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

Jerome M. Laurence*, Peter D. Tran, Arthur J. Richardson, Henry C. C. Pleass, Vincent W. T. Lam

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

48 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)153-161
Number of pages9
JournalHPB
Volume14
Issue number3
DOIs
Publication statusPublished - 1 Jan 2012
Externally publishedYes

Keywords

  • cirrhosis < liver
  • outcomes < gallbladder
  • surgery < cholelithiasis

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