Abstract
Background
The purported advantages of laparoscopic surgery over conventional open techniques are less pain and faster return to normal functional status. Very few studies have included validated measures of quality of life as end points. This study prospectively assessed the health status outcomes of patients undergoing four types of laparoscopic and open operations.
Methods
Preoperatively, patients undergoing elective inguinal hernioplasty, esophageal surgery, cholecystectomy, and splenectomy completed the SF-36, a well-tested, validated health-status instrument. This instrument measures physical functioning (PF), role-physical (RP), role-emotional (RE), bodily pain (BP), vitality (VT), mental health (MH), social functioning (SF), and general health (GH) health status domains. Patients then underwent either laparoscopic or open surgery. Patients were reassessed with the instrument ≥6 weeks after surgery. A total of 100 patients underwent these procedures.
Results
Compared to preoperative values, median SF-36 scores for laparoscopic cholecystectomy patients were improved in the domains of PF (85 vs 95, p=0.01), BP (42 vs 75, p=0.002), and VT (47.5 vs 70, p=0.04); open cholecystectomy patients did not show statistically significant improvements over preoperative values. In addition, laparoscopic cholecystectomy patients had a better score than open cholecystectomy patients in the BP domain (75 vs 41, p=0.05). Laparoscopic esophageal surgery patients had better scores than open surgery patients in the domains of RP (100 vs 0, p=0.02) and VT (65 vs 52.5, p=0.05). Compared to preoperative values, laparoscopic splenectomy patients had an improved score in GH (52 vs 77, p=0.02) and better scores than open splenectomy patients in PF (90 vs 45, p=0.05) and BP (84 vs 55.5, p=0.01). Compared to preoperative values, open mesh hernioplasty patients showed improved scores in PF (70 vs 92.5, p=0.03) and MH (72 vs 84, p=0.05). Laparoscopic hernioplasty did not produce improved scores compared to either preoperative values or open hernioplasty.
Conclusions
Laparoscopic surgery has demonstrably better quality-of-life outcomes than open surgery for cholecystectomy, splenectomy, and esophageal surgery. However, open hernioplasty has at least as good, if not better, health status outcomes than laparoscopic repair.
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References
Ancona E, Anselmino M, Zaninotto G, et al. (1995) Esophageal achalasia: laparoscopic versus conventional open Heller-Dor operation. Am J Surg 170: 265–270
Arregui ME, Fitzgibbons RJ Jr, Katkhouda N, McKernan JB, Reich H (1995) Principles of laparoscopic surgery: basic and advanced techniques. Springer-Verlag, New York
Brunt LM, Langer JC, Quasebarth MA, Whitman ED (1996) Comparative analysis of laparoscopic versus open splenectomy. Am J Surg 172: 596–601
Chung RS, Rowland DY, Diaz J (1998) Is laparoscopic hernia repair better? A meta-analysis. [Abstract]. Surg Endosc 12[suppl]: S2
Delaitre B (1995) Laparoscopic splenectomy: the “hanged spleen” technique. Surg Endosc 9: 528–529
Deziel DJ, Millikan KW, Economou SG, et al. (1993) Complications of laparoscopic cholecystectomy: a national survey of 4,292 hospitals and an analysis of 77,604 cases. Am J Surg 165: 9–14
Eypasch E, Neugebauer E, Fischer F, Troidl H (1997) Laparoscopic antireflux surgery for gastroesophageal reflux disease (GERD): results of a consensus development conference. Surg Endosc 11: 413–426
Filipi CJ, Gaston-Johansson F, McBride PJ, et al. (1996) An assessment of pain and return to normal activity: laparoscopic herniorrhaphy vs open tension-free Lichtenstein repair. Surg Endosc 10: 983–986
Fitzgibbons RJ Jr, Camps J, Cornet DA, et al. (1995) Laparoscopic inguinal herniorrhaphy: results of a multicenter trial. Ann Surg 221: 3–13
Frantzides CT (ed) (1995) Laparoscopic and thoracoscopic surgery. Mosby, St. Louis
Goodwin JS II, Traverso LW (1995) A prospective cost and outcome comparison of inguinal hernia repairs: laparoscopic transabdominal preperitoneal versus open tension-free preperitoneal repairs. Surg Endosc 9: 981–983
Hunter JG, Trus TL, Branum GD, Waring JP, Wood WC (1996) A physiologic approach to laparoscopic fundoplication for gastroesophageal reflux disease. Ann Surg 223: 673–687
Huntington TR (1997) Short-term outcome of laparoscopic paraesophageal hernia repair: a case series of 58 consecutive patients. Surg Endosc 11: 894–890
Isolauri J, Luostarinen M, Viljakka M, et al. (1997) Long-term comparison of antireflux surgery versus conservative therapy for reflux esophagitis. Ann Surg 225: 295–299
Legorretta AP, Silber JH, Costantino GN, Kobylinski RW, Zatz SL (1993) Increased cholecystectomy rate after introduction of laparoscopic cholecystectomy. JAMA 270: 1429–1432
Liem MS, van der Graff Y, van Steensel CJ, et al. (1997) Comparison of conventional anterior surgery and laparoscopic surgery for inguinal hernia repair. N Engl J Med 336: 1541–1547
Pellegrini CA, Wetter L, Patti M, et al. (1992) Thoracoscopic esophagomyotomy: initial experience with a new approach for the treatment of achalasia. Ann Surg 216: 291–299
Peters JH, Heimbucher J, Kauer WKH, et al. (1995) Clinical and physiologic comparison of laparoscopic and open Nissen fundoplication. J Am Coll Surg 180: 385–393
Pilcher DE, Martin DT, Zucker KA (1995) Laparoscopic cholecystectomy. In: Arregui ME, Fitzgibbons RJ Jr, Katkhouda N, McKernan JB, Reich H (eds) Principles of laparoscopic surgery: basic and advanced techniques. Springer-Verlag, New York, pp. 113–128
Raiser F, Perdikis G, Hinder RA, et al. (1996) Heller myotomy via minimal-access surgery: an evaluation of antireflux procedures. Arch Surg 131: 593–598
Rothenberg SS (1996) Laparoscopic splenectomy using the harmonic scalpel. J Laparoendosc Surg 6(suppl 1): S61-S63
Stephens BJ, Justice JL, Sloan DA, Yoder JA (1997) Elective laparoscopic splenectomy for hematologic disorders. Am Surg 63: 700–703
Traverso LW (1996) Technology and surgery: dilemma of the gimmick, true advances, and cost effectiveness. Surg Clin North Am 76: 129–138
Trus TL, Bax T, Richardson WS, et al. (1997) Complications of laparoscopic paraesophageal hernia repair. J Gastrointest Surg 1: 221–228
Velanovich V (1998) Gastroesophageal reflux disease: assessing quality of life and symptom severity. Motility 41: 4–6
Velanovich V, Vallance SR, Gusz JR, Tapia FV, Harkabus MA (1996) Quality of life scale for gastroesophageal reflux disease. J Am Coll Surg 183: 217–224
Willekes CL, Edoga JK, Frezza E (1997) Laparoscopic repair of paraesophageal hernia. Ann Surg 225: 31–38
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Velanovich, V. Laparoscopic vs open surgery. Surg Endosc 14, 16–21 (2000). https://doi.org/10.1007/s004649900003
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DOI: https://doi.org/10.1007/s004649900003