A comparative study of patient satisfaction in conventional versus laparoscopic cholecystectomy in a teaching hospital in Assam
Objective: This study was carried out to assess and compare patient satisfaction, scar pain and cosmesis between open and laparoscopic cholecystectomies.
Study design: Prospective Comparative observational study
Place and duration of study: Guwahati Medical College Hospital (GMCH) and Mahendra Mohan Choudhury hospital (MMCH) May 2014 to Nov 2017
Methodology: A total of 500 patients from each group who had undergone open and laparoscopic cholecystectomy in all units of the Surgical Department, were included. Data was collected on questionnaires given and read to the patients along with counselling and information regarding scar-pain using visual analog score on a 0 - 10 scale and satisfaction using SAPS questionnaire. This was done pre and postoperatively on patients till the patient get discharged from the hospital.
Results: The Mean VAS score postoperatively was higher for open-cholecystectomy 8.14 (OC) compared to 4.97 for laparoscopic-cholecystectomy (LC) (p< 0.001 and < 0.001).
Women Aged between (20-45yrs) were interested to rate the cosmesis on the basis of length of incisional scar and post scare mark (58.1%) rated as best in LC and (36.9%) rated good with p-value < 0.0001. Mean-cosmesis score was higher for laparoscopic-cholecystectomy for those younger than 40, females and unmarried.
36.1% in LC and 19% in OC were very satisfied with the treatment care. In explanation of the treatment and result 42% LC and 24.6% OC patients were fully satisfied. In Clinical care part and only 20% of the LC and OC patients were fully satisfied with Hospital care.
Conclusion: Overall patient-satisfaction and cosmesis scoring was higher for laparoscopic-cholecystectomy especially among females, unmarried and younger than 40 years. Patients of 40 years and older had greater satisfaction scoring for open-cholecystectomy. Despite the superiority of LC in terms of overall morbidity, hospital stay and lesser pain and analgesic requirement, patients admitting in GMCH and MMCH, especially those belonging to rural areas, do not prefer the laparoscopic approach because LC in local language is referred to as laser surgery and chances of reoccurrence in LC is more as per the local belief. Greater fear and little knowledge of LC prior to surgery is associated with a lower or not opted for LC in GMCH and MMCH.