AustralieFrV1, Main, Exploration, bibRecord, 008C40

Is smaller necessarily better? A systematic review comparing the effects of minilaparoscopic and conventional laparoscopic cholecystectomy on patient outcomes

Identifieur interne : 008C40 ( Main/Exploration ); précédent : 008C39; suivant : 008C41

Is smaller necessarily better? A systematic review comparing the effects of minilaparoscopic and conventional laparoscopic cholecystectomy on patient outcomes

Auteurs : Rory Mccloy [Royaume-Uni] ; Delia Randall [Royaume-Uni] ; Stephan A. Schug [Australie] ; Henrik Kehlet [Danemark] ; Christian Simanski [Allemagne] ; Francis Bonnet [France] ; Frederic Camu [Belgique] ; Barrie Fischer [Royaume-Uni] ; Girish Joshi [États-Unis] ; Narinder Rawal [Suède] ; Edmund A. M. Neugebauer [Allemagne]

Source :

Surgical endoscopy [ 0930-2794 ] ; 2008.

RBID : Pascal:09-0041100

Descripteurs français

Pascal (Inist)
- Chirurgie endoscopique, Cholécystectomie, Revue bibliographique, Etude comparative, Pronostic, Homme, Médecine, Traitement, Vésicule biliaire.
Wicri :
- topic : Homme, Médecine.

English descriptors

KwdEn :
- Bibliographic review, Cholecystectomy, Comparative study, Endoscopic surgery, Gallbladder, Human, Medicine, Prognosis, Treatment.

Abstract

Background In recent years, minilaparoscopic cholecystectomy (MLC; total size of trocar incision <25 mm) has been increasingly advocated for the removal of the gallbladder, due to potentially better surgical outcomes (e.g., better cosmetic result, reduced pain, shorter hospital stay, quicker return to activity), but an evidence-based approach has been lacking. The current systematic review was undertaken to evaluate the importance of total size of trocar incision in improving surgical outcomes in adult laparoscopic cholecystectomy (LC). Methods The literature was systematically reviewed using MEDLINE and EmBASE. Only randomized controlled trials in English, investigating minilaparoscopic versus conventional LC (total size of trocar incision ≥25 mm) and reporting pain scores were included. Quantitative analyses (meta-analyses) were performed on postoperative pain scores and other patient outcomes from more than one study where feasible and appropriate. Qualitative analyses consisted of assessing the number of studies showing a significant difference between the techniques. Results Thirteen trials met the inclusion criteria. There was a trend towards reduced pain with MLC compared with conventional LC, without reduction in opioid use. Patients in the MLC group had slightly reduced length of hospital stay, but there were no significant differences for return to activity. The two interventions were also similar in terms of operating times and adverse events, but MLC was associated with better cosmetic result (largely patient rated). There was a significantly greater likelihood of conversion to conventional LC or to open cholecystectomy in the MLC group than there was of conversion to open cholecystectomy in the conventional LC group [OR 4.71 (95% confidence interval 2.67-8.31), p < 0.00001]. Conclusions The data included in this review suggest that reducing the size of trocar incision results in some limited improvements in surgical outcomes after LC. However, it carries a higher risk of conversion to conventional LC or open cholecystectomy.

Affiliations:

Allemagne, Australie, Belgique, Danemark, France, Royaume-Uni, Suède, États-Unis
Hovedstaden, Région de Bruxelles-Capitale, Île-de-France
Bruxelles, Copenhague, Paris

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Le document en format XML

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<sZ>10 aut.</sZ>
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<author><name sortKey="Neugebauer, Edmund A M" sort="Neugebauer, Edmund A M" uniqKey="Neugebauer E" first="Edmund A. M." last="Neugebauer">Edmund A. M. Neugebauer</name>
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<sZ>11 aut.</sZ>
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<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Bibliographic review</term>
<term>Cholecystectomy</term>
<term>Comparative study</term>
<term>Endoscopic surgery</term>
<term>Gallbladder</term>
<term>Human</term>
<term>Medicine</term>
<term>Prognosis</term>
<term>Treatment</term>
</keywords>
<keywords scheme="Pascal" xml:lang="fr"><term>Chirurgie endoscopique</term>
<term>Cholécystectomie</term>
<term>Revue bibliographique</term>
<term>Etude comparative</term>
<term>Pronostic</term>
<term>Homme</term>
<term>Médecine</term>
<term>Traitement</term>
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<front><div type="abstract" xml:lang="en">Background In recent years, minilaparoscopic cholecystectomy (MLC; total size of trocar incision <25 mm) has been increasingly advocated for the removal of the gallbladder, due to potentially better surgical outcomes (e.g., better cosmetic result, reduced pain, shorter hospital stay, quicker return to activity), but an evidence-based approach has been lacking. The current systematic review was undertaken to evaluate the importance of total size of trocar incision in improving surgical outcomes in adult laparoscopic cholecystectomy (LC). Methods The literature was systematically reviewed using MEDLINE and EmBASE. Only randomized controlled trials in English, investigating minilaparoscopic versus conventional LC (total size of trocar incision ≥25 mm) and reporting pain scores were included. Quantitative analyses (meta-analyses) were performed on postoperative pain scores and other patient outcomes from more than one study where feasible and appropriate. Qualitative analyses consisted of assessing the number of studies showing a significant difference between the techniques. Results Thirteen trials met the inclusion criteria. There was a trend towards reduced pain with MLC compared with conventional LC, without reduction in opioid use. Patients in the MLC group had slightly reduced length of hospital stay, but there were no significant differences for return to activity. The two interventions were also similar in terms of operating times and adverse events, but MLC was associated with better cosmetic result (largely patient rated). There was a significantly greater likelihood of conversion to conventional LC or to open cholecystectomy in the MLC group than there was of conversion to open cholecystectomy in the conventional LC group [OR 4.71 (95% confidence interval 2.67-8.31), p < 0.00001]. Conclusions The data included in this review suggest that reducing the size of trocar incision results in some limited improvements in surgical outcomes after LC. However, it carries a higher risk of conversion to conventional LC or open cholecystectomy.</div>
</front>
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<li>États-Unis</li>
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<country name="Suède"><noRegion><name sortKey="Rawal, Narinder" sort="Rawal, Narinder" uniqKey="Rawal N" first="Narinder" last="Rawal">Narinder Rawal</name>
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	Serveur d'exploration sur les relations entre la France et l'Australie
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Serveur d'exploration sur les relations entre la France et l'Australie

Is smaller necessarily better? A systematic review comparing the effects of minilaparoscopic and conventional laparoscopic cholecystectomy on patient outcomes

Is smaller necessarily better? A systematic review comparing the effects of minilaparoscopic and conventional laparoscopic cholecystectomy on patient outcomes

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