname: Werner
authors.forename: Hein G
authors.initials: HG
authors.lastname: Gooszen
authors.forename: Henk J M
authors.initials: HJ
authors.lastname: Oostvogel
authors.forename: Cornelis J H M
authors.initials: CJ
authors.lastname: van Laarhoven
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D002763:Cholecystectomy / Q000379:methods*; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D041761:Cholecystolithiasis / Q000601:surgery*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011183:Postoperative Complications; D018709:Statistics, Nonparametric; D016896:Treatment Outcome