Gallbladder Surgery, Choice of Technique: An Overview

The first cholecystectomy was performed by Langenbuch in 1882 (1), and the surgical approach changed very little in the next century. However, in the 1980s, reports began to appear that described the removal of the gallbladder through a 3-8 cm, muscle-sparing incision (small-incision cholecystectomy, or minicholecystectomy) (2-17). A few years later, laparoscopic cholecystectomy entered the scene (18, 19). These two minimally-invasive techniques have largely replaced the traditional open cholecystectomy, which used a 10 – 20 cm incision in elective gallbladder surgery (20). In 1993, a consensus conference at the National Institute of Health concluded that the experience of small-incision surgery or minilaparotomy cholecystectomy was limited; and that laparoscopic cholecystectomy could be performed at a treatment cost that was equal to or slightly less than that of open cholecystectomy and offered substantial cost savings to the patient and society by reducing the time off work (21). The alternative to surgical removal of the gallbladder, lithotripsy combined with chemical dissolution of gallstones is restricted to single stone disease and runs a risk of stone recurrence (22, 23). However, it has been found to be associated with good long-term quality of life in selected patients (24). The aim of this review is to discuss factors that influence the choice between cholecystectomy techniques, taking into account the applicability and cost of each technique.