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Archived Comments for: Open cholecystectomy for all patients in the era of laparoscopic surgery – a prospective cohort study

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  1. Field Restriction

    Dave Hopkins, other

    25 April 2006

    The only possible contraindication to an open small incision cholecystectomy is that an unexperienced surgeon may be impacted by the limited range of the field. However, seeing as many of these cases were elective cases, unexperienced surgeons probably did not perform them. Looking at this scenario from the perspective of a busy Emergency Department, I would have to say that during a time of increased patient flow or heavy trauma, a case like this would be deemed a non-life-threatening emergency and would most likely be handed off to a less experienced surgeon. This could result in extreme morbidity or mortality in a severe case. This is a very unusual situation and may never occur. But, this is a subject and scenario that could possibly be postulated before such a scenario became standard procedure.

    Competing interests

    None declared

  2. Length of stay comparison.

    Erik Nilsson, Instituion of surgery and perioperative sciences, Umeå university, Sweden

    6 March 2009

    In our study, hospital stay for all patients (3.1 days) was compared with hospital stay for all patients who had cholecystectomy in Sweden 2002 (4.4 days). However, in a subsequent study we found that after exclusion of patients with malignant or benign intra-abdominal or kidney tumor with a procedure code for tumor resection, the mean in-hospital stay for patients who had cholecystectomy in Sweden 2002-03 was 4.1 days[1]. After adjustment for 12% ambulatory cholecystectomies in Motala Hospital, the best comparison would be 3.5 days for patients with in-hospital stay in Motala versus 4.1 for Sweden. However, the main message of the report is that open cholecystectomy and concomitant removal of bile duct stones, should be considered a cost-effective alternative in a unit with emergency service and trainee surgeons, provided small-incision surgery is aimed for.

    We agree totally with Dave Hopkins that the incision should be as wide as safety requires. And furthermore, trainees should be assisted by senior colleagues during critical moments in all gallbladder surgery.
    For the authors,
    Erik Nilsson, M.D., Ph.D.

    1. Rosenmuller M, Haapamaki MM, Nordin P, Stenlund H, Nilsson E: Cholecystectomy in Sweden 2000-2003: a nationwide study on procedures, patient characteristics, and mortality. BMC Gastroenterol 2007, 7:35.

    Competing interests

    The authors declare that they have no competing interests.