Clinical Studies Comparing Laparoscopic and Minilaparotomy Cholecystectomy

McMahon, Andrew J (1993) Clinical Studies Comparing Laparoscopic and Minilaparotomy Cholecystectomy. MD thesis, University of Glasgow.

Abstract

Laparoscopic cholecystectomy was first performed by Mouret in France in 1987. Although laparoscopic cholecystectomy has rapidly been introduced into routine practice, there has been no rigorous evaluation comparing it with open cholecystectomy. Use of a small transverse subcostal incision ("minilaparotomy") for open cholecystectomy has been shown to result in a more rapid postoperative recovery than standard incisions 1-7. Therefore a trial was undertaken in which some 300 patients were randomised to laparoscopic (151) or minilaparotomy (148) cholecystectomy over an eighteen months period. Over the first year of the trial, postoperative pain, opiate analgesia consumption, oxygen saturation and pulmonary function (forced vital capacity (FVC), forced expiratory volume in one second(FEV 1), and peak expiratory flow rate (PEFR)) were assessed after laparoscopic (n=67) and minilaparotomy (n=65) cholecystectomy. Laparoscopic cholecystectomy was associated with lower linear analogue pain scores (median 40 v 59 mm, p<0.001), lower patient-controlled morphine consumption (median 22 versus 40 mg, p<0.001), a smaller reduction in postoperative pulmonary function (mean PEFR 64% of pre-operative value versus 49%, p<0.001) and better oxygen saturation (mean 92.9% versus 91.2%, p=0.008) than mini laparotomy cholecystectomy. In the randomised trial as a whole, recovery after surgery was assessed by length of hospital stay, outpatient review at ten days and four weeks, and a modified version of of the SF-36 health survey questionnaire one, four and twelve weeks after surgery. The median operation time was 20 minutes shorter for minilaparotomy (50 versus 70 minutes, p<0.001), while the median postoperative hospital stay was shorter after laparoscopic cholecystectomy (2 versus 4 days, p<0.001). The mean hospital cost was

• Item Type: Thesis (MD)
• Qualification Level: Doctoral
• Additional Information: Adviser: Patrick O Dwyer
• Keywords: Medicine, Surgery
• Date of Award: 1993
• Depositing User: Enlighten Team
• Unique ID: glathesis:1993-74778
• Copyright: Copyright of this thesis is held by the author.
• Date Deposited: 13 Nov 2019 15:58
• Last Modified: 13 Nov 2019 15:58
• URI: https://theses.gla.ac.uk/id/eprint/74778