TY - JOUR
T1 - Laparoscopic or open cholecystectomy in cirrhosis
T2 - a systematic review of outcomes and meta-analysis of randomized trials
AU - Laurence, Jerome M.
AU - Tran, Peter D.
AU - Richardson, Arthur J.
AU - Pleass, Henry C. C.
AU - Lam, Vincent W. T.
PY - 2012/1/1
Y1 - 2012/1/1
N2 - 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.
AB - 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.
KW - cirrhosis < liver
KW - outcomes < gallbladder
KW - surgery < cholelithiasis
UR - http://www.scopus.com/inward/record.url?scp=84857048683&partnerID=8YFLogxK
U2 - 10.1111/j.1477-2574.2011.00425.x
DO - 10.1111/j.1477-2574.2011.00425.x
M3 - Review article
C2 - 22321033
AN - SCOPUS:84857048683
SN - 1365-182X
VL - 14
SP - 153
EP - 161
JO - HPB
JF - HPB
IS - 3
ER -