Laparoscopic vs open surgery
The purported advantages of laparoscopic surgery over conventional open techniques are less pain and faster return to normal functional status. Very few studies have included validated measures of quality of life as end points. This study prospectively assessed the health status outcomes of patients undergoing four types of laparoscopic and open operations.
Preoperatively, patients undergoing elective inguinal hernioplasty, esophageal surgery, cholecystectomy, and splenectomy completed the SF-36, a well-tested, validated health-status instrument. This instrument measures physical functioning (PF), role-physical (RP), role-emotional (RE), bodily pain (BP), vitality (VT), mental health (MH), social functioning (SF), and general health (GH) health status domains. Patients then underwent either laparoscopic or open surgery. Patients were reassessed with the instrument ≥6 weeks after surgery. A total of 100 patients underwent these procedures.
Compared to preoperative values, median SF-36 scores for laparoscopic cholecystectomy patients were improved in the domains of PF (85 vs 95, p=0.01), BP (42 vs 75, p=0.002), and VT (47.5 vs 70, p=0.04); open cholecystectomy patients did not show statistically significant improvements over preoperative values. In addition, laparoscopic cholecystectomy patients had a better score than open cholecystectomy patients in the BP domain (75 vs 41, p=0.05). Laparoscopic esophageal surgery patients had better scores than open surgery patients in the domains of RP (100 vs 0, p=0.02) and VT (65 vs 52.5, p=0.05). Compared to preoperative values, laparoscopic splenectomy patients had an improved score in GH (52 vs 77, p=0.02) and better scores than open splenectomy patients in PF (90 vs 45, p=0.05) and BP (84 vs 55.5, p=0.01). Compared to preoperative values, open mesh hernioplasty patients showed improved scores in PF (70 vs 92.5, p=0.03) and MH (72 vs 84, p=0.05). Laparoscopic hernioplasty did not produce improved scores compared to either preoperative values or open hernioplasty.
Laparoscopic surgery has demonstrably better quality-of-life outcomes than open surgery for cholecystectomy, splenectomy, and esophageal surgery. However, open hernioplasty has at least as good, if not better, health status outcomes than laparoscopic repair.