Gallstones are one of the major causes of morbidity in western society. Prevalence of persons with asymptomatic and symptomatic gallstones varies between 5% and 22%. There is consensus that only patients with symptomatic gallstones need treatment. Three different operation techniques for removal of the gallbladder exist: the classical open operation technique and two minimally invasive procedures, the laparoscopic and the small-incision technique. This overview evaluates the three surgical procedures and comprises fifty-six trials with 5246 patients randomised.
Complication proportions in all three techniques are high, but there seem to be no significant differences in mortality and complications between the three operation techniques. Both minimally invasive techniques have advantages over the open operation considering postoperative recovery. This overview of three Cochrane Hepato-Biliary Group systematic reviews shows that the laparoscopic and the small-incision operation should be considered equal regarding patient-relevant outcomes (mortality, complications, hospital stay, and convalescence). Operative time seems to be quicker and costs seem to be lower using the small-incision technique.
The question today is why the laparoscopic cholecystectomy has become the standard treatment of cholecystectomy for patients with symptomatic cholecystolithiasis without the evidence being present. We were unable to find any arguments supporting the 'gold standard' status of laparoscopic cholecystectomy.
In future trials, research should concentrate more on outcomes that are relevant to patients (eg, complications and symptom relief). Furthermore, the execution of the trials should comply with CONSORT requirements (www.consort-statement.org).