Editor—We are surprised that in his review of the gall bladder as a cause of upper abdominal pain Johnson fails to mention small incision cholecystectomy (mini-cholecystectomy) as an alternative to the laparoscopic approach.1 This was being used before laparoscopic surgery was adopted, with excellent results—for example, 88% of patients were being operated on as day cases. It is unfair to compare laparoscopic surgery with the traditional (large incision) open operation, which is only occasionally done now.
Several randomised controlled trials comparing mini-cholecystectomy and laparoscopic cholecystectomy have shown virtually no difference between them, except that laparoscopic surgery is more expensive. If Johnson is unhappy with the findings of the Sheffield trial, we would draw his attention to a large Swedish trial with over 700 patients, conducted to the same single blinded design.2 The findings of this study closely paralleled our own.
Mini-cholecystectomy is an even better option for suspected common bile duct stones than the methods mentioned by Johnson: it is easy to explore the duct through this carefully placed small incision, and even to do a cholecystoduodenostomy if necessary.
References
- 1.Johnson CD. ABC of the upper gastrointestinal tract: Upper abdominal pain: Gall bladder. BMJ. 2001;323:1170–1173. doi: 10.1136/bmj.323.7322.1170. . (17 November.) [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Ros A, Gustafsson L, Krook H, Nordgren CE, Thorell A, Wallin G, et al. Laparoscopic cholecystectomy versus mini-laparotomy cholecystectomy: a prospective, randomized, single-blind study. Ann Surg. 2001;234:741–749. doi: 10.1097/00000658-200112000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]