Multivariate comparison of complications after laparoscopic cholecystectomy and open cholecystectomy.

OBJECTIVE

To answer the question whether laparoscopic cholecystectomy (LC) or open cholecystectomy (OC) is safer in terms of complications, the authors evaluated complications relating to 1440 cholecystectomies performed by the same surgeons in a retrospective study.

SUMMARY BACKGROUND DATA

A definite pronouncement on whether LC truly is superior to OC is not possible because prospective trials are burdened with problems of recruitment.

METHODS

After the introduction of LC at the authors' institution in April 1991 and until October 1993, 94.6% (700/740) of all patients admitted for operation because of symptomatic gallstone disease could be treated laparoscopically. The clinical records of the last 700 patients who underwent OC before the introduction of LC were re-evaluated with regard to both overall complications and the grade of complication (severity grade 1-4). A comparison of the incidence of complications relating to the two surgical methods, age, sex, common bile duct stones, acute cholecystitis, concomitant illness, Apache score, and length of operation was calculated by multivariate analysis using the logistic regression model.

RESULTS

The total rate of complications in the OC group was 7.7%, with five postoperative deaths, compared with 1.9% and one postoperative death in the LC group. Multivariate analysis for OC revealed that both old age (p = 0.014) and the existence of common bile duct stones (p = 0.02) had independent prognostic influences in increasing the overall complication rate, whereas only old age (p = 0.019) influenced the overall complication rate after LC. Multivariate analysis of all cholecystectomies (n = 1440) showed that the overall complication rate was influenced independently by OC as a detrimental factor.

CONCLUSIONS

As this analysis emphasizes, LC can be performed safely with an overall complication rate that is distinctly lower than that of OC. For selective surgery, LC is undoubtedly superior to OC and can probably be seen as a new "gold standard" for cholecystectomies.