REDUCED POSTOPERATIVE MORBIDITY AFTER ELECTIVE LAPAROSCOPIC CHOLECYSTECTOMY - STRATIFIED MATCHED CASE-CONTROL STUDY

To answer the question whether laparoscopic cholecystectomy (LC) or op en cholecystectomy (OC) is safer in terms of complications and to what extent the ''learning curve'' influences the frequency of complicatio ns after LC, we conducted a matched case-control study. First, 200 pat ients undergoing LC (LC group A), and two groups of 200 patients under going LC at two different periods of the learning curve (LC groups B a nd C) were matched, taking into account sex, age, anesthesiologic risk , and surgical difficulties. We evaluated the frequency and grade of p ostoperative complications of these patients and of the last 200 patie nts undergoing OC before the introduction of LC, retrospectively match ed with the LC groups. The total rate of complications in the OC group was 16.0% compared with 5.5% in the LC groups (p < 0.003); the differ ence was particularly significant for complications classified as grad e I, in female patients, those younger than 70, those with low anesthe siologic risk (ASA), and those after cholecystectomy without surgical difficulties. Matched case-control analysis revealed that the complica tion rate in the LC group significantly decreases with experience (p < 0.01). We conclude that LC is today the treatment of choice for sympt omatic cholelithiasis and is replacing OC as the gold standard against which new therapies should be compared.