Title of the Dissertation,

Laparoscopic cholecystectomy is the gold standard of treatment of elective symptomatic gallstone disease. Laparoscopic surgery requires special equipment, and there is probably a longer learning curve in laparoscopic procedures than in open techniques. Laparoscopic surgery has an obvious benefit in postoperative recovery compared with standard open surgery. This has lead to a search for minimally invasive open techniques with similar or even better results and probably a shorter learning curve without expensive disposable equipment. The aim of this thesis work was to evaluate (i) the efficacy and safety and (ii) the feasibity of minilaparotomy cholecystectomy as a day case surgery in patients with symptomatic gallstones disease. A total of 335 patients (188 in the minilaparotomy groups and 147 in the laparoscopic groups) were evaluated in 4 studies and the results are presented in 6 publications. In a pivotal prospective clinical study symptomatic patients with gallstones were randomised to minilaparotomy (n=85) or laparoscopic groups (n=72). The mean operative time was statistically significantly shorter in the minilaparotomy group than in the laparoscopic group (mean: 55min SD 20 vs. 79min SD 27, p=0.0001). There were no significant differences in postoperative pain, analgesic consumption, or postoperative pulmonary function. Obesity did not have a statistically significant influence in either group. The patients were re-evaluated 4 weeks postoperatively using the RAND-36 quality of life questionnaire. The laparoscopic procedure was slightly better in the role functioning/physical measure (63 vs. 49, p=0.038, scale 0-100), but in every other parameter there was no difference between the two groups. A phone interview was used to evaluate the long-termoutcomes of the study. The mean follow-up time was 10 years, and 81% of the patients were reached in both groups (n=69 in the minilaparotomy and n= 58 in the laparoscopic group). The prevalence of chronic postsurgical pain was similar in the two groups, 5/69 (7%) in the minilaparotomy group and 1/58 (2%) in the laparoscopic group (p=0.14), respectively. Residual abdominal symptoms were common, but less frequent in the minilaparotomy group (14/69; 20%) than in the laparoscopic group (21/58 patients; 36%) (p=0.039). In the minilaparotomy group 63/69 patients (91%) and 57/58 patients (98%) in the laparoscopy group (p=0.059) were satisfied with the cosmetic outcome. To evaluate the applicability of minilaparotomy for day surgery, a pilot study with 30 prospective patients was carried out. Day surgery was possible in 25 cases (83%). Four patients out of five who stayed overnight at the hospital had an incision longer than 7 cm,