The impact of laparoscopic cholecystectomy on the practice and training of gallbladder surgery in Thailand

Abstract

The objective of this study was to find out the impact laparoscopic cholecystectomy had on the practice and training of cholecystectomy in Thailand. This study involved prospective interviewing by questionnaires, of patients who had had cholecystectomies by laparoscopic cholecystectomy (LC) and open cholecystectomy (OC) techniques starting from their immediate postoperative days, comparison of the length of hospital stay and the costs of LC and OC, and the surveillance of Thai laparoscopic surgeons' experience and surgical residents' attitude towards this procedure. The results revealed that laparoscopic surgeons offered LC to most of their patients with gallstones but in each institution the proportion of cholecystectomies performed was below 70%. Patients' satisfaction was higher and postoperative pain was less after LC. Complications occurred in 2.12% (37 in 1744 patients). The length of hospital stay was slightly shorter (2.68 +/- 0.62 versus 3.30 +/- 0.95 days) and the expenses were only slightly higher for LC. Most residents were interested to learn this procedure only after they have finished their formal surgical training; they still felt that LC was suitable only for patients with a higher economic status and that it was associated with a higher complication rate. This study suggest that LC did have an impact on the practice of cholecystectomy and future planning of trainings should take into account the necessity to change residents' misunderstanding about the suitability of this procedure in appropriate patients.