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Mini-lap cholecystectomy: a viable alternative to laparoscopic cholecystectomy for the Third World?
A K Sharma1, H K Rangan, R P Choubey
1Department of Gastrointestinal Surgery, Army Hospital (Referral and Research), Delhi, India. akms@nda.vsnl.net.in
Background:
Laparoscopic cholecystectomy (LC) requires expensive equipment and special training. Mini-lap cholecystectomy (MLC) has no start-up costs but no large series from a single centre has been reported as the procedure is considered hazardous because of inadequate exposure of the surgical field.
Methods:
We retrospectively reviewed the outcome of 737 cholecystectomies performed through a 3-5-cm transverse subcostal incision and compared the results to published series of laparoscopic cholecystectomy.
Results:
The operating time (61.6 min; range 35-130), conversion rate (4%), rate of postoperative complications (3.6%), bile duct injuries (0.3%), number of analgesic doses required (3.4; range 3-8), duration of postoperative hospital stay (1.4; range 1-15 days), and the time off work (13.3 days; range 8-61) compare well with the reported results of laparoscopic and MLC. Ninety-three per cent of the patients were followed up for a median period of 28.4 months and none developed biliary stricture.
Conclusions:
Mini-lap cholecystectomy is considered a safe, viable alternative to LC in the Third World.