Background
During the last two decades laparoscopic cholecystectomy (LC) has become the golden standard of the treatment of symptomatic gallbladder disease. Compared to the traditional open cholecystectomy (OC), LC is associated with lower morbidity and mortality, shorter length of hospital stay and faster return to normal activities. However LC is associated with higher incidence of iatrogenic bile duct injuries than OC.
Still, according to register studies, some 10 to 30 % of all cholecystectomies are performed using open technique, particularly in elderly population and in acute cholecystitis. In addition, the open technique is still needed, when the laparoscopic operation cannot be completed safely and the conversion to open procedure is required. According to the literature, current conversion rate varies between 5 and 10 %. The majority of conversions are performed because of obscure anatomy (difficult cholecystitis) or bleeding complications.
The incidence of bleeding complications requiring transfusion or reoperation has been reported to be relatively rare, occurring in 0.1 % in patients undergoing LC. Focus in the literature, however, has been on biliary complications of LC. Yet, major vascular complications, even though rare, are also serious complications of laparoscopy. In addition, bleeding remains a frequent reason for conversion. Regarding OC, only few studies have reported the incidence of bleeding complications in the laparoscopic era. Bleeding has been reported to occur in 0.4 % of patients undergoing OC. There are very little data on transfusion rates of red blood cells (RBCs) and hospital costs related to bleeding in cholecystectomies.
The purpose of this study is to compare transfusion rates, amounts of transfusions and related costs between LC and OC in a large Finnish register-based cohort. No prior data of blood transfusion and related costs in LC is currently available.