Negin Sedaghat1, Amy M Cao1,2, Guy D Eslick3,4, Michael R Cox1,2. 1. Department of Surgery, Nepean Hospital, Penrith, NSW, Australia. 2. The Whiteley-Martin Research Centre, Discipline of Surgery, Sydney Medical School, Nepean Hospital, The University of Sydney, Level 5, South Block, Penrith, NSW, 2751, Australia. 3. Department of Surgery, Nepean Hospital, Penrith, NSW, Australia. eslickg@med.usyd.edu.au. 4. The Whiteley-Martin Research Centre, Discipline of Surgery, Sydney Medical School, Nepean Hospital, The University of Sydney, Level 5, South Block, Penrith, NSW, 2751, Australia. eslickg@med.usyd.edu.au.
Abstract
BACKGROUND: The operative management of symptomatic cholelithiasis during pregnancy is either laparoscopic cholecystectomy (LC) or open cholecystectomy (OC). The aim of this systematic review and meta-analysis is to compare the outcomes of the laparoscopic and open approach for cholecystectomy during pregnancy. METHOD: A literature search was conducted using MEDLINE, PubMed, EMBASE, Cochrane Library, Web of Science, CINAHL and Current Contents Connect using appropriate search terms. All comparative studies reporting maternal, fetal, and/or surgical complications were included. RESULTS: Eleven comparative studies, with a total of 10,632 patients, were included. The laparoscopic approach was performed at mean 18-week gestation and the open approach at mean 24-week gestation. LC was associated with decreased risks for fetal (OR 0.42; 95 % CI 0.28-0.63; p < 0.001), maternal (OR 0.42; 95 % CI 0.33-0.53; p < 0.001) and surgical (OR 0.45; 95 % CI 0.25-0.82, p = 0.01) complications. The average length of hospital stay (LOS) was: LC 3.2 days and OC 6.0 days (p = 0.02). The conversion rate from LC to OC was 3.8 %. CONCLUSION: The results of this first meta-analysis suggest that LC is associated with fewer maternal and fetal complications than OC during pregnancy. However, 91 % of included patients were in the first or second trimester at the time of surgery. These findings do not account for gestational age during pregnancy, which may be a significant confounding factor. The results support intervention for symptomatic gallstones in the first and second trimester with a laparoscopic approach.
BACKGROUND: The operative management of symptomatic cholelithiasis during pregnancy is either laparoscopic cholecystectomy (LC) or open cholecystectomy (OC). The aim of this systematic review and meta-analysis is to compare the outcomes of the laparoscopic and open approach for cholecystectomy during pregnancy. METHOD: A literature search was conducted using MEDLINE, PubMed, EMBASE, Cochrane Library, Web of Science, CINAHL and Current Contents Connect using appropriate search terms. All comparative studies reporting maternal, fetal, and/or surgical complications were included. RESULTS: Eleven comparative studies, with a total of 10,632 patients, were included. The laparoscopic approach was performed at mean 18-week gestation and the open approach at mean 24-week gestation. LC was associated with decreased risks for fetal (OR 0.42; 95 % CI 0.28-0.63; p < 0.001), maternal (OR 0.42; 95 % CI 0.33-0.53; p < 0.001) and surgical (OR 0.45; 95 % CI 0.25-0.82, p = 0.01) complications. The average length of hospital stay (LOS) was: LC 3.2 days and OC 6.0 days (p = 0.02). The conversion rate from LC to OC was 3.8 %. CONCLUSION: The results of this first meta-analysis suggest that LC is associated with fewer maternal and fetal complications than OC during pregnancy. However, 91 % of included patients were in the first or second trimester at the time of surgery. These findings do not account for gestational age during pregnancy, which may be a significant confounding factor. The results support intervention for symptomatic gallstones in the first and second trimester with a laparoscopic approach.
Authors: Julie Hong; Jie Yang; Xiaoyue Zhang; Jared Su; Abhinay Tumati; David Garry; Salvatore Docimo; Andrew T Bates; Konstantinos Spaniolas; Mark A Talamini; Aurora D Pryor Journal: Surg Endosc Date: 2020-09-01 Impact factor: 4.584
Authors: E Ball; N Waters; N Cooper; C Talati; R Mallick; S Rabas; A Mukherjee; Y Sri Ranjan; M Thaha; R Doodia; R Keedwell; M Madhra; N Kuruba; R Malhas; E Gaughan; K Tompsett; H Gibson; H Wright; C Gnanachandran; T Hookaway; C Baker; K Murali; D Jurkovic; N Amso; J Clark; S Thangaratinam; T Chalhoub; P Kaloo; E Saridogan Journal: Facts Views Vis Obgyn Date: 2019-03
Authors: Michele Pisano; Niccolò Allievi; Kurinchi Gurusamy; Giuseppe Borzellino; Stefania Cimbanassi; Djamila Boerna; Federico Coccolini; Andrea Tufo; Marcello Di Martino; Jeffrey Leung; Massimo Sartelli; Marco Ceresoli; Ronald V Maier; Elia Poiasina; Nicola De Angelis; Stefano Magnone; Paola Fugazzola; Ciro Paolillo; Raul Coimbra; Salomone Di Saverio; Belinda De Simone; Dieter G Weber; Boris E Sakakushev; Alessandro Lucianetti; Andrew W Kirkpatrick; Gustavo P Fraga; Imitaz Wani; Walter L Biffl; Osvaldo Chiara; Fikri Abu-Zidan; Ernest E Moore; Ari Leppäniemi; Yoram Kluger; Fausto Catena; Luca Ansaloni Journal: World J Emerg Surg Date: 2020-11-05 Impact factor: 5.469