Laparoscopic Versus Open Cholecystectomy: A Prospective Matched-Cohort Study

To compare the results of laparoscopic cholecystectomy (LC) and open cholecystectomy (OC) for symptomatic cholelithiasis in elective surgery we performed a prospective matched-cohort study. Hundred consecutive patients who underwent LC in the period Sept. 1990-June 1992, and 100 patients who were age and sex matched and underwent an elective OC in the foregoing two years (1989-1990) were studied. The median operation time for LC (75, 40-180 min) was significantly longer than for OC (55, 20-155 min; p< 0.001). Postoperative hospitalization was significantly shorter after LC (3, 1-16 days), compared with OC (7, 4-22 days; p< 0.001). Conversion of LC to OC occurred in 12 (12%) patients initially scheduled to undergo LC. Complications occurred in 5 patients (5%) after LC and in 5 patients (5%) after OC. The calculated expenses (operation and postoperative hospitalization, 3rd class) were approximately fl. 3740,- for LC (excl. investments for pieces of apparatus) and fl. 6725,- for OC. This study demonstrates that LC can be performed safely with the number of complications comparable to those for OC. Bile duct injury is a serious potential threat. The main advantages of LC are the minimal trauma, with more rapid recovery. Insurers seem to benefit from reduced postoperative disability and earlier discharge.