LAPAROSCOPIC CHOLECYSTECTOMY FOR CHOLELITHIASIS DURING INFANCY AND CHILDHOOD - COST-ANALYSIS AND REVIEW OF CURRENT INDICATIONS

Eleven consecutive laparoscopic cholecystectomies (LCs) were performed between January 1994 and June 1996 compared with seven open cholecyst ectomies (OCs) performed previously at King Khalid University Hospital . The comparison included surgical, clinical, and economic factors, to gether 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 cholecysti tis. A total of eight children in both group had sickle cell disease. The first two LCs were performed in the presence of an experienced lap aroscopic 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 (50.4 5 +/- 24.57 mg) was significantly less than for OC (135.14 +/- 62.02 m g), and the mean length of hospitalization for LC was significantly sh orter than that for OC (1.68 +/- 0.46 vs. 6.07 +/- 0.30) days. Althoug h the average operative cost per LC (2322 SR) was significantly more e xpensive than for OC (350 SR), the ultimate cost of LC was significant ly less than for OC (5790.00 +/- 787 vs. 12.343 +/- 139 SR) because th e total period of hospitalization was much shorter. In conclusion, LC is safe, effective, and less expensive than OC and therefore is the ap proach of choice for cholecystectomy in children.