Laparoscopic cholecystectomy: the other side of the coin

Choose between a larger scar or a slightly larger risk of bile duct injury

The conventional view, supported by randomised trials, is that laparoscopic surgery is associated with less surgical trauma than surgery by laparotomy, resulting in less pain, quicker recovery, and earlier return to work.1 2 3 Recently, however, another trial has cast doubt on these assumptions,4 and an extensive review of laparoscopic cholecystectomy in Britain has urged surgeons to be cautious in adopting the procedure.5

Two of the three randomised trials comparing laparoscopic cholecystectomy with cholecystectomy by minilaparotomy found that the postoperative hospital stay was shortened by one to two days after laparoscopic cholecystectomy,1 2 and all three studies found that convalescence was shortened by three to eight days.1 2 3 Although the minilaparotomy differs substantially from a classic cholecystectomy, the alleged advantages of the laparoscopic approach seemed proved—until the study of Majeed et al was published last month.4 Majeed et al found no differences in hospital stay, time back to work, and time to resume full activity between the patients who underwent a laparoscopic cholecystectomy and …