Micro-laparotomy cholecystectomy compared with laparoscopic cholecystectomy: a randomized study

Introduction: Cholelithiasis constitutes a major portion of biliary disorders with conventional cholecystectomy being the commonest surgery for it, but there is an attempt towards miniaturization. As a result, mini-laparotomy, micro-laparotomy and laparoscopic approaches have been evolved. By laparoscopic cholecystectomy there is less pain, shorter hospitalization, fast recovery and a small scar. Micro-laparotomy cholecystectomy is an effective alternative to it its advantages being, decreased postoperative morbidity, short hospital stay, and decreased rate of bile duct injury. Also it is more cost effective as it obviates the need for sophisticated equipment and specialized training.
Objective: The aim of the study was to compare micro-laparotomy and laparoscopic cholecystectomy in terms of duration of surgery, intra/post-operative complications rate, post-operative pain, duration of hospital stay and cost of surgery.
Materials and Methods: A total of 400 patients with symptomatic cholelithiasis, were randomly and blindly allocated to undergo Laparoscopic cholecystectomy or Micro-laparotomy cholecystectomy.
Results: The operative time for laparoscopic and micro-laparotomy cholecystectomy was 35 vs. 32 minutes. Intra-operative gall bladder perforation rate was 30 vs. 2. Bile duct injury rate was 2 vs. 0. Post- operative rescue analgesia was required in 131 vs. 99 cases. Post-operative complications rate was almost similar. Mean duration of hospital stay for laparoscopic and micro- laparotomy cholecystectomy was 2.1 days and 1.8 days respectively.The cost of surgery for LC vs MLC was Rs 12,000 vs 4000 (INR).
Conclusion: Intra-operative complications rate is lesser with Micro-laparotomy cholecystectomy and it does offer a safe, low cost alternative to laparoscopic cholecystectomy.