Laparoscopic versus open cholecystectomy: complications and cost

Abstract

Purpose: Laparoscopic cholecystectomy (LC) is currently the most widely used surgical procedure for the treatment of gallstones. The aim of the study was to analyze and compare the postoperative results of patients undergoing laparoscopic cholecystectomy or open cholecystectomy (OC) with regard to complications, recovery time, hospital stay and cost. Method: This is a prospective study, which analyzed 1015 patients, 20-65 years old, diagnosed with gallstones undergoing LC or OC. We evaluated postoperative respiratory complications, surgical site infection, deep vein thrombosis, time to oral feeding and ambulation, use of antibiotics, duration of the postoperative period and the cost of surgery. Results: We analyzed 470 (46%) patients undergoing LC and 545 (54%) OC. Most patients were female (68,4%). Patients' comorbidities were hypertension (15.8%), diabetes mellitus (4.0%) and asthma (1.18%). LC resulted in lower prevalence of postoperative complications (2.9%) than OC (5.13%). Postoperative hospitalization for 18-24 hours was found in 71.68% of LC patients and in 13.4% in OC. The financial cost per surgery was US$ 495.00 in LC and US$ 435.00 in OC. Conclusion: Laparoscopic cholecystectomy showed higher benefits for patients with lower prevalence of postoperative complications, feeding earlier, shorter mean hospital stay and equivalent cost compared with open cholecystectomy. Laparoscopic versus open cholecystectomy: complications and cost Medeiros, AC, et al J Surg Cl Res -Vol. 3 (2) 2012:49-58 50 RESUMO Objetivo: A colecistectomia laparoscópica é atualmente o procedimento cirúrgico mais utilizado para o tratamento de litíase biliar. O objetivo do estudo foi analisar e comparar o pós-operatório imediato de grupos de pacientes submetidos a colecistectomia laparoscópica ou colecistectomia aberta no que diz respeito a complicações, tempo de recuperação, tempo de internação e custo das operações. Método: Estudo prospectivo, no qual foram analisados 1015 pacientes, entre 20 e 65 anos, com diagnóstico de litíase biliar submetidos a colecistectomia laparoscópica ou aberta. Para avaliação do pós-operatório imediato foram avaliadas as complicações respiratórias, infecção do sítio cirúrgico, trombose venosa profunda, tempo para início da alimentação oral e deambulação, o uso de antibióticos, duração do período pósoperatório e o custo do tratamento cirúrgico Resultados. Foram analisados 470 (46%) pacientes submetidos a colecistectomia laparoscópica e 545 (54%), por via aberta. A maioria dos pacientes era do sexo feminino (68,4%). As comorbidades apresentadas pelos pacientes foram hipertensão arterial (15,8%), diabetes mellitus (4,0%) e asma brônquica (1,18%). A colecistectomia laparoscópica resultou em menor prevalência de complicações operatórias (2,9%), maior número de pacientes com tempo de hospitalização pós-operatória abaixo de 18 horas (71,68%) e um custo financeiro de R$ 990,00 por procedimento cirúrgico. Comparada com a cirurgia aberta, os valores de complicações, tempo de hospitalização e custo foram respectivame...

Does Clonidine Affect the Anti-Inflammatory Response of IL-10 in Patients Undergoing Laparoscopic Cholecystectomy?

“…[26] The clonidine premedication provides perioperative hemodynamic stability in laparoscopic cholecystectomy, and hence clonidine can be recommended as a routine premedication for laparoscopic procedure. [27] In the present study, the clonidine (1 mcg/kg) as premedication for general anaesthesia had significantly better hemodynamic control than normal saline group. Our study is supported by Gupta et al (2013) who had given clonidine 1mcg/Kg and found that intraoperatively patient is hemodynamically stable.…”

“…The incidence of postoperative nausea and vomiting was less in the clonidine group which is similar in our study. [27,44] It also reduced shivering. The clonidine inhibits cold thermo regulatory response due to an effect on central integration control and output from thermoregulatory centres.…”

A Prospective Randomized Comparative Study between Baska Mask, Proseal LMA and I Gel during Positive Pressure Ventilation in Laparoscopic Cholecystectomy

“…Laparoscopic cholecystectomy has become a standard and less invasive technique for cholecystectomy surgeries in gall bladder diseases (1,2) . Although tracheal intubation is considered as an ideal approach, it has disadvantages like raised respiratory and hemodynamic responses during intubation, pneumoperitoneum and extubation (3)(4)(5)(6)(7)(8)(9) .…”

Optical architecture design for detection of absorbers embedded in visceral fat

“…Eventually, the surgeon should cut the cystic duct intentionally to remove the gallbladder, but while trying to locate the cystic duct, injury to the CBD can occur. Injuring the CBD leads to increased morbidity and recovery time, which adds to the overall cost of healthcare in secondary procedures and increased hospitalization [3][4][5][6]. Minimally invasive laparoscopic procedures are guided by cameras inserted a single 10 mm abdominal incision port, which only give a surface view of the fat covering the biliary tree.…”