Miniinvasive surgical interventions in management of cholelithiasis

The aim of the present study is to analyze outcomes after laparoscopic cholecystectomy (LC) and minilaparotomy cholecystectomy (MC) for gallstone disease and determine the algorithm of treatment for different groups of patients according to the age, severity of disease and comorbid conditions. This is a multicenter retrospective review of 2997 patients who underwent LC or MC between January 1, 2002 and December 31, 2008. The patients were categorized into LC (1479) and MC (1518) groups. When preoperative examination data were not reliable, we performed abdominal wall lifting with the retractors to visualise abdominal cavity with laparoscope during minilaparotomy. There were statistically significant differences in conversion rate (47 LC and 22 MC cases) (P=0.002), mean operating time (76 and 55 minutes in LC and MC, respectively) (P<0.001), mean duration of usage of non-narcotic analgesics postoperatively (1.3 and 1.1 days in LC and MC, respectively) (P<0.001), intra (15 LC and 6 MC cases) (P=0.02) and postoperative complications (96 LC and 72 MC cases) (P=0.05) and in mean hospital stay (1.5 and 1.3 days in LC and MC, respectively) (P<0.001). The difference in outcomes was more significant in elderly and senile patients. Following the review of previous trials, the only clear significant difference between both procedures was a shorter operative time using MC 24. MC is an attractive alternative for elderly patients, with their high incidence of acute cholecystitis 23. The minilaparotomy cholecystectomy is effective, safe and optimal operative procedure. Especially, it is important for countries with lower economic capacity.