Quality of life after randomization to laparoscopic versus open living donor nephrectomy: long-term follow-up

BACKGROUND: The aim of this randomized study was to compare patient-reported outcome after laparoscopic versus open donor nephrectomy during 1 year follow-up. The evidence base has so far not allowed for a decision as to which method is superior as seen from a long-term quality of life-perspective. METHODS: The donors were randomized to laparoscopic (n=63) or open (n=59) nephrectomy, with follow-up at 1, 6, and 12 months. Primary outcomes were health status (SF-36) and overall quality of life (QOLS-N). Secondary outcomes were donor perception of the surgical scar, the donation's impact on personal finances, and whether the donor would make the same decision to donate again. RESULTS: There was a significant difference in favor of laparoscopic surgery regarding the SF-36 subscale bodily pain at 1 month postoperatively (P<0.05). Analysis based on intention to treat revealed no long-term differences between groups in SF-36 scores. When subtracting the reoperated/converted donors of the laparoscopic group, significant differences in favor of laparoscopy were revealed in the subscales bodily pain at 6 months (P<0.05) and social functioning at 12 months (P<0.05). No significant differences were found in QOLS-N scores between groups. CONCLUSIONS: Laparoscopic donor nephrectomy is an attractive alternative to open donor nephrectomy because of less postoperative pain. However, long-term comparison only revealed significant differences in favor of laparoscopy when adjusting for reoperations/conversions. Both groups reached baseline scores in most SF-36 subscales at 12 months and this may explain why possible minor benefits are hard to prove.     

How do bile duct injuries sustained during laparoscopic cholecystectomy differ from those during open cholecystectomy?

BACKGROUND AND PURPOSE: Bile duct injuries sustained during laparoscopic cholecystectomy differ from those of open cholecystectomy. The authors conducted a retrospective analysis of their experience with 124 major bile duct injuries to identify these differences. PATIENTS AND METHODS: Biliary injury in 83 patients (67%) was sustained during open cholecystectomy, while in 41 patients (33%), it occurred during laparoscopic cholecystectomy. Intraoperative recognition was possible in 21 patients (25%) in the former group and in 14 patients (34%) in the latter (P < 0.05). RESULTS: The median time of presentation after laparoscopic cholecystectomy was 37 days v 240 days after open cholecystectomy (P < 0.001). Twenty-eight patients presented with external biliary fistulae in both groups. Spontaneous closure of these fistulae occurred in 21 patients (75%) in the open cholecystectomy group and in only 10 patients (36%) in the laparoscopic group (P < 0.01). Bismuth type III or IV injuries were the commonest type in the laparoscopic cholecystectomy group (N = 25; 61%) while Bismuth type I or II were the usual injuries in open cholecystectomy (N = 57; 69%) (P < 0.01). After hepaticojejunostomy, over a mean follow-up period of 3.4 years, stenosis of the hepaticojejunostomy was seen in two patients in both groups. CONCLUSION: Compared with open cholecystectomy, biliary injuries sustained during laparoscopic cholecystectomy are more likely to present earlier, are more often associated with persistent bile leaks, and are usually high injuries. However, the results of surgical repair do not appear to be different in these two groups.     

Three-year follow-up of a prospective randomized trial comparing laparoscopic versus open gastric bypass

OBJECTIVE: To analyze long-term weight loss, changes in comorbidities and quality of life, and late complications after laparoscopic and open gastric bypass. SUMMARY BACKGROUND DATA: Early results from our prospective randomized trial comparing the outcome of laparoscopic versus open gastric bypass demonstrated less postoperative pain, shorter length of hospital stay, fewer wound-related complications, and faster convalescence for patients who underwent laparoscopic gastric bypass. METHODS: Between May 1999 and March 2001, 155 morbidly obese patients were enrolled in this prospective trial, in which 79 patients were randomized to laparoscopic gastric bypass and 76 to open gastric bypass. Two patients in the laparoscopic group required conversion to open surgery; their data were analyzed within the laparoscopic group on an intention-to-treat basis. The 2 groups were well matched for body mass index, age, and gender. Outcome evaluation included weight loss, changes in comorbidities and quality of life, and late complications. RESULTS: The mean follow-up was 39+/-8 months. There were no significant differences in the percent of excess body weight loss between the 2 groups at the 3-year follow-up (77% for laparoscopic versus 67% for open). The rate of improvement or resolution of comorbidities was similar between groups. Improvement in quality of life, measured by the Moorehead-Ardelt Quality of Life Questionnaire, was observed in both groups without significant differences between groups. Late complications were similar between groups except for the rate of incisional hernia, which was significantly greater after open gastric bypass (39% versus 5%, P<0.01), and the rate of cholecystectomy, which was greater after laparoscopic gastric bypass (28% versus 5%, P=0.03). CONCLUSIONS: In this randomized trial with a 3-year follow-up, we found that laparoscopic gastric bypass was equally effective as open gastric bypass with respect to weight loss and improvement in comorbidities and quality of life. A major advantage at long-term follow-up for patients who underwent laparoscopic gastric bypass was the reduction in the rate of incisional hernia.     

