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Comparative Analysis of Laparoscopic versus Conventional Cholecystectomy Outcomes (2001-2004)

This study analyzes the outcomes of laparoscopic cholecystectomy (LC) versus conventional cholecystectomy (SIC) in patients operated on between January 1, 2001, and March 31, 2004. A total of 257 patients met the criteria for inclusion, with no significant demographic differences observed. Findings revealed more intraoperative complications in the LC group, yet no significant differences in overall complications or postoperative complaints such as dietary issues and fatigue. Follow-up rates were also comparable between groups, indicating similar effectiveness over three months.

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Comparative Analysis of Laparoscopic versus Conventional Cholecystectomy Outcomes (2001-2004)

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  1. Results

  2. Results • Patients were operated on between January 1, 2001,and March 31, 2004. • Initially, 366 patients fulfilled the inclusioncriteria and agreed to be included in the trial. • A total of102 patients were not randomized for various reasons . • 264 patients were randomly assigned • 7 patientswere excluded due to: • unwillingness to participatefurther (2 patients) • intraoperative suspicion of malignantneoplasm (2 patients) • transfer to another ward not participatingin the trial (1 patient) • participation in 2 trials which is not inline with the Helsinki declaration (1 patient) • insufficientknowledge of the Dutch language (1 patient). • A total of 257patients were left for analysis .

  3. Baseline Characteristics • The 2 groups did not differ with regard to age, sex, body massindex, and ASA classification. • Patients were evaluated on thefollowing classic diagnostic symptoms of cholecystolithiasisin both groups: • severe pain, episodic pain, epigastric pain,pain in the right upper quadrant, pain radiating to the back,pain lasting 1 to 5 hours, awakening at night, and Murphy’ssign. • There were no significant differences in the presenceand the duration of these symptoms. • The numbers of patientspresenting with complicated gallstone disease and operated onin a later stage also were equally distributed. • Pre-op blood analysis consisting of ESR, WBC count, and levels of CRP, alanineaminotransferase, aspartateaminotransferase, -glutamyltransferase,alkaline phosphatase, and bilirubin showed no significant differencesbetween groups.

  4. Operative Results • Among intraoperative factors, more adhesions (2 = 9.15,P = .002) and intraoperativebile leakage (by gallbladderperforation) (2 = 10.26, P = .001) were found in theLC group. • Skin was left open for secondarywound healing more often in the LC group (2 = 31.69,P < .001). • Intraoperative stone loss, presenceof inflammation, and identification of the cystic duct and thecommon bile duct were not statistically different between the2 groups. • The cystic artery (P = .005) and Calot triangle(P < .001) were identified more frequently in theLC group. • SIC group a combined ligation of the cysticduct and artery was performed more frequently (P < .001).

  5. Surgical residents performed 105 LCs (87.5%) and 118 SICs (86.1%). • Operative time was shorter for SIC (60 vs 72 minutes; U = 6013.0;P < .001). • Conversion rates were similar,with similar distribution of reasons for conversion. • Total incision length of scars, measured in 229 patients, appearedto be not statistically different between the LC and SIC groups.

  6. Complications • There were no deaths in the trial. • There were 5 intraoperativecomplications in the LC group and 3 in the SIC group. • 1 common bile duct injury occurred in eachgroup (treated by T-drainage and hepaticojejunostomy). • No significatnt difference in complications between the two groups.

  7. POSTOPERATIVE COMPLAINTS • Follow-up rate between the groups was not statisticallydifferent. • Follow-up in the LC and SIC groups • @ 6 weeks 88.3% and 94.9% • @ 3 month 80.0% and 81.0% • all patients showed up at either their 6-week or their 3-monthfollow-up appointment. • All patients who did not show up at their2-week or 6-week follow-up appointment appeared not to haveany problems at their next scheduled follow-up appointment. • 9.2% and 10.2% of patientsin the LC and SIC groups experienced failureof symptom relief.

  8. POSTOPERATIVE COMPLAINTS • Postoperative complaints at follow-up: • Dietary complaints (26 vs 30 patients ; P = .96) • Diarrhea(17 vs 15; P = .44), • Fatigue (13 vs 6; P = .049), • Complaints suggestive of presence of common bile duct stones(6 vs 9; P = .59). T • No statistical differencein the number of patients undergoing endoscopic retrograde cholangiopancreatographyor magnetic resonance cholangiopancreaticography postoperatively(2 vs 5; P = .24).

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