Cholecystectomy through a mini laparotomy alongside laparoscopic technique

The authors present the surgical treatment of gallstones with special instruments and technique through a mini laparotomy, as developed in Kaposvár (Hungary). Despite the fact that the widespread use of laparoscopic cholecystectomy (LC) has succeeded over open cholecystectomy (OC), in their opinion, there are some instances where cholecystectomy through a mini laparotomy (MLC) would be advantageous. Last year (1996), in the authors' department, 32 MLCs were performed in addition to 72 OCs and 176 LCs. Due to unspecified techniques and differing criteria used to define MLC, it is difficult to find any data related to this subject in the literature available. In Hungary, there are two cities--Kaposvár and Szolnok--where only MLCs are performed for the surgical treatment of gallstones. Conversely, the University hospital of Szeged and the County hospital of Békéscsaba use all three procedures i.e. OC, LC and MLC; as is the case in the authors' hospital. In the article, the pros and cons of MLC are compared to those of LC. (The MLC being more cost effective, enables quick conversion to an OC if required, and provides the surgeon with a three dimensional picture, it is also suitable for the surgical treatment of common bile duct stones. However, it is cosmetically worse, obesity can cause technical difficulties, the incidence of hernia formation is higher, and wound healing is affected.) In the authors' opinion, it would be important to establish set criteria in order to screen patients that are unsuitable for LC, and they attempt to do so in this article.