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Laparoscopic or open cholecystectomy in cirrhosis: a systematic review of outcomes and meta-analysis of randomized trials

Identifieur interne : 002337 ( Main/Curation ); précédent : 002336; suivant : 002338

Laparoscopic or open cholecystectomy in cirrhosis: a systematic review of outcomes and meta-analysis of randomized trials

Auteurs : Jerome M. Laurence [Australie] ; Peter D. Tran [Australie] ; Arthur J. Richardson [Australie] ; Henry C C. Pleass [Australie] ; Vincent W T. Lam [Australie]

Source :

HPB : The Official Journal of the International Hepato Pancreato Biliary Association [ 1365-182X ] ; 2012.

RBID : PMC:3371197

Abstract

Background

Cholecystectomy is associated with increased risks in patients with cirrhosis. The well-established advantages of laparoscopic surgery may be offset by the increased risk for complications relating particularly to portal hypertension and coagulopathy.

Methods

A systematic search was undertaken to identify studies comparing open cholecystectomy (OC) and laparoscopic cholecystectomy (LC) in patients with cirrhosis. A meta-analysis was performed of the available randomized controlled trials (RCTs).

Results

Forty-four studies were analysed. These included a total of 2005 patients with cirrhosis who underwent laparoscopic (n= 1756) or open (n= 249) cholecystectomy, with mortality rates of 0.74% and 2.00%, respectively. A meta-analysis of three RCTs involving a total of 220 patients was conducted. There was a reduction in the overall incidences of postoperative complications and infectious complications and a shorter length of hospital stay in LC. However, frequencies of postoperative hepatic insufficiency did not differ significantly.

Conclusions

There are few RCTs comparing OC and LC in patients with cirrhosis. These studies are small, heterogeneous in design and include almost exclusively patients with Child–Pugh class A and B disease. However, LC appears to be associated with shorter operative time, reduced complication rates and reduced length of hospital stay.

Url:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3371197

DOI: 10.1111/j.1477-2574.2011.00425.x
PubMed: 22321033
PubMed Central: 3371197

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PMC:3371197

Le document en format XML

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<front><div type="abstract" xml:lang="en"><sec><title>Background</title>
<p>Cholecystectomy is associated with increased risks in patients with cirrhosis. The well-established advantages of laparoscopic surgery may be offset by the increased risk for complications relating particularly to portal hypertension and coagulopathy.</p>
</sec>
<sec><title>Methods</title>
<p>A systematic search was undertaken to identify studies comparing open cholecystectomy (OC) and laparoscopic cholecystectomy (LC) in patients with cirrhosis. A meta-analysis was performed of the available randomized controlled trials (RCTs).</p>
</sec>
<sec><title>Results</title>
<p>Forty-four studies were analysed. These included a total of 2005 patients with cirrhosis who underwent laparoscopic (<italic>n</italic>
= 1756) or open (<italic>n</italic>
= 249) cholecystectomy, with mortality rates of 0.74% and 2.00%, respectively. A meta-analysis of three RCTs involving a total of 220 patients was conducted. There was a reduction in the overall incidences of postoperative complications and infectious complications and a shorter length of hospital stay in LC. However, frequencies of postoperative hepatic insufficiency did not differ significantly.</p>
</sec>
<sec><title>Conclusions</title>
<p>There are few RCTs comparing OC and LC in patients with cirrhosis. These studies are small, heterogeneous in design and include almost exclusively patients with Child–Pugh class A and B disease. However, LC appears to be associated with shorter operative time, reduced complication rates and reduced length of hospital stay.</p>
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Laparoscopic or open cholecystectomy in cirrhosis: a systematic review of outcomes and meta-analysis of randomized trials

Laparoscopic or open cholecystectomy in cirrhosis: a systematic review of outcomes and meta-analysis of randomized trials

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Abstract

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