Laparoscopic versus open cholecystectomy for patients with symptomatic cholecystolithiasis Edited (no change to conclusions)

Abstract

Abstract Background

Cholecystectomy is one of the most frequently performed operations. Open cholecystectomy has been the gold standard for over 100 years. Laparoscopic cholecystectomy was introduced in the 1980s.

Objectives

To compare the beneficial and harmful effects of laparoscopic versus open cholecystectomy for patients with symptomatic cholecystolithiasis.

Search methods

We searched The Cochrane Hepato‐Biliary Group Controlled Trials Register (April 2004), The Cochrane Library (Issue 1, 2004), MEDLINE (1966 to January 2004), EMBASE (1980 to January 2004), Web of Science (1988 to January 2004), and CINAHL (1982 to January 2004) for randomised trials.

Selection criteria

All published and unpublished randomised trials in patients with symptomatic cholecystolithiasis comparing any kind of laparoscopic cholecystectomy versus any kind of open cholecystectomy. No language limitations were applied.

Data collection and analysis

Two authors independently performed selection of trials and data extraction. The methodological quality of the generation of the allocation sequence, allocation concealment, blinding, and follow‐up was evaluated to assess bias risk. Analyses were based on the intention‐to‐treat principle. Authors were requested additional information in case of missing data. Sensitivity and subgroup analyses were performed when appropriate.

Main results

Thirty‐eight trials randomised 2338 patients. Most of the trials had high bias risk. There was no significant difference regarding mortality (risk difference 0,00, 95% confidence interval (CI) ‐0.01 to 0.01). Meta‐analysis of all trials suggests less overall complications in the laparoscopic group, but the high‐quality trials show no significant difference ('allocation concealment' high‐quality trials risk difference, random effects ‐0.01, 95% CI ‐0.05 to 0.02). Laparoscopic cholecystectomy patients have a shorter hospital stay (weighted mean difference (WMD), random effects ‐3 days, 95% CI ‐3.9 to ‐2.3) and convalescence (WMD, random effects ‐22.5 days, 95% CI ‐36.9 to ‐8.1) compared to open cholecystectomy.

Authors' conclusions

No significant differences were observed in mortality, complications and operative time between laparoscopic and open cholecystectomy. Laparoscopic cholecystectomy is associated with a significantly shorter hospital stay and a quicker convalescence compared with the classical open cholecystectomy. These results confirm the existing preference for the laparoscopic cholecystectomy over open cholecystectomy.

Author(s)

Frederik Keus, Jeroen de Jong, H G Gooszen, C JHM Laarhoven

Abstract

Plain language summary

Laparoscopic and open cholecystectomy seem equivalent considering complications and operative time, but laparoscopic cholecystectomy is associated with quicker recovery

The classical open cholecystectomy and the minimally invasive laparoscopic cholecystectomy are two alternative operations for removal of the gallbladder. There are no significant differences in mortality and complications between the laparoscopic and the open techniques. The laparoscopic operation has advantages over the open operation regarding duration of hospital stay and convalescence.

Author(s)

Frederik Keus, Jeroen de Jong, H G Gooszen, C JHM Laarhoven

Reviewer's Conclusions

Authors' conclusions

Implications for practice

Laparoscopic cholecystectomy did not differ significantly from open cholecystectomy regarding mortality, complications, bile duct injuries, and operative time. However, laparoscopic cholecystectomy leads to shorter incisional wounds and seems to be associated with a significantly shorter hospital stay and faster return to work. These seem the reasons for laparoscopic cholecystectomy being the preferred method of choice above open cholecystectomy.

Implications for research

Cost‐minimisation analyses could probably play a decisive role.

Future research on implementation issues of laparoscopic techniques in general, with the cholecystectomy as a model, should focus not only on clinical outcome measures, but also, or more importantly, on differences in costs.

In accordance with research in general, the overall quality of the randomised trials included in this systematic review varied enormously, with the majority of trials having several methodological deficiencies. In line with conclusions from other systematic reviews, the quality of trials needs to improve in order to limit bias. Reports can be improved importantly by adopting the CONSORT Statement while conducting and reporting trials (www.consort‐statement.org).

More trials ought to become multi‐centre trials with larger number of participants.

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