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 24 May 2018

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Laparoscopic cholecystectomy is the treatment of choice for cholecystitis

Better outcomes can be achieved using laparoscopic cholecystectomy compared to open cholecystectomy when treating acute and chronic cholecystitis, finds a new study of 43,433 patients.

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Laparoscopic cholecystectomy (LC) has become a popular alternative to open cholecystectomy (OC). However, previous studies comparing outcomes in LC and OC have only used small selected cohorts of patients, and did not control for comorbid conditions that might affect outcome.

A report from scientists at the University of North Carolina at Chapel Hill, USA, has now attempted to rectify this.

Writing in the latest issue of the American Journal of Gastroenterology, the research group carried out their study on a large unselected cohort of patients, with the aims of characterizing the morbidity, mortality, and costs of LC and OC.

The group used the population-based North Carolina Discharge Abstract Database for January 1, 1991, to September 30, 1994 (n = 850,000) to identify patients undergoing LC and OC.

This produced a cohort of 43,433 patients (19,662 LC and 23,771 OC).

Indications for surgery, complications, and the type of preoperative biliary imaging used were then identified for all subjects within the cohort.

Open patients - 3 times more likely to die than laparoscopy patients
American Journal of Gastroenterology

In addition, the length of stay, hospital charges, complications, morbidity, and mortality between LC and OC patients were compared.

To account for variations in outcomes from differences in age and comorbidity between the LC and OC groups, researchers applied the age-adjusted Charlson Comorbidity Index in regression analyses quantifying the association between type of surgery and outcome.

The mean-age adjusted Charlson Comorbidity Index score was found to be slightly higher for the OC group compared to the LC group.

The OC patients had longer hospitalizations, generated more charges and also required home care more frequently.

The crude risk ratio, comparing risk of death in OC to LC was 5.0 (95% CI = 3.9-6.5).

After controlling for age, comorbidity, and sex, the likelihood of dying in the OC group was still 3.3 times (95% CI = 1.4-7.3) greater than in the LC group.

In the LC group, the number of patients with acute cholecystitis rose over the study period, whereas the number of patients with chronic cholecystitis declined.

In the OC group however, the number of patients with both chronic and acute cholecystitis declined.

The use of intra-operative cholangiography was greater in the OC group, but declined in both groups over the study period.

The use of ERCP was greater in the LC group and increased in both groups over time.

Summarizing the research group's findings, Dr S.L. Zacks, said, "The introduction of LC has resulted in a change in the management of cholecystitis."

"Despite a higher proportion of patients with acute cholecystitis, our study found the risk of dying was significantly less in LC than in OC patients, even after controlling for age and comorbidity."

He concluded, "Based on lower costs and better outcomes, LC seems to be the treatment of choice for acute and chronic cholecystitis."

Am J Gastroenterol 2002; 97(2): 334-40
12 March 2002

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