Laparoscopic versus open cholecystectomy: the Canadian experience. The McGill Gallstone Treatment Group

Numerous uncontrolled trials have suggested that laparoscopic cholecystectomy (LC) is a major improvement over open cholecystectomy (OC). In an effort to objectively document the benefits of LC, two Canadian studies are reviewed. The first is a matched time series based on prospective data from a single surgeon's practice in which patients are closely matched for baseline characteristics. The groups consist of 121 patients from each of 3 time periods: 1989, prior to the introduction of LC; 1990, when LC was being introduced; and 1991, when LC had become the preferred method of cholecystectomy. The second study is a randomized trial, in which LC is compared with mini-cholecystectomy. In both studies, the superior efficacy of LC is demonstrated with respect to the duration of hospitalization and the duration of postoperative convalescence. The incidence of complications as well as their severity is also less in LC patients. Although quality of life improves after any type of cholecystectomy, LC patients improve faster and seem to accept the operation better. These studies support the widespread dispersion of LC in Canada, although comparative efficacy with nonsurgical alternatives has not been addressed.