Cholelithiasis is one of the most common biliary tract disorders and remains a major indication for abdominal surgery worldwide.[1] Since its introduction in the late 1980s, laparoscopic cholecystectomy has become the preferred surgical approach due to reduced postoperative pain, shorter hospital stay, faster recovery, and improved cosmetic outcomes.[2-4] Despite these advantages, open cholecystectomy continues to play a role in patients with complicated gallbladder disease, dense adhesions, unclear anatomy, or limited laparoscopic resources.[5,6] Hence this study was conducted to evaluate the outcome of laparoscopic versus open cholecystectomy in patients with cholelithiasis.

A prospective observational comparative study was conducted in the Department of General Surgery at SMS Hospital, Jaipur over an eight-month period (October 2023 to May 2024). A total of 220 patients with ultrasonography-confirmed symptomatic cholelithiasis were included and divided into two groups based on the surgical approach: laparoscopic cholecystectomy (LC, n = 110) and open cholecystectomy (OC, n = 110). The choice of surgical technique was determined by clinical indication, surgeon discretion, and intraoperative findings. Adult patients aged 18–65 years who were fit for surgery under general anesthesia and provided informed consent were included. Patients with gallbladder malignancy, choledocholithiasis, acute pancreatitis, empyema or perforation of the gallbladder, severe systemic illness (ASA grade IV or above), or incomplete data were excluded. Preoperative evaluation included detailed clinical assessment, routine laboratory investigations, and abdominal ultrasonography to confirm diagnosis and assess gallbladder pathology. Anesthetic fitness was assessed according to ASA classification. Primary outcome measures included postoperative complications such as surgical site infection, bile leak, postoperative fever, and respiratory complications. Secondary outcomes included duration of hospital stay, time to return to daily activities, analgesic requirement beyond 24 hours, and mortality. Patients were followed up to one month postoperatively. Data were analyzed using SPSS software 23 version, with continuous variables expressed as mean ± standard deviation and categorical variables as frequencies and percentages. Comparisons were performed using Student’s t-test and Chi-square test, with p < 0.05 considered statistically significant. Ethical approval was obtained from the Institutional Ethics Committee, and patient confidentiality was maintained throughout the study.

Table 1. Baseline Characteristics Variable LC (n=110) OC (n=110) Mean age (years) 42.9 ± 11.6 44.3 ± 12.1 Female, n (%) 86 (78.2%) 82 (74.5%) Diabetes mellitus, n (%) 20 (18.2%) 25 (22.7%) Hypertension, n (%) 23 (20.9%) 27 (24.5%) A total of 220 patients were included in the study, with 110 patients each in the laparoscopic cholecystectomy (LC) and open cholecystectomy (OC) groups. The mean age of patients in the LC group was 42.9 ± 11.6 years, which was comparable to the OC group, where the mean age was 44.3 ± 12.1 years. Female patients constituted the majority in both groups, accounting for 78.2% in the LC group and 74.5% in the OC group. The prevalence of diabetes mellitus was 18.2% among LC patients and 22.7% among OC patients, while hypertension was present in 20.9% of the LC group and 24.5% of the OC group. Table 2. Postoperative Complications Complication LC (n=110) OC (n=110) Any postoperative complication 25 (22.7%) 40 (36.4%) Wound infection 5 (4.5%) 15 (13.6%) Postoperative fever 11 (10.0%) 18 (16.4%) Bile leak 2 (1.8%) 5 (4.5%) Respiratory complications 2 (1.8%) 7 (6.4%) Mortality 0 0 Postoperative complications were observed more frequently in patients undergoing open cholecystectomy compared to those undergoing laparoscopic cholecystectomy. Any postoperative complication occurred in 22.7% of patients in the LC group, whereas a higher proportion of 36.4% was observed in the OC group. Wound infection was notably more common following open surgery, occurring in 13.6% of OC patients compared to 4.5% in the LC group. Postoperative fever was reported in 10.0% of LC patients and 16.4% of OC patients. Bile leak was infrequent in both groups but occurred more often in the OC group (4.5%) than in the LC group (1.8%). Respiratory complications were also higher following open cholecystectomy, affecting 6.4% of OC patients compared to 1.8% of those in the LC group. No mortality was recorded in either group. Table 3. Recovery Outcomes Outcome LC OC Mean hospital stay (days) 3.1 ± 1.4 6.9 ± 2.3 Return to daily activities (days) 9.8 ± 2.6 16.1 ± 3.8 Opioid analgesic use >24 h 43 (39.1%) 83 (75.5%) Recovery parameters demonstrated a clear advantage for laparoscopic cholecystectomy over open cholecystectomy. The mean duration of hospital stay was significantly shorter in the LC group at 3.1 ± 1.4 days, compared to 6.9 ± 2.3 days in the OC group. Functional recovery, assessed by time to return to daily activities, was earlier in patients undergoing LC, with a mean duration of 9.8 ± 2.6 days, whereas OC patients required a longer recovery period of 16.1 ± 3.8 days. Analgesic requirements were also reduced following laparoscopic surgery, with 39.1% of LC patients requiring opioid analgesics beyond 24 hours, compared to 75.5% of patients in the OC group.