Laparoscopic versus open appendectomy: a prospective randomized double-blind study

SUMMARY BACKGROUND DATA: The value of laparoscopy in appendicitis is not established. Studies suffer from multiple limitations. Our aim is to compare the safety and benefits of laparoscopic versus open appendectomy in a prospective randomized double blind study. METHODS: Two hundred forty-seven patients were analyzed following either laparoscopic or open appendectomy. A standardized wound dressing was applied blinding both patients and independent data collectors. Surgical technique was standardized among 4 surgeons. The main outcome measures were postoperative complications. Secondary outcome measures included evaluation of pain and activity scores at base line preoperatively and on every postoperative day, as well as resumption of diet and length of stay. Activity scores and quality of life were assessed on short-term follow-up. RESULTS: There was no mortality. The overall complication rate was similar in both groups (18.5% versus 17% in the laparoscopic and open groups respectively), but some early complications in the laparoscopic group required a reoperation. Operating time was significantly longer in the laparoscopic group (80 minutes versus 60 minutes; P = 0.000) while there was no difference in the pain scores and medications, resumption of diet, length of stay, or activity scores. At 2 weeks, there was no difference in the activity or pain scores, but physical health and general scores on the short-form 36 (SF36) quality of life assessment forms were significantly better in the laparoscopic group. Appendectomy for acute or complicated (perforated and gangrenous) appendicitis had similar complication rates, regardless of the technique (P = 0.181). CONCLUSIONS: Unlike other minimally invasive procedures, laparoscopic appendectomy did not offer a significant advantage over open appendectomy in all studied parameters except quality of life scores at 2 weeks. It also took longer to perform. The choice of the procedure should be based on surgeon or patient preference.     

Quality-of-life assessment of surgical reconstruction after laparoscopic cholecystectomy-induced bile duct injuries: what happens at 5 years and beyond?

HYPOTHESIS: Quality of life of patients after biliary reconstruction for laparoscopic injuries is comparable to that of patients after laparoscopic cholecystectomy. DESIGN: Outcomes study. SETTING: Tertiary referral center. PATIENTS: Records of 59 consecutive patients undergoing surgical reconstruction of the biliary tract after injury induced by laparoscopic cholecystectomy between 1990 and 1997 were reviewed. Hepp-Couinaud technique or Roux-en-Y hepaticojejunostomy was used in 53 patients; other procedures included cholangiojejunostomy, choledochorrhaphy, and hepaticoduodenostomy. INTERVENTIONS: Quality-of-life questionnaires (36-Item Short-Form Health Survey [SF-36]) were mailed to each patient in the group and to patients who underwent uneventful laparoscopic cholecystectomy, matched individually by year, sex, and age group. Values from the general population matched by age and sex were gathered (national norms). Minimum time of follow-up was 5 years. RESULTS: Eighty-nine (81%) of 110 potential respondents to the survey completed the SF-36 questionnaires. All 8 values evaluated in the SF-36 questionnaire (physical functioning, role-physical, bodily pain, general health perceptions, vitality, social functioning, role-emotional, and mental health index) for patients undergoing biliary reconstruction were similar to those of both their matched controls (all P >.10) and national norms (all P >.05). The standardized physical component scale was also similar between the 2 groups (cases vs controls, 51 vs 48; P =.47), as was the standardized mental component scale (cases vs controls, 55 vs 55; P =.60). CONCLUSIONS: With a minimum of 5 years of follow-up, the quality of life after surgical biliary reconstruction compares favorably with that of both patients undergoing uneventful laparoscopic cholecystectomy and national norms.     

