USPOREDBA OTVORENE I LAPAROSKOPSKE KOLECISTEKTOMIJE U LIJEČENJU AKUTNOG KOLECISTITISA

LJUBO BEGIĆ, ŽELJKO GLAVIĆ, DAMIR ŠIMLEŠA, ANTUN RUKAVINA, DUJO GVERIĆ, SREĆKO SABALIĆ

U radu su analizirani i uspoređeni rezultati liječenja akutnog kolecistitisa otvorenim i laparoskopskim načinom u sedmogodišnjem periodu. U sedmogodišnjem periodu (od 1994. do 2000.) operirano je 311 bolesnika zbog kliničke slike akutnog kolecistitisa. Otvorena kolecistektomija učinjena je kod 162 (52,09%) bolesnika, a laparoskopska kod 149 (47,91%). U obje grupe bolesnika vrijeme od pojave kliničkih simptoma do operacije te prijeoperacijska obrada i priprema bili su jednaki. U grupi bolesnika operiranih otvorenom metodom operacija je trajala 93 (±SD) minute, a u grupi laparoskopski operiranih 114 (±SD) minuta. Bolesnici operirani otvorenom metodom primili su 5,83 (±SD) ampule i 3,75 (±SD) tableta analgetika, a laparoskopski operirani 3,2 (±SD) ampule i 2,1 (±SD) tabletu po bolesniku. Antibiotik je primalo 149 bolesnika operiranih otvorenom metodom 4,9 (±SD) dana i 68 laparoskopski operiranih bolesnika 2,29 (±SD) dana. Bolesnici operirani otvorenom metodom boravili su u bolnici 9,55 (±SD) dana i na bolovanju proveli 43 (±SD) dana, a laparoskopski operirani su u bolnici bili 4,35 (±SD) dana i na bolovanju 16 (±SD) dana. Bolji klinički rezultati i brži povratak svakodnevnim aktivnostima upućuju na značajnu prednost laparoskopske kolecistektomije. Analiza rezultata pokazuje da su ukupni troškovi liječenja zaposlenih i radno aktivnih bolesnika značajno niži kod laparoskopski operiranih, zbog kraćeg bolničkog liječenja, kraćeg trajanja bolovanja i bržeg oporavka.

Summary. The paper analyses and compares the results of the treatment of acute cholecystitis with open and laparoscopic approach in a seven-year period. From 1994 to 2000, 311 patients with clinical picture of acute cholecystitis were operated. Open cholecystectomy was done in 162 (52.09%) patients, and laparoscopy in 149 (47.91%). In both patient groups the time from the onset of clinical symptoms to the surgery, and preoperative workup and preparation, were the same. In patients with open surgery the procedure lasted 93 (±SD) minutes, and in those with laparoscopic surgery 114 (±SD) minutes. Those operated with open method received 5.83 (±SD) ampules and 3.75 (±SD) tablets of analgesics, and those with laparoscopic surgery 3.2 (±SD) ampules and 2.1 (±SD) tablets per patient. Antibiotics were administered to 149 patients with open surgery for 4.9 (±SD) days and to 68 of those with laparoscopic surgery for 2.29 (±SD) days. Patients with open surgery stayed in the hospital 9.55 (±SD) days and were on sick leave 43 (±SD) days, and those with laparoscopy spent 4.35 (±SD) days in hospital and were 16 (±SD) days on sick leave. In conclusion, better clinical results and faster return to everyday activities point to the significant advantage of laparoscopic cholecystectomy. Analysis of the results shows that total costs of treatment of working patients are significantly lower than of those with laparoscopic surgery, due to shorter hospital stay, shorter sick leave, and faster recovery.