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Laparoscopic versus minilaparotomy cholecystectomy: a randomised trial
A J McMahon1, I T Russell, J N Baxter
1University Department of Surgery, Western Infirmary, Glasgow, UK.
Lancet (London, England)
|January 15, 1994
Summary
Laparoscopic cholecystectomy offers faster recovery and better short-term function than minilaparotomy. However, this gallbladder surgery is more expensive and offers no long-term benefits beyond 3 months.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Comparative Effectiveness Research
Background:
- Laparoscopic cholecystectomy is standard in the UK, but lacks rigorous comparison with open procedures.
- Open cholecystectomy, specifically minilaparotomy, remains an alternative surgical approach.
Purpose of the Study:
- To rigorously compare laparoscopic cholecystectomy with minilaparotomy cholecystectomy.
- To evaluate recovery, complications, and costs associated with each surgical method.
Main Methods:
- A randomized trial involving 302 patients comparing laparoscopic and minilaparotomy cholecystectomy.
- Assessment of recovery included hospital stay, outpatient reviews, and patient-reported outcomes at 1, 4, and 12 weeks.
Main Results:
- Laparoscopic cholecystectomy led to a shorter hospital stay (2 days median) and quicker return to work and daily activities.
- Laparoscopic patients reported better physical functioning, social functioning, and less pain/depression at 1 week post-surgery.
- Complication rates were similar (20%) for both procedures, but laparoscopic surgery incurred higher costs (£400).
Conclusions:
- Laparoscopic cholecystectomy provides faster recovery and improved short-term patient outcomes compared to minilaparotomy.
- Despite higher costs and similar complication rates, laparoscopic cholecystectomy is associated with quicker return to normal activities.
- Long-term differences between the two procedures were not observed at 3 months post-surgery.