Comparison of Early Outcomes and Costs Between Laparoscopic and Open Cholecystectomy for Mild and Moderate Cases of Cholelithiasis in Rural Morocco: A Retrospective Comparative Study

Background: Laparoscopic cholecystectomy (LC) was first introduced in the late 80’s, replacing open cholecystectomy as the standard surgical approach for cholelithiasis in developed countries. In contrast, there were initially many controversies in developing countries regarding the laparoscopic techniques. Objectives: This study aimed to compare the early outcomes and costs between laparoscopic and open cholecystectomy for cholelithiasis in a rural hospital in a developing country. Patients and Methods: This retrospective study included all consecutive patients who underwent cholecystectomy for mild and moderate symptomatic gallstone, in the Marche Verte hospital, in the Boulemane province in Morocco between January and December 2011. Demographics, postoperative outcomes, and costs were compared between laparoscopic and open surgery groups. Duration of hospital stay was calculated from the time of operation to the time of discharge. The total costs for each patient included the sum of: the average hospitalization costs per day; the average operating room costs; and material and medications costs. Chi-square test or Fisher’s exact test and student or Mann-Whitney U tests were used for comparison, as appropriate. Results: During the study period, 95 patients were included; among them, 53 patients underwent laparoscopic surgery and 42 laparotomy. There were no statistical differences between the two groups concerning age, gender distribution, American society of anesthesiologists (ASA) classification, and number of acute cholecystitis. Rate of conversion to open surgery was 5.6% (3 patients). Patients in the laparoscopic group had shorter hospital stay (2.9 vs. 4.7 days, P = 0.0001), lower rates of infectious complications (3.7% vs. 16.6%, P = 0.04), and lower costs (169 vs. 231.62 US dollars, P = 0.0001). Conclusions: The results of the present study showed that, in a rural hospital setting in a developing country, laparoscopic cholecystectomy for symptomatic cholelithiasis was associated with shorter hospital stay, less infectious morbidity rates, and reduced costs, compared to open surgery. Thus, laparoscopic cholecystectomy should be advised as a routine technique for management of cholelithiasis in rural areas of developing countries.