Laparoscopic cholecystectomy for severe acute cholecystitis. A meta-analysis of results |
| |
Authors: | Giuseppe Borzellino Stefan Sauerland Anna Maria Minicozzi Giuseppe Verlato Carlo Di Pietrantonj Giovanni de Manzoni Claudio Cordiano |
| |
Institution: | (1) 1st Department of General Surgery, OCM Borgo Trento Hospital, University of Verona, Verona, Italy;(2) Institute for Research in Operative Medicine, University of Witten/Herdecke, Witten, Germany;(3) Department of Medical Statistics, University of Verona, Verona, Italy;(4) Regional department of Epidemiology, Alessandria, Italy;(5) Chirurgia Clinicizzata, Ospedale di Borgo Trento, Piazzale A. Stefani 1, 37126 Verona, Italia |
| |
Abstract: | Objective The aim of this review was to evaluate surgical outcomes of laparoscopic cholecystectomy for gangrenous and empyematous acute
cholecystitis defined as severe acute cholecystitis.
Background It is not known to what extent surgical outcomes of laparoscopic cholecystectomy for severe acute cholecystitis differ from
those for the nonsevere acute form, making it questionable whether urgent laparoscopic cholecystectomy is the best approach
even in severe acute cases.
Methods Literature searches were conducted to identify: (1) comparative studies which reported laparoscopic surgical outcomes separately
for severe acute and nonsevere acute cholecystitis; (2) studies comparing such an approach with open cholecystectomy, subtotal
laparoscopic cholecystectomy or cholecystostomy in severe acute cholecystitis. Results were pooled by standard meta-analytic
techniques.
Results Seven studies with a total of 1,408 patients undergoing laparoscopic cholecystectomy were found. The risks of conversion (RR
3.2, 95% CI 2.5 to 4.2) and overall postoperative complications (RR 1.6, 95% CI 1.2–2.2) were significantly higher in severe
acute cholecystitis with respect to the nonsevere acute forms. However, no difference was detected as regards to local postoperative
complications. No studies comparing open cholecystectomy or cholecystostomy with urgent laparoscopy were found.
Conclusion A lower feasibility of laparoscopic cholecystectomy has been found for severe cholecystitis. A lower threshold of conversion
is recommended since this may allow to reduce local postoperative complications. Literature data lack valuable comparative
studies with other treatment modalities, which therefore need to be investigated. |
| |
Keywords: | Cholecystectomy Statistical Technical Complications |
本文献已被 PubMed SpringerLink 等数据库收录! |
|