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Laparoscopic cholecystectomy for cholelithiasis during infancy and childhood: cost analysis and review of current
A J Jawad1, K Kurban, A el-Bakry
1Department of Surgery, King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia.
Insights
Laparoscopic cholecystectomy (LC) is a safe and effective procedure for children, offering reduced pain and shorter hospital stays compared to open cholecystectomy (OC). Ultimately, LC proves to be more cost-effective despite higher initial operative expenses.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
Background:
- Cholecystectomy is a common surgical procedure for gallbladder diseases in children.
- Open cholecystectomy (OC) has been the traditional approach.
- Laparoscopic cholecystectomy (LC) offers potential benefits but requires evaluation in pediatric populations.
Purpose of the Study:
- To compare the safety, efficacy, and cost-effectiveness of laparoscopic cholecystectomy (LC) versus open cholecystectomy (OC) in children.
- To evaluate surgical, clinical, and economic factors associated with both procedures.
- To establish LC as the preferred method for pediatric cholecystectomy.
Main Methods:
- A retrospective comparison of 11 consecutive laparoscopic cholecystectomies (LCs) with 7 previous open cholecystectomies (OCs).
- Inclusion of surgical, clinical, and economic data.
- Review of relevant medical literature.
Main Results:
- LC demonstrated no major morbidity or mortality.
- Postoperative analgesia requirements were significantly lower for LC (50.45 mg) compared to OC (135.14 mg).
- Hospitalization duration was significantly shorter for LC (1.68 days) versus OC (6.07 days).
- Despite higher initial operative costs (2522 SR vs. 350 SR), the overall cost of LC (5790 SR) was significantly less than OC (12,343 SR) due to shorter hospital stays.
Conclusions:
- Laparoscopic cholecystectomy (LC) is a safe and effective surgical option for children.
- LC offers significant advantages in terms of reduced postoperative pain and shorter hospitalizations.
- The overall cost-effectiveness of LC makes it the preferred approach for pediatric cholecystectomy.
Abstract:
Eleven consecutive laparoscopic cholecystectomies (LCs) were performed between January 1994 and June 1996 compared with seven open cholecystectomies (OCs) performed previously at King Khalid University Hospital. The comparison included surgical, clinical, and economic factors, together with a review of the literature. In the laparoscopic group the main indication for cholecystectomy was symptomatic gallstones. Other indications include mucocele of the gallbladder and chronic cholecystitis. A total of eight children in both group had sickle cell disease. The first two LCs were performed in the presence of an experienced laparoscopic surgeon. There is a learning curve to pass through with LC. The operating time for LC ranged between 65 and 135 minutes (mean +/- SD 89.81 +/- 21.89 minutes). There was no major morbidity or mortality. The average postoperative parenteral analgesia required for LC (50.45 +/- 24.57 mg) was significantly less than for OC (135.14 +/- 62.02 mg), and the mean length of hospitalization for LC was significantly shorter than that for OC (1.68 +/- 0.46 vs. 6.07 +/- 0.30) days. Although the average operative cost per LC (2522 SR) was significantly more expensive than for OC (350 SR), the ultimate cost of LC was significantly less than for OC (5790.00 +/- 787 vs. 12,343 +/- 139 SR) because the total period of hospitalization was much shorter. In conclusion, LC is safe, effective, and less expensive than OC and therefore is the approach of choice for cholecystectomy in children.
