European Journal of Cardiovascular Medicine

Cholecystectomy is one of the most frequently performed abdominal surgeries worldwide, primarily indicated for symptomatic cholelithiasis and its complications. Traditionally, open cholecystectomy (OC) was regarded as the gold standard, but the advent of minimally invasive surgery has made laparoscopic cholecystectomy (LC) the preferred approach in most centers [1–3]. The advantages of LC, such as reduced postoperative pain, shorter hospitalization, and faster return to normal activities, have been consistently demonstrated in recent comparative analyses [2–4].

Nevertheless, LC is not devoid of risks. Complications such as bile duct injury, hemorrhage, or bile leak, though infrequent, remain clinically important [1,3]. On the other hand, OC provides direct visualization and operative access but is associated with higher morbidity, particularly wound infection, respiratory complications, prolonged analgesic use, and delayed convalescence [1,2,5].

Multiple studies and meta-analyses have highlighted these differences. For example, large-scale reviews and institutional studies have shown that LC reduces overall complication rates and enhances recovery compared to OC, while still requiring careful patient selection and surgical expertise [3–6]. However, variations persist across institutions depending on patient demographics, surgeon experience, and perioperative protocols [4,5].

Understanding short-term postoperative outcomes remains essential for refining surgical decision-making and improving patient safety. Evaluating complications, recovery time, and analgesic requirements in a comparative framework provides valuable insights, particularly for centers where both approaches are practiced and resources may limit universal adoption of minimally invasive surgery [2,4,6].

This study was therefore designed to comparatively analyze postoperative complications and recovery time in patients undergoing OC and LC. By systematically assessing short-term surgical outcomes, the study aims to generate evidence that may guide clinicians in refining treatment choices and inform patients about the relative risks and benefits of each technique.

Study Design and Setting:
This was a comparative observational study conducted at the Department of Surgery, Father Colombo Institute of Medical Sciences, Warangal, in collaboration with Medicare General Hospital, Warangal. The study was carried out over a period of four months, from November 2024 to February 2025.

Study Population:
A total of 100 patients diagnosed with symptomatic cholelithiasis and scheduled for cholecystectomy were enrolled. Patients were allocated into two groups based on the surgical approach: Open Cholecystectomy (OC, n = 50) and Laparoscopic Cholecystectomy (LC, n = 50).

Inclusion Criteria:

1. Adults aged 18–65 years with symptomatic gallstone disease.
2. Patients consenting to undergo either OC or LC.
3. Patients fit for surgery under general anesthesia.

Exclusion Criteria:

1. Patients with acute cholecystitis, empyema, or gallbladder perforation.
2. Previous upper abdominal surgery.
3. Known bleeding disorders or severe systemic illness (ASA ≥ IV).
4. Patients unwilling to provide informed consent.

Data Collection:
Baseline demographic details including age and gender were recorded. Postoperative parameters assessed included type and frequency of complications (wound infection, respiratory complications, bile leak, and mortality), duration of hospital stay, time to return to daily activities, and analgesic requirements. Analgesic usage was specifically categorized based on the need for opioid administration beyond 24 hours postoperatively.

Ethical Considerations:
Institutional Ethics Committee approval was obtained prior to the initiation of the study. Written informed consent was obtained from all participants.

Statistical Analysis:
Data were entered in Microsoft Excel and analyzed using SPSS version 26.0 (IBM Corp., Armonk, NY, USA). Categorical variables were expressed as frequencies and percentages, and compared using the chi-square test. Continuous variables were presented as mean ± standard deviation (SD) and analyzed using the independent Student’s t-test. A p-value < 0.05 was considered statistically significant.

A total of 100 patients were included in the study, with 50 undergoing open cholecystectomy (OC) and 50 undergoing laparoscopic cholecystectomies (LC). The baseline demographic profile, including mean age and gender distribution, was comparable between both groups, with no statistically significant differences observed (Table 1).

