Feasibility of minilaparotomy versus laparoscopic cholecystectomy for day surgery: a prospective randomised study.
OBJECTIVE
minilaparotomy (MC) and laparoscopic cholecystectomy (LC) are commonly applied surgical techniques in the management of symptomatic gallstone disease. Both techniques are used in day surgery patients, but to our knowledge MC and LC have not been compared in randomised trials as day surgery procedures.


METHODS
in this randomised parallel group clinical trial we compared the suc-cess rate of day surgery of MC with that of LC in 60 consecutive patients with non-complicated symptomatic gallstones presented for elective surgery at the Kuusankoski District Hospital (n = 38) and the Kuopio University Hospital (n = 22). Twenty nine patients underwent MC and 31 LC. The patients' outcome was recorded up to four weeks after the operation.


RESULTS
the success rate as a day surgery for MC was 66% (19/29) and that for LC 55% (17/31) with no difference between the two groups. Chronic cholecystitis, postoperative nausea and vomiting were significant variables associated with failure in day surgery. There was no difference between the two groups in operation time, perioperative bleeding, conversion to conventional open cholecystectomy (one with MC and three with LC), length of hospital stay or sick leave. Three patients developed superficial infection (two with MC and one with LC). One patient with conversion in the LC-group developed a common bile duct stricture and was readmitted at the 10th postoperative day.


CONCLUSIONS
both MC and LC are feasible surgical techniques for day surgery. However, appropriate prevention and prompt management of established postoperative nausea and vomit-ing and careful patient selection are important aspects for success of short-stay approach. If there is a sign of chronic cholecystitis preoperatively, it might be considered as a contraindication for day surgery.
Department of Surgery, Helsinki University Central Hospital, Helsinki, Finland. jukka.harju@firmnet.fi
J
J
Harju
H
H
Kokki
M
M
Pääkkönen
K
K
Karjalainen
M
M
Eskelinen
D000556:Ambulatory Surgical Procedures / Q000379:methods; D002763:Cholecystectomy / Q000379:methods*; D017081:Cholecystectomy, Laparoscopic; D002764:Cholecystitis / Q000209:etiology / Q000601:surgery; D002769:Cholelithiasis / Q000150:complications / Q000601:surgery*; D000075202:Contraindications; D006801:Humans; D007813:Laparotomy / Q000379:methods; D007902:Length of Stay; D011446:Prospective Studies