[1000 cases of cholecystectomy: 500 by laparotomy versus 500 by laparoscopy]

The authors report 1,000 cases of cholecystectomy for cholelithiasis, excluding all cases with associated common bile duct surgery. The aim of the study was to compare two groups of cholecystectomies, one of 500 laparotomic procedures, evaluated retrospectively, and one of 500 laparoscopic ones, evaluated prospectively. Sex ratio was the same in both groups, and mean age was higher in the second group (54 vs 60) (p < 0.05): acute cholecystitis ratio was similar in both groups (23% vs 19%; NS). During the laparoscopic period, 84 laparotomic interventions were performed (17%), with a 0% mortality and a 18% morbidity rate. Mean operating time was 69' in the first group vs 91' in the second one, with a mean hospital stay of 11 vs 4.5 days (p < 0.001). Mortality rate was 1% vs 0% (p < 0.03) for laparotomic and laparoscopic procedures, and morbidity rate was respectively 11% and 1% (p < 0.001). Conversion rate in laparoscopic surgery was 7%. Two cases (0.4%) in laparoscopic group had a common bile duct lesion diagnosed intraoperatively and 1 case (0.2%) had a residual stone in common bile duct. Laparoscopic surgery is at present the standard technique for the treatment of cholelithiasis and laparotomic cholecystectomy seems only indicated when laparoscopic procedure is contraindicated or impossible.