Open cholecystectomy for all patients in the era of laparoscopic surgery – a prospective cohort study

From 1 January 2002 through 31 December 2003, all operations upon the gallbladder in a district hospital with emergency admission and responsibility for surgical training were done as intended small-incision open cholecystectomy.182 women and 90 men with a median age of 56 (interquartile range 45 to 68 years) underwent cholecystectomy for symptomatic gallbladder disease, 170 as elective and 102 as emergency cases. Trainee surgeons assisted by consultants or registrars having passed an examination for open cholecystectomy performed surgery in 194 cases (71%). The common bile duct was explored in 52 patients. Total postoperative morbidity was six percent. Median postoperative stay was one day and mean total (pre- and postoperative) hospital stay 3.1 days. 32 operations (12%) were done as day surgery procedures. Nationally in Sweden in 2002, mean total hospital stay was 4.4 days, and 13% of all cholecystectomies were performed on an outpatient basis.Open, small-incision cholecystectomy for all patients is compatible with short hospital stay, evidence-based gall-bladder surgery, and training of surgical residents.Soon after its introduction, laparoscopic cholecystectomy was considered the method of choice for treatment of gallstone disease, and an early consensus conference concluded that it might confer economic advantages over open surgery[1]. At that time, little information was available concerning mini-laparotomy or small-incision, open cholecystectomy. Later single-blind, randomised controlled trials have indicated that convalescence differences between laparoscopic and small-incision surgery are small[2,3]. In previous reports from a controlled trial, no significant differences were observed between mini-laparotomy and laparoscopic cholecystectomy in terms of patients' opinion of general well-being, abdominal pain, and scarring one year after surgery[4,5]. Health-care costs are lower after mini-laparotomy cholecystectomy than after laparoscopic cholecystectomy [5