Laparoscopic Versus Open Common Bile Duct Exploration And Choledocholithotomy: A Review Study Of Outcomes, Quality Of Life, And Costs

Objective: To compare outcomes, quality of life(QOL), and costs of laparoscopic and open common bile duct exploration and choledocholithotomy(CBDEC).Summary Background Data: Laparoscopic cholecystectomy(LC) has been reported to be a safe and effective approach for the treatment of cholelithiasis. As choledocholith, the laparoscopic common bile duct exploration and choledocholithotomy is being applied widely than before also. The authors performed a review trial to compare outcomes, QOL, and costs of laparoscopic CBDEC with those of open CBDEC.Methods: From May 2005 to March 2007, 40 patients with choledocholith were collected who underwent laparoscopic(n 15) or open(n 25) CBDEC in China-Japan Friendship Hospital. The two groups were similar in age, sex ratio, ASA class. Main outcome measures included operative time, estimated blood loss, length of hospital stay, operative complications, and time to return to activities of daily living and work. Changes in QOL were assessed using the SF-36 Health Survey and the gastrointestinal quality of life index(GIQLI). Operative and hospital costs of the two operations were also compared.Results: Mean operative time was longer for laparoscopic CBDEC than for open CBDEC, but operative blood loss was less. Median length of hospital stay was shorter for laparoscopic CBDEC patients. Wound-related complications were more common after open CBDEC. Time to return to activities of daily living and work were shorter after laparoscopic CBDEC than after open CBDEC. Preoperative SF-36 scores and GIQLI were similar between the two groups; however, at 1 month after surgery, laparoscopic patients had better physical conditioning, social functioning, general health, and less body pain than open CBDEC patients. Operative costs were higher for laparoscopic CBDEC patients, but hospital costs were similar.Conclusions: Laparoscopic CBDEC is a safe and cost-effective alternative to open CBDEC. Despite a longer operative time, patients undergoing laparoscopic CBDEC benefited from less blood loss, a shorter hospital stay, and faster convalescence. The higher initial operative costs for laparoscopic CBDEC were adequately offset by the similar hospital costs.