Open versus laparoscopic cholecystectomy in acute cholecystitis. Systematic review and meta-analysis

Federico Coccolini, Fausto Catena, Michele Pisano, Federico Gheza, Stefano Fagiuoli, Salomone Di Saverio, Gioacchino Leandro, Giulia Montori, Marco Ceresoli, Davide Corbella, Massimo Sartelli, Michael Sugrue, Luca Ansaloni

Research output: Contribution to journalArticle

Abstract

Laparoscopic cholecystectomy (LC) has become a popular alternative to open cholecystectomy (OC) in the treatment of acute cholecystitis (AC). Laparoscopic cholecystectomy (LC) is now considered the gold standard of therapy for symptomatic cholelithiasis and chronic cholecystitis. However no definitive data on its use in AC has been published. CIAO and CIAOW studies demonstrated 48.7% of AC were still operated with the open technique. The aim of the present meta-analysis is to compare OC and LC in AC. Material and methods: A systematic-review with meta-analysis and meta-regression of trials comparing open vs. laparoscopic cholecystectomy in patients with AC was performed. Electronic searches were performed using Medline, Embase, PubMed, Cochrane Central Register of Controlled Trials (CCTR), Cochrane Database of Systematic Reviews (CDSR) and CINAHL. Results: Ten trials have been included with a total of 1248 patients: 677 in the LC and 697 into the OC groups. The post-operative morbidity rate was half with LC (OR=0.46). The post-operative wound infection and pneumonia rates were reduced by LC (OR 0.54 and 0.51 respectively). The post-operative mortality rate was reduced by LC (OR=0.2). The mean postoperative hospital stay was significantly shortened in the LC group (MD=-4.74 days). There were no significant differences in the bile leakage rate, intraoperative blood loss and operative times. Conclusions: In acute cholecystitis, post-operative morbidity, mortality and hospital stay were reduced by laparoscopic cholecystectomy. Moreover pneumonia and wound infection rate were reduced by LC. Severe hemorrhage and bile leakage rates were not influenced by the technique. Cholecystectomy in acute cholecystitis should be attempted laparoscopically first.

Original languageEnglish
Pages (from-to)196-204
Number of pages9
JournalInternational Journal of Surgery
Volume18
DOIs
Publication statusPublished - Jun 1 2015

Keywords

  • Acute cholecystitis
  • Laparoscopic
  • Meta-analysis
  • Morbidity
  • Mortality
  • Open
  • Surgery
  • Treatment

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

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  • Cite this

    Coccolini, F., Catena, F., Pisano, M., Gheza, F., Fagiuoli, S., Di Saverio, S., Leandro, G., Montori, G., Ceresoli, M., Corbella, D., Sartelli, M., Sugrue, M., & Ansaloni, L. (2015). Open versus laparoscopic cholecystectomy in acute cholecystitis. Systematic review and meta-analysis. International Journal of Surgery, 18, 196-204. https://doi.org/10.1016/j.ijsu.2015.04.083