[Cholecystectomy: laparoscopic or conventional?]

Cholecystectomy remains the gold standard in the treatment of cholelithiasis. With the emerging of laparoscopic techniques a new modality in the surgical therapy is available. However efficacy, morbidity and pretended advantages have to be judged in comparison to the conventional technique. Indications for cholecystectomy are not altered by the new technique. Beside some few preoperative contraindications, the definite choice of the operative procedure is determined intraoperatively according to the anatomical facts and the experience of the surgeon. The frequency of the laparoscopic approach varies between 67 and 97%. A conversion to open cholecystectomy is necessary in 3.6-4.7%. The overall complication rate is 2.6-5.1%. Outstanding from those are the iatrogenic lesions of the bile-duct, especially in the initial learning period with 1-2%. The hospital stay is dramatically reduced to 1.2-3 days as well as the postoperative recovery period with 7-14 days. Thus resulting in a cost saving up to $1200 per patient. Because of the obvious advantages of less pain, early mobilisation, less scars and an enormous cost saving the laparoscopic cholecystectomy will be the gold standard in the future. Open cholecystectomy will be restricted to complicated cases. However, in order to prevent serious injuries of the bile-duct an appropriate training in laparoscopic surgery is necessary.