In the present study (n=220), laparoscopic cholecystectomy (LC) demonstrated lower postoperative morbidity than open cholecystectomy (OC), with overall complications of 22.7% in LC versus 36.4% in OC. These values align closely with the comparative observational data reported by Cheruku et al., where overall complications were 20% in LC and 36% in OC. The direction and magnitude of difference between approaches remain consistent across datasets, supporting the routine preference for LC when feasible. Wound infection was substantially higher in the OC group (13.6%) compared with the LC group (4.5%). A similar gradient has been reported by Cheruku et al. (12% OC vs 4% LC). In large LC-only series, wound infection commonly remains in the low single digits; Taki-Eldin and Badawy reported wound infection of 4.3% across 492 LC cases, comparable to the LC wound infection rate observed in the current results. The higher wound infection burden in OC is compatible with the larger incision, greater tissue handling, and delayed mobilization associated with open surgery, as also summarized in comparative reviews. Postoperative fever occurred more frequently after OC (16.4%) than LC (10.0%). The complication profile reported by Cheruku et al. also documented higher postoperative morbidity in OC, with wound and respiratory morbidities dominating the open arm. Although fever is not uniformly defined across studies, the consistent pattern of higher minor postoperative events after OC remains compatible with the overall higher complication rate and longer convalescence reported in open surgery cohorts. Bile leak was uncommon in both groups in the present study (1.8% LC vs 4.5% OC). In the Cheruku et al. dataset, bile leak occurred equally in both techniques (4% vs 4%). In the large LC series by Taki-Eldin and Badawy, bile leak was reported at 2.4%, indicating that low single-digit bile leak rates are observed across institutional experiences. Variation across cohorts is expected due to differences in case mix (acute vs chronic cholecystitis), operative difficulty, and documentation thresholds for minor bile staining versus clinically significant leaks. Respiratory complications were higher following OC (6.4%) compared to LC (1.8%). A similar distribution was noted in Cheruku et al. (8% OC vs 2% LC). This pattern is consistent with the larger incision, pain-limited deep breathing, and delayed ambulation seen more often following open procedures. The combined effect of wound morbidity and respiratory events contributes to the higher overall complication rate and greater postoperative care requirements in OC. Recovery outcomes strongly favored LC. The mean postoperative hospital stay was 3.1 ± 1.4 days in LC compared with 6.9 ± 2.3 days in OC, closely matching the comparative observational findings of Cheruku et al. (3.1 ± 1.2 days LC vs 6.8 ± 2.1 days OC). In large LC cohorts, mean stay around 2–3 days is also documented; Taki-Eldin and Badawy reported a mean hospital stay of 2.6 ± 1.5 days across 492 LC cases. In contrast, the Cureus study by Khalid et al. reported longer average stays in both groups (9.55 days OC vs 7.2 days LC), indicating that institutional protocols, discharge criteria, and patient selection can materially influence length-of-stay benchmarks. Return to daily activities occurred earlier in the LC group (9.8 ± 2.6 days) than the OC group (16.1 ± 3.8 days), again paralleling Cheruku et al. (9.4 ± 2.5 vs 15.6 ± 3.4 days). The analgesic requirement profile further supports faster recovery after LC in the present results, with opioid use beyond 24 hours recorded in 39.1% after LC compared with 75.5% after OC, consistent with the comparative observational study showing 38% versus 76%, respectively. Reduced opioid requirement after LC is compatible with the smaller incisions and reduced postoperative pain burden associated with minimally invasive surgery. Overall, across complication rates, wound morbidity, respiratory events, hospital stay, return to activities, and opioid requirement, the present results remain concordant with published comparative evidence and large LC series, supporting LC as the preferred approach for symptomatic cholelithiasis while maintaining the role of OC in selected cases or where laparoscopy is not feasible.

Laparoscopic cholecystectomy offers clear advantages over open cholecystectomy in patients with cholelithiasis, including lower postoperative morbidity, shorter hospital stay, reduced analgesic requirements, and faster recovery.

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