Table 1. Baseline Demographic Characteristics

Postoperative complications were reported in 28 patients (28%). The overall incidence was significantly higher in the OC group (36%) compared with the LC group (20%) (p = 0.04). Wound infection was the most frequent complication, occurring in 12% of OC cases and 4% of LC cases (p = 0.04). Respiratory complications were observed in 8% of OC patients versus 2% of LC patients, though this difference was not statistically significant. Bile leak occurred in 2 patients from each group, and no mortality was recorded (Table 2).

Table 2. Postoperative Complications

Recovery outcomes showed a clear advantage for laparoscopic surgery. The mean postoperative hospital stay was significantly shorter in the LC group (3.1 ± 1.2 days) compared to the OC group (6.8 ± 2.1 days; p < 0.001). Similarly, return to normal daily activities was earlier in LC patients (9.4 ± 2.5 days) than in OC patients (15.6 ± 3.4 days; p < 0.001) (Table 3).

Table 3. Recovery and Hospital Stay

Figure 1. Recovery and Hospital Stay After Cholecystectomy

Analgesic requirements were also lower among patients undergoing laparoscopic surgery. A significantly higher proportion of patients in the OC group (76%) required opioid analgesics beyond the first 24 hours postoperatively compared to 38% in the LC group (p < 0.001) (Table 4).

Table 4. Analgesic Requirement

This comparative observational study evaluated postoperative complications and recovery outcomes in patients undergoing open cholecystectomy (OC) and laparoscopic cholecystectomy (LC). The findings clearly demonstrated that LC was associated with fewer complications, shorter hospital stay, earlier return to daily activities, and reduced analgesic requirement compared to OC.

In the present study, the overall complication rate was significantly higher in OC (36%) than in LC (20%), with wound infection and respiratory complications being the most common morbidities in the OC group. Similar trends have been documented in multicenter studies, where LC consistently showed reduced postoperative morbidity due to minimal tissue trauma and faster mobilization [7,8].

The mean hospital stay was notably longer in OC patients (6.8 days) compared with LC patients (3.1 days). This finding aligns with previous international data, which confirmed that LC significantly reduces hospitalization and accelerates discharge when compared with conventional open procedures [8,9]. Furthermore, earlier resumption of daily activities in LC patients underscores the benefits of small incisions, reduced pain, and faster recovery, supporting its integration into enhanced recovery after surgery (ERAS) pathways [7,10].

Analgesic requirement was also markedly lower in LC, with fewer patients needing opioids beyond 24 hours postoperatively. Prior observational and systematic reviews have emphasized that reduced postoperative pain in LC not only minimizes opioid exposure but also improves long-term quality of life and patient satisfaction [11,13].

Despite its widespread acceptance, LC is not without limitations. Complications such as bile duct injury, though rare, require surgical expertise and careful intraoperative assessment. In difficult gallbladder cases, where LC is technically challenging, OC or subtotal cholecystectomy may still be warranted as a safe alternative [12]. Thus, surgical decision-making must be individualized, balancing patient factors, disease severity, and institutional resources.

Limitations: The study was limited by its single-center design and relatively small sample size. Long-term outcomes, including chronic pain and quality of life measures, were not assessed. Future multicenter studies with larger cohorts and extended follow-up are warranted to validate and generalize these findings.

This comparative observational study demonstrated that laparoscopic cholecystectomy offers significant advantages over open cholecystectomy in terms of postoperative outcomes. Patients undergoing the laparoscopic approach experienced fewer complications, particularly wound infections and respiratory issues, along with a markedly shorter hospital stay, earlier return to daily activities, and reduced analgesic requirements. These findings reaffirm the role of laparoscopic surgery as the preferred technique for managing symptomatic gallstone disease, aligning with enhanced recovery protocols. However, open cholecystectomy continues to remain relevant in select situations where laparoscopic intervention is not feasible. Broader multicenter studies with larger cohorts are recommended to strengthen generalizability and guide surgical decision-making.

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