Clinical Analysis of 2504 Cases of a Laparoscopic Cholecystectomy and 2672 Cases of an Open Cholecystectomy

ABSTRACT

BACKGROUND: The surgical treatment of gall stone disease consists of a conventional open cholecy stectomy (OC) and a laparoscopic cholecystectomy (LC), both of which are accepted standard methods. METHODS: The goal of this study was to compare the two operations which are used at present in the treatment of gall stone disease. During the period from September 1990 to April 1997, 2504 laparoscopic cholecystectomies and from August 1984 to April 1997, 2672 open cholecystectomies were performed at the Department of Surgery, Yong San Hospital, Chung-Ang University. We did a retrospective study of these cases and addressed the age and the sex distributions, the chief complaints, the previous operation history, associated diseases, radiologic findings, operation time, pathology, postoperative admission period, perioperative changes of bilirubin, AST (aspartate aminotransferase) & ALT (alanine aminotransferase), complications, and reasons for conversion to an open cholecystectomy. RESULTS: 1) The most common age was fifty, and female patients were in the majority. 2) The most common chief complaint was right upper-quadrant pain. 3) If ultrasonography showed wall thickening, an open cholecystectomy was more acceptable. 4) A LC had advantages in operation time and period of hospitalization. 5) The most common pathology of the gallbladder was chronic cholecystitis; others were polyps, metaplasia, and adenocarcinomas. 6) Elevation of the liver function was more prominant in LC cases than in OC cases. 7) The complication rate was 10.9% for LC cases and 12.5% for OC cases, but major complications were higher among LC paitents than among OC patients. 8) The conversion rate was 1.4%, and reasons for conversion were bile duct injury, bleeding, adhesion, and bowel injury. CONCLUSIONS: A LC has many advantages, but its problems are elevation of the liver function after the operation and a high major-complication rate. If ultrasonography shows no empyema or wall thickening, LC is more acceptable and good results are expected.