Introduction: Upper abdominal surgery is associated with severe postoperative pain and a concomitant vulnerability to a troublesome postoperative period. Laparoscopic cholecystectomy is thought to result in less postoperative pain compared with open cholecystectomy. The incision used for open cholecystectomy has been getting smaller over the past decade, with an attendant reduction in postoperative morbidity. This minimal trauma procedure had a good safety record. Before mini­cholecystectomy could be established in surgical practice, laparoscopic removal of the gallbladder was introduced and rapidly became popular despite early concerns about its safety.

Objective: The purpose of this study was to assess laparoscopic cholecystectomy and mini-cholecystectomy; comparing feasibility, operative time, postoperative pain, analgesic requirement and complications.

Patients and Methods: This work was conducted in the general surgical department in Ain Shams University Hospitals in the period between December 1999 and January 2002. In this prospective study 50 patients with acute (n=5, 10%) and Symptomatic chronic (n=45, 90%) cholelithiasis were operated upon, 25 laparoscopic cholecystectomy and 25 mini­cholecystectomy. A four port technique was used for laparoscopic procedures and an incision less than 10 cm for the open surgery.

Results: Compared with mini-cholecystectomy, laparoscopic cholecystectomy took significantly shorter operative time (46 min versus 69 min, P<0.001), was associated with lower pain scoring (P<0.001) and less postoperative morphine consumption in the first and second postoperative days (23 mg versus 40 mg and 3 mg versus 12 mg, P<0.001). Laparoscopic cholecystectomy has no significant difference over mini- cholecystectomy in operative and postoperative complications. Both techniques showed no significant difference in hospital stay or in the period to return to full activity.

Conclusion: This study confirms that the operative time, postoperative pain and its sequelae are significantly reduced by the laparoscopic technique. A safe mini- cholecystectomy needs special instruments and illumination that may not be available in some hospitals. However, the latter approach can be applied if laparoscopy is not available and if safety is questioned the mini-scar should be converted to a formal right subcostal incision.