Laparoscopic cholecystectomy. A clinical and financial analysis of 280 operations.

Two hundred eighty patients underwent laparoscopic cholecystectomy (LC) and were compared with 304 patients who underwent traditional "open" cholecystectomy (OC). Laparoscopic cholecystectomy was performed electively in 72.5% of cases and urgently in 27.5% of cases. Conversion from LC to OC was required in 14 patients (5%), six of whom required common bile duct exploration. Common bile duct stones were managed with video-laparoscopic techniques in 11 patients, with percutaneous transhepatic laser lithotripsy in three patients, and with laparotomy in six patients. Hospital stay was significantly shorter and complications were significantly fewer for LC compared with OC. Hospital expenses for LC were significantly higher than for OC because of longer duration of operation and higher operating room expenses. Patients who underwent elective LC returned to work an average of 31 days earlier than patients who underwent OC (10 days vs 41 days). These data indicate that LC can be performed safely although at a higher cost than OC, and that patients as well as employers benefit from a short length of hospital stay.