Mini-laparotomy cholecystectomy: A reasonable answer to a difficult situation

Abstract

Introduction:Laparoscopic cholecystectomy is the gold standard treatment modality for symptomatic calculus cholecystitis. Patients who are unfit for laparoscopy such as elderly patients with severe cardiopulmonary disease, mini-laparotomy cholecystectomy may be a good alternative to laparoscopic cholecystectomy. Objectives: To compare between mini-laparotomy cholecystectomy (MLC) and laparoscopic cholecystectomy (LC) as regards operative time, risk of complications, postoperative hospital stay, return to normal activities and aesthetic results. Patients and methods: A study of 50 patients with gall stones who underwent LC (group A, n = 25 patients) or MLC (group B, n = 25 patients). Age, sex, Body Mass Index (BMI), pain scores (visual analog scale), analgesic consumption, operative time, complications, length of hospital stay, return to normal daily activities and patient satisfaction were recorded. Results: In this study, both groups were found to be matching, with no statistically significant difference, in their preoperative assessment. In group A; the overall operative time ranged between (30 and 55 minutes) with a mean of39.50 ±2.0347 minutes. In group B; the operative time ranged between (30 and 50 minutes) with a mean of 40.857±1.56 minutes. There was no statistically significant difference between the operative time in both groups (p=0.601). No statistically significant difference was found between the mean postoperative pain score and postoperative analgesic consumption in both groups (p= 0.952, 0.843 respectively).Postoperative hospital stay, return to normal daily activities, postoperative complications and patient satisfaction were comparable in both groups. Conclusions: In non obese patients mini-laparotomy cholecystectomy can be a good alternative to laparoscopic cholecystectomy in developing countries where laparoscopy is not available and in patients who are not fit for laparoscopy such as patients with severe cardiopulmonary disease.