Impact of choice of therapeutic strategy for acute cholecystitis on patient's health-related quality of life. Results of a randomized, controlled clinical trial

BACKGROUND: The aim of this prospective, randomized study was to determine if health related quality of life is affected by the choice of surgical strategy in the management of acute cholecystitis. MATERIAL AND METHODS: After diagnostic workup, patients were randomized to one of two groups: (1) early laparoscopic cholecystectomy (i.e. within 7 days after onset of symptoms) or (2) initial conservative treatment followed by delayed laparoscopic cholecystectomy. Seventy-four patients entered the early operation group and 71 patients were assigned to the delayed operation strategy. Assessments of quality of life were made at 1, 3 and 6 months after surgery, and in the delayed operation group also one month after the initial conservative treatment. RESULTS: The gastrointestinal symptom scores were significantly better in three dimensions (diarrhea, indigestion, abdominal pain) one month after surgery for the acute operation group (p < 0.01). Three and 6 months after the operation we were unable to detect any significant differences between the groups. The patients in the delayed operation group did not appear to suffer from more symptoms in the period of time waiting for their elective operation. Psychological general well-being showed no major differences between the groups. CONCLUSION: Cholecystectomy in the acute phase of acute cholecystitis offers a significant reduction of gastrointestinal symptoms during the first postoperative month and to that associated improved quality of life in this group of patients.     

Diminished interleukin-6 and C-reactive protein responses to laparoscopic versus open cholecystectomy

BACKGROUND: Cytokines and their inhibitors are thought to be involved in many of the pathophysiological changes associated with trauma and infection. The magnitude of the trauma and the degree of tissue damage have an impact on the trauma response. The purpose of the study was to examine cytokine and hormonal responses to elective cholecystectomy and the extent to which these responses are influenced by the surgical procedure employed. METHODS: Sixteen patients, ASA grades I and II, were studied: 8 of them underwent laparoscopic cholecystectomy while the remaining 8 were operated on using the open technique. Systemic concentrations of tumour necrosis factor alpha (TNF), interleukin-1 beta (IL-1), interleukin-6 (IL-6), cortisol, epinephrine and norepinephrine were measured before and during the operation and subsequently for up to 48 h postoperatively. The degree of pain and fatigue were recorded during the study period. RESULTS: The preoperative levels of cytokines and hormones were all similar in the groups. Concentrations of TNF and IL-1 were detected only sporadically. The rise in plasma IL-6 was less marked following laparoscopic than after open cholecystectomy. However, the hormonal response was quite similar in the two groups. Pain and fatigue scores were lower (P < 0.05-0.01) in the laparoscopic group than in the open surgery group. CONCLUSION: In summary, cholecystectomy, irrespective of whether it was performed using the laparoscopic or open technique, was followed by a trauma response and increased pain and fatigue. However, the magnitude of stress, pain and fatigue was less pronounced in laparoscopic cholecystectomy patients. Concentrations of IL-6 seem to be more sensitive when it comes to delineating the trauma response than systemic norepinephrine and epinephrine levels.     

Laparoscopic-assisted versus open ileocolic resection for Crohn's disease: a randomized trial

OBJECTIVE: The aim of the study was to compare laparoscopic-assisted and open ileocolic resection for primary Crohn's disease in a randomized controlled trial. METHODS: Sixty patients were randomized for laparoscopic-assisted or open surgery. Primary outcome parameter was postoperative quality of life (QoL) during 3 months of follow-up, measured by SF-36 and GIQLI questionnaire. Secondary parameters were operating time, morbidity, hospital stay, postoperative morphine requirement, pain, and costs. RESULTS: Patient characteristics were not different. Conversion rate was 10% (n=3). Median operating time was longer in laparoscopic compared with open surgery (115 versus 90 minutes; P<0.003). Hospital stay was shorter in the laparoscopic group (5 versus 7 days; P=0.008). The number of patients with postoperative morbidity within the first 30 days differed between the laparoscopic and open group (10% versus 33%; P=0.028). There was no statistically significant difference in QoL between the groups during follow-up. Significant time effects were found on all scales of the SF-36 (P<0.001) and the GIQLI score (P<0.001). QoL declined in the first week, returned to baseline levels after 2 weeks, and was improved 4 weeks and 3 months after surgery. Median overall costs during the 3 months follow-up were significantly different: euro6412 for laparoscopic and euro8196 for open surgery (P=0.042). CONCLUSIONS: Although QoL measured by SF-36 and GIQLI questionnaires was not different for laparoscopic-assisted compared with the open ileocolic resection, morbidity, hospital stay, and costs were significantly lower.     

