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Surgical Outcomes of Open Cholecystectomies in the Laparoscopic Era
Bram A Nijsse1, Suzanne M Sokal2, Yuchiao Chang2, David L Berger2
1University of Amsterdam, Amsterdam, The Netherlands2Massachusetts General Hospital, Boston, MA
Objectives: To determine the outcome of patients undergoing open cholecystectomies in relation to converted procedures in the laparoscopic era.
Design: Retrospective analysis from July 1997 through September 2006.
Setting: Tertiary care center.
Patients: We evaluated 1629 consecutive patients who underwent cholecystectomy performed by a single surgeon who was trained in laparoscopy during residency from 1997 to 2007. After excluding cholecystectomies performed in conjunction with another procedure, patients were divided into three groups. Group I consisted of 136 open cholecystectomies, group II consisted of 68 converted cases, and group III consisted of 1210 laparoscopic cholecystectomies.
Main outcome measures: Morbidity and mortality as well as length of procedure and hospitalization in this patient population.
Results: Overall complication rates were 34%, 29%, and 6.4% for the respective groups. However, major complications (3.7%) were less in the open group than the converted group (4.4%). Fifteen day readmission rates and re-operative rates were also worse in the converted group. Open procedures took less time than converted procedures. The mean length of stay for both open and converted procedures was not significantly different. Mortality rates were 2.2%, 1.5% and 0 for groups I, II, and III consecutively. Patient’s BMI did not have a significant impact. Patients in group I were older, more often male, and had a higher ASA classification.
Conclusions: Over the last decade, laparoscopic cholecystectomy has become the gold standard. Nevertheless, for various reasons, open cholecystectomy represents approximately 10% of all cholecystectomies in this series. Patients and referring physicians are always interested in laparoscopic procedures but judicious use of an open procedure leads to better outcomes in borderline cases where conversion ultimately becomes necessary.
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