Trials have demonstrated the following differences between laparoscopic and standard open (i.e., right oblique subcostal incision) cholecystectomy for chronic cholecystolithiasis:
- Usually somewhat longer operating time, depending on experience (↑↑ [1; 11; 23; 24; 28; 30])
- Slightly higher rate of major complications, with rather infrequent local complications, e.g. Bile duct injury (↑↑ [2; 25; 32])
- Slightly lower rate of general complications, particularly in patients at risk (↑ 16)
- Postoperative pain comparable or only slightly less (↑↑ [3; 5; 12; 19; 24; 33; 36])
- Somewhat faster recovery and slightly shorter length of stay in hospital (↑↑ [1-3; 5; 11; 18; 20; 23-26; 28-30; 33; 36; 37])
- Only slightly better cosmesis (↑ 31)
- Usually higher inpatient costs (↑↑ [4; 7; 26; 27; 34; 37]) which, however may be compensated to some extent by savings outside the hospital (↑ [7; 34])
In acute cholecystitis, laparoscopic cholecystectomy offers the following benefits compared with open surgery:
- Somewhat faster recovery and slightly shorter length of stay in hospital (↑↑ [6; 17; 21])
- Otherwise slight benefits like those listed above despite higher conversion rate overall (↑↑ [6; 17; 21])
Regarding preoperative biliary tree imaging in uncomplicated cholecystolithiasis, one trial demonstrated:
- No benefits in terms of reducing the complication rate (↑ [10; 15])
Regarding perioperative prophylactic antibiotics in laparoscopic cholecystectomy, all trials to date have demonstrated:
- No difference in the rate of infection (↑↑ [8; 13; 14; 22; 35])
Regarding drains in laparoscopic cholecystectomy, a meta-analysis demonstrated:
- No difference in the rate of infection (↑↑ 9)