Laparoscopic cholecystectomy. A clinical and financial analysis of 280 operations
M. E. Stoker, J. Vose, P. O'Mara and B. S. Maini
Department of Surgery, Fallon Clinic, Worcester, MA 01606.
Two hundred eighty patients underwent laparoscopic cholecystectomy (LC) and
were compared with 304 patients who underwent traditional "open"
cholecystectomy (OC). Laparoscopic cholecystectomy was performed electively
in 72.5% of cases and urgently in 27.5% of cases. Conversion from LC to OC
was required in 14 patients (5%), six of whom required common bile duct
exploration. Common bile duct stones were managed with video-laparoscopic
techniques in 11 patients, with percutaneous transhepatic laser lithotripsy
in three patients, and with laparotomy in six patients. Hospital stay was
significantly shorter and complications were significantly fewer for LC
compared with OC. Hospital expenses for LC were significantly higher than
for OC because of longer duration of operation and higher operating room
expenses. Patients who underwent elective LC returned to work an average of
31 days earlier than patients who underwent OC (10 days vs 41 days). These
data indicate that LC can be performed safely although at a higher cost
than OC, and that patients as well as employers benefit from a short length
of hospital stay.
