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Minicholecystectomy vs conventional cholecystectomy: A prospective randomized trial—Implications in the laparoscopic era

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Abstract

The objective of this study was to compare results of elective “open” conventional cholecystectomy (CC) to those of minicholecystectomy (MC). A clinical prospective, randomized trial was designed. The setting was an academic general surgical unit. In the CC group were 26 patients; in the MC group were 24 patients. In the CC group a conventional open cholecystectomy was performed through a subcostal incision; in the MC group operation through an initial 5-cm subcostal incision was done. Mean length of wound was 14.4 cm and 5.4 cm in the two groups, respectively (p<0.001). Mean operative time was 60 and 59 minutes, respectively. Mean operative difficulty, estimated on a 1–10 scale, was 3.4 and 5.6, respectively (p<0.05). Mean postoperative analgesia requirements (number of doses of 10 mg morphine sulphate) were 5.8 and 4.0, respectively (p=0.002). Mean duration of hospitalization was 4.7 and 3.0 days, respectively (p<0.001). Mean “overall patient satisfaction,” estimated on 1–10 scale, was 6 and 8.3, respectively (p=0.002). We conclude that Minicholecystectomy offers less pain, earlier recovery, and better cosmetic results than the conventional “open” procedure. Published results of MC compare favorably with those of laparoscopic procedures. The implications of these results in the “laparoscopic era” are discussed.

Résumé

Objectif

comparer les résultats de la cholécystectomie traditionnelle (CT) à la cholécystectomie par minilaparotomie (CM).

Type d'étude

clinique, prospective, randomisée

Lieu

Unité de soins universitaire

Malades

26 patients ayant eu une CT, 24 ayant eu une CM

Interventions

La CT a été réalisée par une incision souscostale, la MC, à travers une incision sous-costale de 5 cm.

Résultats

La longeur moyenne de l'incision de la CT a été de 14.4 cm et celle de la CM de 5.4 cm (p<0.001). La durée moyenne des interventions a été respectivement de 60 et de 59 minutes. La difficulté de l'intervention, évaluée sur une échelle de 1 à 10 a été respectivement de 3.4 et de 5.6 (p<0.05). Les besoins moyens d'analgésie postopératoire (nombre de doses de sulphate de morphine, 10 mg) ont été respectivement de 5.8 et de 4.0 (p=0.002). La durée moyenne de l'hospitalisation a été respectivement de 4.7 et de 3.0 jours (p<0.001). L'évaluation des soins par les patients, notée de 1 à 10, a été respectivement de 6 et de 8.3 (p=0.002).

Conclusions

La CM est moins douleureuse, permet une récupération plus précoce et donne un meilleur résultat esthétique. Ces résultats sont comparables à ceux de la littérature. Les implications de ces résultats, à l'heure de la cholécystectomie laparoscopique, sont discutées.

Resumen

Objetivo

comparar los resultados de la colecistectomía convencional ‘abierta’ (CC) con los de la minicolecistectomía (MC).

Diseño

ensayo clínico prospectivo randomizado en una unidad académica de cirugía general.

Sujeto

grupo CC de 26 pacientes, MC de 24. Intervenciones: colecistectomía por incisión subcostal en la CC y por incisión subcostal de 5 cm en la MC.

Resultados

las longitudes promedio fueron 14.4 cm y 5.4 cm (p<0.001); los tiempos operatorios promedio fueron 60 y 59 minutos respectivamente; la dificultad técnica promedio fue calificada como 3.4 y 5.6 en una escala de 1–10, respectivamente (p<0.05); los requerimientos postoperatorios de analgesia (número de dosis de 10 mg de sulfato de morfina) fueron 5.8 y 4.0 (p<0.002); los días de hospitalización fueron de 4.7 y 3.0 dias, respectivamente (p<0.001); el grado de satisfacción del paciente fue estimado en 6 y 8.3 sobre una escala de 1–10 (p=0.002).

Conclusion

la MC se asocia con menos dolor, recuperación más temprana y mejor resultado estético que la operación convencional abierta. La literatura presenta resultados comparativamente favorables entre MC y los procedimientos lapascópicos. Se discuten las implicaciones de ello en la “era laparoscópica”.

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Authors and Affiliations

  1. Department of Surgery B, Rambam Medical Center, Haifa, Israel

    Ahmad Assalia M.D., Moshe Schein M.D. F.C.S. (S.A.), Doron Kopelman M.D. & Moshe Hashmonai M.D., F.A.C.S.

  2. The Faculty of Medicine the Technion-Israeli Institute of Science, Haifa, Israel

    Ahmad Assalia M.D., Moshe Schein M.D. F.C.S. (S.A.), Doron Kopelman M.D. & Moshe Hashmonai M.D., F.A.C.S.

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  1. Ahmad Assalia M.D.
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  2. Moshe Schein M.D. F.C.S. (S.A.)
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  3. Doron Kopelman M.D.
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  4. Moshe Hashmonai M.D., F.A.C.S.
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Assalia, A., Schein, M., Kopelman, D. et al. Minicholecystectomy vs conventional cholecystectomy: A prospective randomized trial—Implications in the laparoscopic era. World J. Surg. 17, 755–759 (1993). https://doi.org/10.1007/BF01659087

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