Open Surgery of Gallstones

Open Procedures versus Laparoscopy.

Until the early 1990s, open cholecystectomy (the removal of the gallbladder through a wide abdominal incision) was the standard treatment. Now, laparoscopic cholecystectomy (commonly called lap choly ), which uses small incisions, is the most commonly used surgical approach. First performed in 1987, lap choly is now used in most cholecystectomies in the United States. In fact, about 700,000 people now have their gallbladders removed each year -- 200,000 more than before the introduction of laparoscopy. Of concern, then, is a significant increase in its use in patients who have inflammation in the gallbladder but no infection or gallstones and in those who have gallstones but no symptoms.

Laparoscopy has largely replaced open cholecystectomy because of some significant advantage:

1. The patient can leave the hospital and resume normal activities earlier than with open surgery.
2. The incisions are small, and there is less postoperative pain and disability than with the open procedure.
3. Laparoscopy has fewer complications.
4. It is less expensive than open cholecystectomy in the long term. The immediate treatment cost of laparoscopy may be higher than the open procedure, but the more rapid recovery with lap choly and fewer complications translate into shorter hospital stays and fewer sick days and so a greater reduction in overall costs.
   

Some experts believe, however, that the open procedure still has a number of advantages compared to laparoscopy:

1. It is faster to perform.
2. It poses less of a risk for bile duct injury, which occurs in only 0.1% to 0.5% of open procedures, compared to about 0.3% to more than 2% with laparoscopy. (It has more overall complications than laparoscopy, however, and laparoscopy bile-duct injury rates are declining.)

The type of surgery performed on specific patients may vary depending on different factors.