Multivariate Comparison of Complications After Laparoscopic Cholecystectomy and Open Cholecystectomy

Abstract

ObjectiveTo answer the question whether laparoscopic cholecystectomy (LC) or open cholecystectomy (OC) is safer in terms of complications, the authors evaluated complications relating to 1440 cholecystectomies performed by the same surgeons in a retrospective study. Summary Background DataA definite pronouncement on whether LC truly is superior to OC is not possible because prospective trials are burdened with problems of recruitment. MethodsAfter the introduction of LC at the authors' institution in April 1991 and until October 1993, 94.6% (700/740) of all patients admitted for operation because of symptomatic gallstone disease could be treated laparoscopically. The clinical records of the last 700 patients who underwent OC before the introduction of LC were re-evaluated with regard to both overall complications and the grade of complication (severity grade 1-4). A comparison of the incidence of complications relating to the two surgical methods, age, sex, common bile duct stones, acute cholecystitis, concomitant illness, Apache score, and length of operation was calculated by multivariate analysis using the logistic regression model. ResultsThe total rate of complications in the OC group was 7.7%, with five postoperative deaths, compared with 1.9% and one postoperative death in the LC group. Multivariate analysis for OC revealed that both old age (p = 0.014) and the existence of common bile duct stones (p = 0.02) had independent prognostic influences in increasing the overall complication rate, whereas only old age (p = 0.019) influenced the overall complication rate after LC. Multivariate analysis of all cholecystectomies (n = 1440) showed that the overall complication rate was influenced independently by OC as a detrimental factor. ConclusionsAs this analysis emphasizes, LC can be performed safely with an overall complication rate that is distinctly lower than that of OC. For elective surgery, LC is undoubtedly superior to OC and can probably be seen as a new "gold standard" for cholecystectomies.

Laparoscopic partial cholecystectomy: A safe and effective alternative surgical technique in "difficult cholecystectomies"

“…Laparoscopic cholecystectomy (LC) has become the gold standard for the surgical treatment of benign gallbladder diseases owing to its shorter hospitalization, more rapid recovery, and much fewer wound complications when compared to open cholecystectomy (1)(2)(3)(4). However, a direct vision is essential for safe dissection of Calot's triangle -outlined by the cystic duct, right liver lobe, and the common hepatic duct-, which indicates the importance of a clear anatomical demonstration of the cystic duct and cystic artery to perform a safe cholecystectomy (5).…”

“…Several reports suggested that postoperative hospital stay was significantly shorter in LC series when compared with CC series (2,4,22,(42)(43)(44). Ivatury et al (45) concluded that postoperative stay after LC was associated with ASA score.…”

Complications and Reasons for Conversion of Laparoscopic Cholecystectomy to Open Cholecystectomy- A Retrospective Analysis of 400 Patients at the Turn of the Century

“…Jatzko G R, (21) Orlando et al (22) and Daniel J et al (4) reported an overall complication rate of 1.5%, 8.6% and 2% respectively in their studies on laparoscopic cholecystectomy. Jatzko and others in their study have observed that the main detrimental factors relating to overall complications are open cholecystectomy for Grade 1 complication, old age and acute cholecystitis for Grade 2a complication and old age, acute cholecystitis and length of operation for Grade 2b complications.…”

“…Jatzko and others in their study have observed that the main detrimental factors relating to overall complications are open cholecystectomy for Grade 1 complication, old age and acute cholecystitis for Grade 2a complication and old age, acute cholecystitis and length of operation for Grade 2b complications. (21) In their study on laparoscopic cholecystectomy Cusheri et al, (20,10) Orlando et al (22) and Paulino Netto (9) reported mortality rate of 0.3% each, Deziel et al (22) of 0.04%, while no mortality was reported by Rubio, Voyles et al, Flower et al and Dubois F. (8,23,24) In the end, we might assume that introduction of LC, a new surgical method for treatment of patients with cholelithiasis was adopted due to its great advantages for the patients and hence can be defined as the 'New Gold Standard' for their treatment. A number of problems still under discussion as well as the negative views of the supporters of conventional methods should not discourage us to continue our efforts and research in this field.…”

Morphometric Study of Coeliac Trunk Specific Reference to Hepatic Artery Pattern in the West-Indian Population

“…At the time of the repair, the most serious problem is the injury to the main bile duct. Although the differences are not statistically significant, this injury is more frequently seen in laparoscopic cholecystectomy (1 % of cases) [13][14][15][16]. In open cholecystectomy in the operation of portocaval anastomosis, the portal vein is mobilized circumferentially at its midpoint [17].…”