Federico Coccolini1, Fausto Catena2, Michele Pisano3, Federico Gheza4, Stefano Fagiuoli5, Salomone Di Saverio6, Gioacchino Leandro7, Giulia Montori3, Marco Ceresoli3, Davide Corbella3, Massimo Sartelli8, Michael Sugrue9, Luca Ansaloni3. 1. General Surgery Dept., Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy. Electronic address: federico.coccolini@gmail.com. 2. Surgical Clinic, University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy. 3. General Surgery Dept., Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy. 4. Emergency Surgery Dept., Ospedale Maggiore, Viale Gramsci 14, 43126 Parma, Italy. 5. Gastroenterology I Dept., Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy. 6. General and Emergency Surgery Dept., Ospedale Maggiore, Bologna, Italy. 7. Gastroenterology I Dept., IRCCS De Bellis Hospital, Castellana Grotte, 70013, Italy. 8. General Surgery Dept., Macerata Hospital, Macerata, Italy. 9. Letterkenny Hospital and the Donegal Clinical Research Academy, Donegal, Ireland; University College Hospital, Galway, Ireland.
Abstract
INTRODUCTION: Laparoscopic cholecystectomy (LC) has become a popular alternative to open cholecystectomy (OC) in the treatment of acute cholecystitis (AC). Laparoscopic cholecystectomy (LC) is now considered the gold standard of therapy for symptomatic cholelithiasis and chronic cholecystitis. However no definitive data on its use in AC has been published. CIAO and CIAOW studies demonstrated 48.7% of AC were still operated with the open technique. The aim of the present meta-analysis is to compare OC and LC in AC. MATERIAL AND METHODS: A systematic-review with meta-analysis and meta-regression of trials comparing open vs. laparoscopic cholecystectomy in patients with AC was performed. Electronic searches were performed using Medline, Embase, PubMed, Cochrane Central Register of Controlled Trials (CCTR), Cochrane Database of Systematic Reviews (CDSR) and CINAHL. RESULTS: Ten trials have been included with a total of 1248 patients: 677 in the LC and 697 into the OC groups. The post-operative morbidity rate was half with LC (OR = 0.46). The post-operative wound infection and pneumonia rates were reduced by LC (OR 0.54 and 0.51 respectively). The post-operative mortality rate was reduced by LC (OR = 0.2). The mean postoperative hospital stay was significantly shortened in the LC group (MD = -4.74 days). There were no significant differences in the bile leakage rate, intraoperative blood loss and operative times. CONCLUSIONS: In acute cholecystitis, post-operative morbidity, mortality and hospital stay were reduced by laparoscopic cholecystectomy. Moreover pneumonia and wound infection rate were reduced by LC. Severe hemorrhage and bile leakage rates were not influenced by the technique. Cholecystectomy in acute cholecystitis should be attempted laparoscopically first.
INTRODUCTION: Laparoscopic cholecystectomy (LC) has become a popular alternative to open cholecystectomy (OC) in the treatment of acute cholecystitis (AC). Laparoscopic cholecystectomy (LC) is now considered the gold standard of therapy for symptomatic cholelithiasis and chronic cholecystitis. However no definitive data on its use in AC has been published. CIAO and CIAOW studies demonstrated 48.7% of AC were still operated with the open technique. The aim of the present meta-analysis is to compare OC and LC in AC. MATERIAL AND METHODS: A systematic-review with meta-analysis and meta-regression of trials comparing open vs. laparoscopic cholecystectomy in patients with AC was performed. Electronic searches were performed using Medline, Embase, PubMed, Cochrane Central Register of Controlled Trials (CCTR), Cochrane Database of Systematic Reviews (CDSR) and CINAHL. RESULTS: Ten trials have been included with a total of 1248 patients: 677 in the LC and 697 into the OC groups. The post-operative morbidity rate was half with LC (OR = 0.46). The post-operative wound infection and pneumonia rates were reduced by LC (OR 0.54 and 0.51 respectively). The post-operative mortality rate was reduced by LC (OR = 0.2). The mean postoperative hospital stay was significantly shortened in the LC group (MD = -4.74 days). There were no significant differences in the bile leakage rate, intraoperative blood loss and operative times. CONCLUSIONS: In acute cholecystitis, post-operative morbidity, mortality and hospital stay were reduced by laparoscopic cholecystectomy. Moreover pneumonia and wound infection rate were reduced by LC. Severe hemorrhage and bile leakage rates were not influenced by the technique. Cholecystectomy in acute cholecystitis should be attempted laparoscopically first.
Authors: Crystal B Chen; Francesco Palazzo; Stephen M Doane; Jordan M Winter; Harish Lavu; Karen A Chojnacki; Ernest L Rosato; Charles J Yeo; Michael J Pucci Journal: Surg Endosc Date: 2016-08-05 Impact factor: 4.584
Authors: Sami A Chadi; Keegan Guidolin; Antonio Caycedo-Marulanda; Abdu Sharkawy; Antonino Spinelli; Fayez A Quereshy; Allan Okrainec Journal: Ann Surg Date: 2020-05-20 Impact factor: 12.969