Randomized clinical trial of open versus laparoscopic cholecystectomy in the treatment of acute cholecystitis

BACKGROUND: The aim of this prospective trial was to determine whether surgical approach (open versus laparoscopic) had an impact on morbidity and postoperative recovery after cholecystectomy for acute cholecystitis. METHODS: Seventy patients who met the criteria for acute cholecystitis were randomized to open or laparoscopic cholecystectomy. The type of operation was unknown to the patient and all hospital staff involved in the postoperative care. RESULTS: The two groups were similar with respect to demographic and clinical characteristics. There were no significant differences in rate of postoperative complications, pain score at discharge and sick leave. In eight patients a laparoscopic procedure was converted to open cholecystectomy. Median operating time was 90 (range 30-155) and 80 (range 50-170) min in the laparoscopic and open groups respectively (P = 0.040). The direct medical costs were equivalent in the two groups. Although median postoperative hospital stay was 2 days in each group, it was significantly shorter in the laparoscopic group (P = 0.011). CONCLUSION: Cholecystectomy for acute cholecystitis can be performed by either laparoscopic or open techniques without any major clinically relevant differences in postoperative outcome. Both techniques offer low morbidity and rapid postoperative recovery.     

胆道镜联合腹腔镜对保胆取石患者胃肠功能及生存质量研究

目的:评价经纤维胆道镜+腹腔镜微创保胆取石手术的临床效果.方法:将121例择期手术的胆囊功能正常的胆囊结石患者随机分为观察组(采用纤维胆道镜+腹腔镜微创保胆取石术)和对照组(采用腹腔镜胆囊切除术),比较两组术后胃肠功能及术前、术后2,4,8周及6个月的消化系统疾病生存质量指数(GIQLI)的变化.结果:观察组术后肠鸣音恢复时间、肛门排气及排便时间均明显短于对照组,胃肠道不良反应发生率及复发率均低于对照组(均P＜0.05);两组术前GIQLI无统计学差异(P＞0.05),但术后2,4,8周观察组GIQLI均明显高于对照组(均P＜0.01),至术后6个月两组的GIQLI基本接近(P＞0.05).结论:胆道镜+腹腔镜保胆取石术后患者胃肠功能恢复更快,短期内生存质量提升更高.     

The technique of laparoscopic cholecystectomy in children.

Twelve children underwent elective laparoscopic cholecystectomy for symptomatic cholelithiasis during a 10-month period in one institution. The operative technique that has been described for adults was modified because of the smaller dimensions of pediatric patients. These modifications are discussed in this report, as are new alternatives for evaluating the common duct. No operative complications or conversions to open cholecystectomy occurred, and no complications after surgery were seen during an average follow-up period of 4.5 months. The benefits of laparoscopic cholecystectomy include decreased pain and ileus after surgery, shortened hospitalization, and improved cosmesis. Laparoscopic cholecystectomy is safe and efficacious in children, and it compares favorably with traditional cholecystectomy in the pediatric age group.     

急性结石性胆囊炎行小切口胆囊切除术与腹腔镜胆囊切除术的疗效分析

目的:分析腹腔镜胆囊切除术与小切口胆囊切除术治疗急性结石性胆囊炎的临床效果.方法:回顾总结2017年5月至2019年8月手术治疗的61例急性结石性胆囊炎患者的临床资料,42例行腹腔镜胆囊切除术(腹腔镜组),19例行开腹小切口胆囊切除术(小切口组).比较两组手术时间、术中出血量、切口长度、术后第1天疼痛评分、引流管留置时...     

腹腔镜与传统开腹手术治疗胆总管结石的临床应用比较

目的比较腹腔镜胆囊切除＋胆总管切开探查取石术和传统开腹胆囊切除＋胆总管切开探查取石术的临床效果和医疗费用。方法55例胆总管结石患者分两组,A组25例行腹腔镜胆囊切除＋胆总管切开取石术;B组30例行传统开腹胆囊切除＋胆总管切开取石术。统计手术时间,术后开始下床活动时间,术后胃肠功能恢复时间,术后住院时间,术后并发症和总住院费用。结果两组患者都顺利完成手术,术后两组各有1例患者胆道造影残留结石,两组手术时间无显著差异,A组患者术后下床活动时间、胃肠功能恢复时间较B组患者早,术后A组住院时间较B组短,住院费用A组较B组增多。结论腹腔镜胆总管切开取石术完全能达到传统开腹胆道切开取石术的效果,并具有创伤小,痛苦少,恢复快的优点,是治疗胆总管结石的理想手术方式之一。     

