Laparoscopic cholecystectomy for severe acute cholecystitis. A meta-analysis of results

To conduct a randomized controlled trial (RCT), meta-analysis to assess the effectiveness of drains in reducing complications after laparoscopic cholecystectomy (LC) for acute cholecystitis needs to be carried out. An electronic search of PubMed, Embase, Science Citation Index, and the Cochrane Library from January 1990 to January 2018 was performed to identify randomized clinical trials that compare prophylactic drainage with no drainage in LC for acute cholecystitis. The outcomes were calculated as odds ratios (ORs) with 95 per cent confidence intervals (CIs) using RevMan 5.2. Four RCTs, which included 796 patients, were identified for analysis in our study. There was no statistically significant difference in the rate of morbidities (OR = 1.23, 95% CI 0.55–2.76, P = 0.61). Abdominal pain was more severe in the drain group 24 hours after surgery (mean difference = 0.80, 95% CI 0.47–1.14; P < 0.00001). No significant difference was present with respect to wound infection rate and hospital stay. The use of abdominal drainage does not appear to be of any benefit in patients having undergone early LC for acute cholecystitis.

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Peer review report 2 on “Open versus laparoscopic cholecystectomy in acute cholecystitis. Systematic review and meta-analysis”

International Journal of Surgery ◽

10.1016/j.ijsu.2015.06.004 ◽

2015 ◽

Vol 13 ◽

pp. S39

Author(s):

Ali Uzunkoy

Keyword(s):

Systematic Review ◽

Laparoscopic Cholecystectomy ◽

Acute Cholecystitis ◽

Peer Review ◽

Meta Analysis ◽

Open Versus

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Acute Laparoscopic Cholecystectomy: Delays in Acute Surgery and Cost Analysis of Aproposed New Service

Bulletin of The Royal College of Surgeons of England ◽

10.1308/147363511x579468 ◽

2011 ◽

Vol 93 (7) ◽

pp. 261-265

Author(s):

AJ Cockbain ◽

AL Young ◽

E McGinnes ◽

GJ Toogood

Keyword(s):

Laparoscopic Cholecystectomy ◽

Acute Cholecystitis ◽

Meta Analysis ◽

Gallstone Disease ◽

Cochrane Review ◽

Length Of Hospital Stay ◽

Biliary Colic ◽

Complication Rates ◽

Acute Surgery ◽

Symptomatic Gallstone Disease

Acute laparoscopic cholecystectomy (ALC) is widely considered the most appropriate management for patients presenting with acute cholecystitis as supported by a recent meta-analysis and Cochrane review. Although the benefit of ALC is less clear in patients with biliary colic, few would disagree that earlier cholecystectomy is preferable for most patients with symptomatic gallstone disease. ALC has similar complication rates to elective laparoscopic cholecystectomy (ELC) and a reduced total length of hospital stay. Recurrent symptoms from untreated gallstone disease are common, with the risk of developing more severe complications such as acute cholecystitis, acute pancreatitis or cholangitis while waiting for an operation. It has been reported that patients awaiting ELC after an acute admission have significantly more general practitioner (GP) attendances than those who receive ALC, that they have an average of one emergency department attendance for symptom recurrence and that one in six requires hospital admission due to the severity of recurrent symptoms.

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