Minilaparotomy cholecystectomy: the Third World solution for gallstones - abstract

ABSTRACT

Although many authors view laparoscopic cholecystectomy as the treatment of choice for gallstones there is evident that it has probably caused more deaths and major postoperative morbidity than open cholecystectomy. The Medical Defence Union has reported increased claims for bile duct injury from laparoscopic cholecystectomy (LC). The technology is expensive and not readily available in third world countries. Because minilaparotomy cholecystectomy (MC) also minimally invasive and offers similar advantages to LC we studied it prospectively and report our experience. MC was performed in 160 consecutive patients through a 4.8 cm (3 - 6 cm) incision, with operating time of 35 minutes (18 - 80 ). No major ductal injury and no reoperation occurred. Patients were discharged after 38 hours (range 16 - 60 hours). The operating time is much shorter, hospital stay and postoperative morbidity similar to LC. Review of the world literature shows no clear advantage of LC over MC. Because MC is cheap, effective, requires no specialised training or expensive equipment and can be done by any competent surgeon in most hospitals in the developing world, we recommend it as treatment of choice for gall stones in the third world. (AU)