Comparison of Open and Laparoscopic Cholecystectomies

Jang, Young Ho; Kim, Hong Ran; Cheun, Jae Kyu; Lee, Jung Koo

Abstract

Laparoscopic cholecystectomy, a surgical technique first performed in France, which has gained widespread acceptance among surgeons in Korea. The advantages of the laparoscopic technique include lesser patient discomfort, shorter hospitalization, and a shorter return interval to full activities after operation. It has been postulated that due to the minimal incisional discomfort of laparoscopic cholecystectomy, the postoperative pulmonary function following this procedure would be improved as compared to open cholecystectomy. Laparoscopic cholecystectomy uses carbon dioxide, a highly diffusable gas, for insufflation. With extended periods of insufflation, a patient's arterial carbon dioxide levels may be adversely altered. We performed 44 laparoscopic cholecystectomy in 1993. There were 22 women and 22 men, with a mean age of 50.0+/-11.9 years. The mean operative time was 86.7+/-24.3 minutes, reflecting a 62 percent decrease in operative time compared to the open cholecystectomy. The mean hospital stay was 4.6+/-2.0 days. To analyze the hemodynamic effects of carbon dioxide during laparoscopic cholecystectomy, the changes of pH, PaCO2, PaO2, and SaO2 were studied. The measurement showed significant increase of arterial carbon dioxide. Finally, during laparoscopic cholecystectomy patients may require careful intraopererative arterial blood gas monitoring of the absorbed carbon dioxide.