Laparoscopic cholecystectomy: a remarkable development

Article Abstract:

During the past couple of years there have been remarkable advances in the treatment of gallstones. The new technique is described by Robin Miller-Catchpole, in the March 27, 1991 issue of The Journal of the American Medical Association. By using a laparoscope, the usual incision is avoided, resulting in less pain, shorter hospitalization, lower cost, faster recovery, and a very small scar. In spite of this, there is very little published material substantiating the superiority of the laparoscopic technique over the older procedure, therefore guidelines about when the technique should or should not be used have been difficult to establish. Public demand was so great at the authors' institution that it was not possible to perform of trial comparing the old and new techniques. The results of a panel of 20 surgeons and 20 gastroenterologists indicated that 85 percent of these physicians found the effectiveness of laparoscopic cholecystectomy either established or promising. It was deemed to have the same outcome as the older, open procedure, as well as similar long-term results. They physicians were more cautious about the safety of the technique, with just over 12.5 percent rating it as established. However, when those who rated it as promising are added, the total is 77 percent. Some risks, such as injury to the common bile duct or intestine may be more common than with the older procedure. There was one report of one injury to the common bile duct among 100 patients, and another of two such injuries among 100 patients; there were two among 381 patients at the authors' institution, but both were fatal. This is excessive when compared with open cholecystectomy. There is a ''learning curve'' for surgeons beginning to do this procedure, and there are inherent risks of the technique as well. More data are required before the older, reliable techniques are replaced. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, editorial

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Gallstones and laparoscopic cholecystectomy

Article Abstract:

Some patients suffering from gallstones should undergo a laparoscopic cholecystectomy rather than an open cholecystectomy. Laparoscopic cholecystectomy is surgical removal of the gallbladder using a laparoscope, an instrument usually used to examine the abdominal cavity through one or more very small incisions. Most patients with gallstones do not experience any symptoms, but some may develop life-threatening complications. Patients who develop such serious complications usually undergo removal of their gallbladder via an abdominal incision. The first patients underwent laparoscopic cholecystectomy in the US in 1988. Patients whose gall bladder is removed by laparoscopic cholecystectomy usually experience less pain and require a shorter recovery period than those who undergo open surgery. The incidence of complications and death is not significantly higher among patients who undergo laparoscopic cholecystectomy than among those who undergo open surgery.

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Falling cholecystectomy thresholds since the introduction of laparoscopic cholecystectomy

Article Abstract:

Doctors appear to be performing gallbladder surgery on patients with less severe gallstone disease since the introduction of laparoscopic cholecystectomy. Laparoscopic cholecystectomy is a less invasive method of removing gallstones than traditional open surgery. Researchers tracked the rate of gallstone surgery in Medicare patients between 1986 and 1993 in Pennsylvania hospitals. After laparoscopic surgery was introduced in 1989, the rate of gallstone surgery increased 22%. Patients who had laparoscopic surgery were younger and had less severe gallstone disease. They were more likely to be scheduled for elective surgery and had lower 30-day mortality rates. The higher costs associated with a higher rate of gallstone surgery may be offset by the fact that patients who have laparoscopic surgery can be discharged quickly and return to work sooner than patients who have open surgery.

Aged, Elderly, Diseases

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