PUBLIC HEALTH ASPECT OF COMPARISON OF LAPAROSCOPIC AND OPEN METHOD OF CHOLECYSTECTOMY

The inflammation of the gallbladder (cholecystitis) is a disease which surgical treatment accounts for the largest percentage of abdominal surgeries. Surgery may be laparoscopic or open approach. The purpose of this study was to compare the laparoscopic to the open method of cholecystectomy in terms of public health interest. The survey included 194 patients with inflammation of the gallbladder, which depending on the type of surgical technique of cholecystectomy were divided into two groups. The first group consisted of 98 (50.52%) patients who were operated on with laparoscopic approach and the second group of 96 (49.48%) patients that were operated on with the open access method. Comparison of the two surgical techniques was based on the evaluation of objective parameters: the duration of surgical intervention, days of hospitalization, days of justified absence from work, financial cost for antibiotics, analgesics and anticoagulants used in the therapy, and total financial cost of the medical institution running the surgical procedure. A unified protocol for diagnosis and treatment was applied in all patients. The study was conducted in accordance with the provisions of the Helsinki Declaration and the Declaration of Human Rights of the European Union. Statistical data processing was done using the statistical program SPSS for Windows 17,0. The results showed that the laparoscopic cholecystectomy compared to the open method is characterized by a significantly shorter duration of surgical intervention (p = 0.000016), shorter hospital stay of the patient (p <0.0001) and faster return to job (p <0.0001). Significantly lower doses of analgesics (p = 0.0013), antibiotics (p <0.0001) and anticoagulant therapy (p = 0.00004) were used. The total cost of treatment for laparoscopic treated patients group was significantly lower compared to the group treated with the method of open access (p = 0.0001). The total financial benefit of laparoscopic cholecystectomy expressed through lower total cost of treatment and lower total cost spent on medication, and fewer days spent on sick leave, and thus faster return to normal duties, proved the advantage of this method.