Which one is the best timing for laparoscopic cholecystectomy?
Posted on 12/27/2011
Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a meta-analysis of randomized clinical trials
Abstract
Background: The appropriate timing for laparoscopic cholecystectomy in the treatment of acute cholecystitis remains controversial. More recent evaluation indicates early laparoscopic surgery may be a safe option in acute cholecystitis, although conversion rates may be higher. No conclusive evidence establishing best practice in terms of clinical benefit exists.
Methods: All randomized clinical studies published between 1987 and 2006 comparing early versus delayed laparoscopic cholecystectomy for acute cholecystitis were analyzed, irrespective of language, blinding, or publication status. Exclusions were quasi-randomized trials, inadequate follow-up description, or allocation concealment. Endpoints included conversion rates, postoperative complications, total hospital stay, and operation time. Random and fixed-effect models were used to aggregate the study endpoints and assess heterogeneity.
Results: Four studies containing 375 patients were included. No significant study heterogeneity or publication bias was found. There was no significant difference in conversion rates (odds ratio= .915 [95% confidence interval (CI), .567–1.477], P= .718) and postoperative complications (odds ratio= 1.073 [95% CI, .599–1.477], P .813) between both groups. Operation time was significantly reduced (weighted mean difference [WMD]=.412 [95%CI,.149–.675],P=.002) with delayed cholecystectomy. The total hospital stay was significantly reduced (WMD= .905 [95% CI, .630–1.179], P= .0005) with early cholecystectomy. The postoperative stay was significantly reduced in the delayed group (WMD= .393 [95% CI, .128–.659], P= .004).
Conclusions: These meta-analysis data suggest that early laparoscopic cholecystectomy allows significantly shorter total hospital stay at the cost of a significantly longer operation time with no significant differences in conversion rates or complications.
Tamim Siddiqui, M.B.Ch.B., M.R.C.S., Alisdair MacDonald, M.B.Ch.B., M.R.C.S., Peter S. Chong, M.B.Ch.B., F.R.C.S., John T. Jenkins, M.B.Ch.B., F.R.C.S.* Department of Surgery, Southern General Hospital, Glasgow, Scotland
Manuscript received July 19, 2006; revised manuscript March 21, 2007
T. Siddiqui et al. / The American Journal of Surgery 195 (2008) 40–47
The American Journal of Surgery 195 (2008) 40–47
Clinical surgery–International
