LAPAROSCOPIC VERSUS MINILAPAROTOMY CHOLECYSTECTOMY - A RANDOMIZED TRIAL

Although laparoscopic cholecystectomy has rapidly become routine pract ice in the UK, there has been no rigorous comparison of it with open c holecystectomy. In our trial, 302 patients were randomised to laparosc opic or minilaparotomy cholecystectomy. Recovery after surgery was ass essed by length of hospital stay, outpatient review at 10 days and 4 w eeks, and patient questionnaires 1, 4, and 12 weeks after surgery. The mean operation time was 14 min shorter for minilaparotomy, while medi an post-operative hospital stay was 2 days shorter after laparoscopic cholecystectomy. The hospital costs were about 400 Pounds greater for the laparoscopic procedure. Laparoscopic patients returned to work in the home sooner; at 1 week, they had better physical and social functi oning, were less limited by physical problems, and had less pain and d epression. At 4 weeks, only physical functioning and depression scores were better in the laparoscopic group, and by 3 months there were no differences. Laparoscopic patients were more satisfied with the appear ance of their scars. The incidence of complications after both procedu res was 20%. Compared to minilaparotomy cholecystectomy, laparoscopic cholecystectomy results in shorter hospital stay, less postoperative d ysfunction, and quicker return to normal activities, but is more costl y.