COMPARISON OF LAPAROSCOPIC CHOLECYSTECTOMY WITH OPEN CHOLECYSTECTOMY IN A SINGLE CENTER

In this retrospective study, we compared the results of 1,283 open cho lecystectomies (OCs) performed at our medical center during the pre-la paroscopic era with 1,107 laparoscopic cholecystectomies (LCs) perform ed from 1990 to 1992. There was no difference in the percentage of cas es of acute and chronic cholecystitis in each time period (16.8% in ea ch), nor were there differences in the patient characteristics for eac h group. The percentage of patients. undergoing intraoperative cholang iography was similar for patients with chronic cholecystitis for each period, although the incidence of abnormal cholangiograms was lower in the laparoscopic era (5.8% versus 15.2%, p <0.001). There was one bil e duct injury in the OC group and three in the LC group (although one of these occurred after conversion to an open procedure), but this dif ference was not statistically significant. However, there was a higher mortality rate in the patients with acute cholecystitis treated with OC (2.3% versus 0%, p = 0.03) and an increase in the overall complicat ions in the patients with chronic cholecystitis in the OC group (7.5% versus 3.1%, p <0.001) compared with the LC group. The increase in ove rall complications appeared to be primarily related to the increased r ate of wound-related complications (3.6% versus 0%, p <0.001) in the p atients with chrome cholecystitis in the OC group. LC appears to be a safe procedure with a low incidence of complications including bile du ct injury when performed by adequately trained surgeons.