Observed outcomes and costs of laparoscopic versus open cholecystectomy in Juba, South Sudan

Abstract

Introduction: Cholecystectomy is the standard operative treatment for symptomatic gallstone disease and may be performed using either an open or laparoscopic approach. Laparoscopic cholecystectomy is now the preferred approach in many settings, although open cholecystectomy remains common in parts of sub-Saharan Africa. This study compared observed outcomes and admission costs for laparoscopic and open cholecystectomy in a low-resource clinical setting.
Methods: We conducted a retrospective comparative study of 100 adult patients who underwent open cholecystectomy (OC) or laparoscopic cholecystectomy (LC) between January 2023 and June 2024. OC was performed at South Sudan Modern Specialist Hospital, Juba Teaching Hospital, and Juba Military Hospital. LC was performed at Nile Kings Specialist Hospital in Juba. After application of the inclusion and exclusion criteria, 50 patients were included in each group. All the patients consented to surgery. Medical records were
reviewed for the cost of the operative package, medication use, complications, and length of hospital stay. Ethical approval was sought and approved for the retrospective study of the notes.
Results: The mean age was 44.9 years, 46.3 years in the OC group and 43.6 years in the LC group. In the OC group, 11 patients (22%) were male, and 39 (78%) were female; in the LC group, 14 patients (28%) were male, and 36 (72%) were female. Mean hospital stay was 6.2 days after OC and 2.1 days after LC. Complications were recorded in 5 patients (10%) after OC and in 1 patient (2%) after LC. The mean total admission cost was USD 2,553.60 for OC and USD 2,179.82 for LC, a difference of USD 373.78 in favour of LC.
Conclusion: LC was associated with shorter hospital stay, fewer recorded complications and lower observed admission costs than OC. Further prospective evaluation is recommended to confirm these findings and to inform wider implementation of laparoscopic surgery in low-resource settings.