Laparoscopic vs. open cholecystectomy for cirrhotic patients: a systematic review and meta-analysis

Yao Cheng, Xian-Ze Xiong, Si-Jia Wu, Yi-Xin Lin, Nan-Sheng Cheng
Hepato-gastroenterology 2012, 59 (118): 1727-34

BACKGROUND/AIMS: To compare the safety and effectiveness of laparoscopic cholecystectomy (LC) versus open cholecystectomy (OC) for cirrhotic patients.

METHODOLOGY: The Cochrane Library, MEDLINE, Science Citation Index Expanded, EMBASE and CBM (Chinese Biomedical Database) were searched until August 2011 to indentify relevant and eligible studies.

RESULTS: Twenty three articles with 1316 cirrhotic patients were included. All patients were allocated to the LC group (n=694) or the OC group (n=622). They were primarily in Child-Pugh class A (n=957, 72.7%) and class B (n=343, 26.1%). Meta-analysis of 5 randomized controlled trials (n=284) indicated LC group was associated with the following advantages: significant lower surgery-related morbidity, less postoperative complications (e.g. incision hernia, wound infection), shorter hospital stay and less loss of blood. There were no significant differences in the intra-hospital mortality and total operative time between the two groups. Meta-analysis of 19 non-randomized studies (n=1082) showed similar results in favour of LC group. In addition, it showed significant lower intra-hospital mortality and less total operative time in the LC group than the OC group.

CONCLUSIONS: LC is safe and offers various significant benefits over OC. Thus, it should be recommended for compensated cirrhotic patients.

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