3D腹腔镜手术治疗胃底部间质瘤的临床疗效

目的:探讨3D腹腔镜手术治疗胃底部间质瘤的临床应用价值。方法:回顾性分析武汉大学人民医院2014年1月—2015年6月间收治的36例胃底部间质瘤患者临床资料,其中18例行3D腹腔镜手术(3D腔镜组),18例行开腹手术(开放手术组),比较两组患者的围手术期指标,术后病理资料及复发转移情况。结果:两组患者在年龄、性别、BMI、肿瘤大小等一般资料方面差异无统计学意义(均P0.05)。两组手术时间差异无统计学意义(P0.05),但3D腔镜组在术中出血量、手术切口长度、术后排气时间及住院天数等指标方面均明显优于开放手术组(均P0.05)。两组患者均未出现肿瘤破裂以及切缘阳性的情况,均未发生大出血、吻合口瘘、术后肠梗阻等严重并发症,术后病理及免疫组化特征均无明显差异(均P0.05)。所有患者随访12~36个月,无复发、转移及死亡病例。结论:应用3D腹腔镜技术治疗胃底部间质瘤,能明显减少患者的手术创伤,且远期疗效与开放手术相似。     

Three-port versus standard four-port laparoscopic cholecystectomy: a randomized controlled clinical trial in a community-based teaching hospital in eastern Nepal.

OBJECTIVES: With increasing surgeon experience, laparoscopic cholecystectomy has undergone many refinements including reduction in port number and size. Three-port laparoscopic cholecystectomy has been reported to be safe and feasible in various clinical trials. However, whether it offers any additional advantages remains controversial. This study reports a randomized trial that compared the clinical outcomes of 3-port laparoscopic cholecystectomy versus conventional 4-port laparoscopic cholecystectomy. METHODS: Seventy-five consecutive patients who underwent elective laparoscopic cholecystectomy were randomized to undergo either the 3-port or the 4-port technique. Four surgical tapes were applied to standard 4-port sites in both groups at the end of the operation. All dressings were kept intact until the first follow-up 1 week after surgery. Postoperative pain at the 4 sites was assessed on the first day after surgery by using a 10-cm unscaled visual analog scale (VAS). Other outcome measures included analgesia requirements, length of the operation, postoperative stay, and patient satisfaction score on surgery and scars. RESULTS: Demographic data were comparable for both groups. Patients in the 3-port group had shorter mean operative time (47.3+/-29.8 min vs 60.8+/-32.3 min) for the 4-port group (P=0.04) and less pain at port sites (mean score using 10-cm unscaled VAS: 2.19+/-1.06 vs 2.91+/-1.20 (P=0.02). Overall pain score, analgesia requirements, hospital stay, and patient satisfaction score (mean score using 10-cm unscaled VAS: 8.2+/-1.7 vs 7.8+/-1.7, P=0.24) on surgery and scars were similar between the 2 groups. CONCLUSION: Three-port laparoscopic cholecystectomy resulted in less individual port-site pain and similar clinical outcomes with fewer surgical scars and without any increased risk of bile duct injury compared with 4-port laparoscopic cholecystectomy. Thus, it can be recommended as a safe alternative procedure in elective laparoscopic cholecystectomy.     

Quality of life,pain and return to normal activities following laparoscopic donor nephrectomy versus open mini-incision donor nephrectomy

PURPOSE: We evaluated pain, convalescence and health related quality of life in patients undergoing laparoscopic and open mini-incision donor nephrectomy. MATERIALS AND METHODS: We compared the records of consecutive patients who underwent laparoscopic and mini-incision open donor nephrectomy from our donor nephrectomy data base in retrospective fashion using 2 questionnaires. The first questionnaire evaluated postoperative pain, return to functioning time and satisfaction. The second questionnaire was the RAND 36-Item Health Survey, version 2, a standardized and validated health survey quality of life assessment tool. Mean patient sex, age and followup were similar for the 2 groups. All data were analyzed using the 2-tailed t test for independent variables with commercially available statistical analysis software. RESULTS: Pain in the laparoscopic group was significantly less than in the mini-incision group at all followup time points (p <0.05). Statistically significant differences demonstrated that laparoscopy led to more rapid recovery time in certain categories, including walking, discontinuation of prescribed oral pain relievers, return to driving, and resumption of normal work and home daily activities. More subjective questions in the survey showed high levels of acceptance for the 2 procedures. Using the RAND 36-Item Health Survey, version 2 health related quality of life was significantly higher in the laparoscopy group in 3 domains that measure bodily pain, physical functioning and emotional role functioning. However, each group scored at or above age matched American averages in all domains. CONCLUSIONS: The laparoscopy group had significantly less postoperative pain and required less time to return to normal functional activities than the mini-incision group. In addition, the laparoscopic group showed significantly higher quality of life scores than the mini-incision group in 3 domains.     

