Laparoscopic or open cholecystectomy: A prospective randomised trial to compare postoperative pain, pulmonary function, and stress response

Objective: Open cholecystectomy (OC) has been superseded by laparoscopic ch olecystectomy (LC) for the treatment of cholelithiasis, although this fashi on has not been validated by prospective studies. Our aim was to compare th e two techniques. Design: Prospective, randomised, open study. Setting: University hospital, Finland. Patients: 49 patients who required cholecystectomy for cholelithiasis confi rmed by ultrasound. Interventions: 49 patients were randomly allocated to LC (n = 27) or OC (n = 22): 25 and 22, respectively, eventually had the operation. LC was done u sing a four-trocar technique, and OC through a transverse right subcostal i ncision, as short as possible. Main outcome measures: Length of hospital stay and the duration of the sick leave were the primary outcome measures. Secondary outcome measures were: postoperative pain evaluated by visual analogue scale (VAS) and the need fo r opioids; pulmonary function measured by forced vital capacity (FVC), forc ed expiratory volume in one second (FEV1), peak flow velocity (PEFV), and a rterial oxygen tension (PaO2), and endocrine stress measured by plasma cate cholamines, cortisol and glucose concentrations. Results: The median (range) hospital stay was significantly shorter after L C than OC, being 2.0 (1-15) compared with 4.5 (2-19) days p < 0.01. The dur ation of sick leave was also significantly shorter after LC than OC, bring 14 (7-17) compared with 29 (4-34), p, < 0.01. Patients had significantly le ss postoperative pain after LC than OC as reflected by the need for opioids . Pulmonary function and arterial oxygen tension deteriorated significantly less after LC than OC. The stress response was equal. There were three doc umented complications, one pneumonia after LC and two wound infections afte r OC. Conclusions: LC gives significantly better results in terms of less postope rative pain, better pulmonary function, better arterial oxygenation, and sh orter hospital stay and duration of sick leave.