Minilaparotomy cholecystectomy with ultrasonic dissection versus conventional laparoscopic cholecystectomy: a randomized multicenter study

Abstract

Objective. Cholecystectomy by minilaparotomy (MC) or by laparoscopy (LC) has been shown to have equal results of both early and late recovery. Although, the ultrasonic dissection (UsD) technique has seen used in LC, the technique is rarely used in MC. Material and methods. Initially, 88 patients with uncomplicated symptomatic gallstones were randomized into MC with UsD (n = 44) or conventional LC (n = 44) over a 2-year period (2010–2012). The two groups were similar in terms of age and American Society of Anesthesiologists (ASA) physical status score. Results. Both groups were similar in terms of the operative time and the time in the operation theatre, the success of day-surgery and satisfaction with the procedure. The MC group had significantly less postoperative pain than the LC group, p = 0.002, and the MC group used less analgesics doses during the first 24 h: 2.8 (1.2) doses vs. 3.8 (1.4) doses, p = 0.003. The convalescence needed was 3 days shorter in the MC group, 7 (3) days, than that in the LC-group, 10 (8) days, p = 0.024. In the MC group 4 patients and in the LC group 11 (p = 0.046) required more than 14 days of sick leave. In the MC group there was one and in the LC group two conversions to open surgery. Conclusion. The patients in the MC group had less early postoperative pain and had a shorter convalescence than the patients in the LC group.

Key Words::

• cholecystectomy
• laparoscopy
• minilaparotomy
• ultrasonic dissection

Acknowledgements

The study was funded by the EVO-funding of the Helsinki University Hospital and the Kuopio University Hospital.

Declaration of interest: Drs Harju, Juvonen, Kokki, Remes, Scheinin and Eskelinen have no conflicts of interest or financial ties to disclose.