Retrospective comparison of outcome of 100 consecutive open cholecystectomies and 100 consecutive laparoscopic...

If laparoscopic cholecystectomy is to be a viable option for community surgeons and their patients, it should have a safety profile similar to or better than that of open cholecystectomy. Morbidity and mortality from 100 consecutive open cholecystectomies were compared to morbidity and mortality from 100 consecutive laparoscopic cholecystectomies. All procedures were done at Davis Community Hospital (Statesville, NC, population 25,000). Open cholecystectomies were done by seven staff surgeons from July 1987 to March 1990. Laparoscopic cholecystectomies were done by three staff surgeons from February 1990 to August 1990. Cholangiography during open cholecystectomy was selective. After an initial learning experience of 11 cases, cholangiography was routine during laparoscopic cholecystectomy. Patients having cholecystectomy coincidental to a planned common duct exploration for stones or neoplasia were excluded. For open cholecystectomy, morbidity was 13% and mortality, 2%. For laparoscopic cholecystectomy, morbidity was 9% and mortality, 1%. One death after open cholecystectomy was due to pulmonary embolus. The other two deaths in the series were due to underlying severe cardiopulmonary disease. Complications related directly to cholecystectomy were bleeding requiring transfusion (open 2, laparoscopic 1), bile leak (open 1, laparoscopic 1), wound infection (open 1), and prolonged back pain (laparoscopic 2). In two patients, the laparoscopic procedure was converted to open cholecystectomy. There were no common bile duct injuries in either group of patients. Results of this study suggest that laparoscopic cholecystectomy can be done as safely as open cholecystectomy, even in smaller community hospitals.