Abstract
Laparoscopic cholecystectomy has been introduced for gallstone therapy and its use
appears currently to be spreading very rapidly. A clinical decision analysis was performed
to assess this new technique by quantitative comparison with other therapeutic modalities.
A decision tree-based state transition model implemented to simulate a five-year period
of follow-up was constructed. Nonsurgical treatments were superior to surgical treatments
in enhancing both life expectancy and quality-adjusted life expectancy on the basis
of the optimal indications; one radiolucent stone < 2 cm for extracorporeal shock-wave
lithotripsy and multiple floating stones for oral dissolution therapy respectively,
especially in the elderly. Laparoscopic cholecystectomy was superior to open cholecystectomy
in enhancing the quality of life for all eligible patients. Sensitivity analysis revealed
that a higher incidence of the bile duct injury resulting from laparoscopic cholecystectomy
would result in a poorer quality-adjusted life expectancy. The results of the analysis
suggest the following. Nonsurgical treatments are acceptable alternatives to surgery
on the basis of their optimal indications. Laparoscopic cholecystectomy has an advantage
over open cholecystectomy in enhancing the patient's utility, and appears to be an
attractive therapeutic modality. A proper training program is necessary to ensure
the quality of this procedure in order to maintain its advantage.