腹腔镜与传统开腹胆囊切除术对糖尿病患者影响的对比研究

目的:对比分析腹腔镜胆囊切除术与传统开腹手术对糖尿病患者的影响.方法:回顾分析85例患者行胆囊切除术的临床资料,分为腹腔镜组与传统手术组,对比两组患者术后并发症发生率及住院时间.结果:腹腔镜组术后并发症及住院时间优于传统开腹手术(P＜0.05).结论:腹腔镜胆囊切除术能有效地减少糖尿病患者术后并发症的发生,可作为糖尿病...     

腹腔镜胆囊切除术与传统开腹胆囊切除术治疗胆囊结石临床疗效比较

目的 比较腹腔镜胆囊切除术与开腹胆囊切除术两种术式治疗胆囊结石的临床疗效.方法 选取2012年5月至2013年3月我院行手术治疗胆囊结石患者120例,其中60例行腹腔镜胆囊切除术作为观察组,开腹胆囊切除术手术治疗60例作为对照组.观察并比较两组临床疗效结果.结果 研究组术中出血量少于对照组,手术时间、胃肠道功能恢复时间及术后住院时间短于对照组,两组比较,差异有统计学意义（P＜0.05）;对照组、观察组术后并发症发生率分别为20％、5.0％,差异有统计学意义（P＜0.05）.结论 腹腔镜胆囊切除术具有创伤小、恢复快、住院时间短和并发症少等优点,值得临床推广.     

Minilap辅助经脐单孔腹腔镜下胆囊切除术的临床应用研究

目的:探讨Minilap辅助下经脐单孔腹腔镜下胆囊切除术的可行性。方法:随机选取2015年1月—2015年12月包头医学院第一附属医院普外一科住院胆囊结石、胆囊息肉患者40例,按照自愿的原则分为对照组与观察组,每组20例,分别行经脐单孔腹腔镜胆囊切除术(对照组)与Minilap辅助经脐单孔腹腔镜胆囊切除术(观察组)。比较两组患者的相关临床指标。结果:40例腹腔镜手术均获成功,无中转开腹。与对照组比较,观察组平均手术时间(29.90 min vs.19.10 min,P=0.000)与术中出血量(4.90 mL vs.8.05 mL,P=0.000)明显减少;术后住院时间、疼痛评分、术后使用镇痛药物、对瘢痕满意度方面两组间均无统计学差异(均P0.05)。术后随访10~18个月,患者术后恢复良好,Minilap穿刺点无明显疤痕。结论:Minilap辅助下经脐腹腔镜胆囊切除术安全可行、术后美容效果好,降低了手术难度,值得临床应用。     

Elective transumbilical compared with standard laparoscopic cholecystectomy.

OBJECTIVE: To compare the transumbilical technique of laparoscopic cholecystectomy with standard laparoscopic cholecystectomy. DESIGN: Randomised open study. SETTING: Teaching hospital, Italy. SUBJECTS: 90 patients who required elective cholecystectomy under general anaesthesia. INTERVENTIONS: Standard laparoscopic cholecystectomy through 4 ports or transumbilical cholecystectomy through 2 ports. MAIN OUTCOME MEASURES: Amount of pain and analgesia, cost, side effects, and cosmesis. RESULTS: 25 patients were excluded from analysis (8 in the standard group because relevant data were not recorded; and 17 in the transumbilical group in 4 of whom relevant data were not recorded, and 13 for technical reasons). 32 patients who had standard, and 25 who had transumbilical cholecystectomy had operative cholangiograms. There were no complications, no side effects, and no conversions to open cholecystectomy. Those who had transumbilical cholecystectomy had significantly lower pain scores (p<0.05) and required significantly less analgesia during the first 24 hours (p<0.05) than those who had standard laparoscopic cholecystectomy. CONCLUSION: Once the learning curve has been completed, transumbilical cholecystectomy is possible without some of difficulties associated with standard laparoscopic cholecystectomy.