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- Title
Same-admission versus delayed cholecystectomy for mild acute biliary pancreatitis: a systematic review and meta-analysis.
- Authors
Lyu, Yun-Xiao; Cheng, Yun-Xiao; Jin, Hang-Fei; Jin, Xin; Cheng, Bin; Lu, Dian
- Abstract
<bold>Background: </bold>The timing of laparoscopic cholecystectomy (LC) performed after the mild acute biliary pancreatitis (MABP) is still controversial. We conducted a review to compare same-admission laparoscopic cholecystectomy (SA-LC) and delayed laparoscopic cholecystectomy (DLC) after mild acute biliary pancreatitis (MABP).<bold>Methods: </bold>We systematically searched several databases (PubMed, EMBASE, Web of Science, and the Cochrane Library) for relevant trials published from 1 January 1992 to 1 June 2018. Human prospective or retrospective studies that compared SA-LC and DLC after MABP were included. The measured outcomes were the rate of conversion to open cholecystectomy (COC), rate of postoperative complications, rate of biliary-related complications, operative time (OT), and length of stay (LOS). The meta-analysis was performed using Review Manager 5.3 software (The Cochrane Collaboration, Oxford, United Kingdom).<bold>Results: </bold>This meta-analysis involved 1833 patients from 4 randomized controlled trials and 7 retrospective studies. No significant differences were found in the rate of COC (risk ratio [RR] = 1.24; 95% confidence interval [CI], 0.78-1.97; p = 0.36), rate of postoperative complications (RR = 1.06; 95% CI, 0.67-1.69; p = 0.80), rate of biliary-related complications (RR = 1.28; 95% CI, 0.42-3.86; p = 0.66), or OT (RR = 1.57; 95% CI, - 1.58-4.72; p = 0.33) between the SA-LC and DLC groups. The LOS was significantly longer in the DLC group (RR = - 2.08; 95% CI, - 3.17 to - 0.99; p = 0.0002). Unexpectedly, the subgroup analysis showed no significant difference in LOS according to the Atlanta classification (RR = - 0.40; 95% CI, - 0.80-0.01; p = 0.05). The gallstone-related complications during the waiting time in the DLC group included gall colic, recurrent pancreatitis, acute cholecystitis, jaundice, and acute cholangitis (total, 25.39%).<bold>Conclusion: </bold>This study confirms the safety of SA-LC, which could shorten the LOS. However, the study findings have a number of important implications for future practice.
- Subjects
PANCREATITIS; CHOLECYSTECTOMY; LAPAROSCOPIC surgery; DISEASE relapse; JAUNDICE
- Publication
BMC Surgery, 2018, Vol 18, Issue 1, pN.PAG
- ISSN
1471-2482
- Publication type
Article
- DOI
10.1186/s12893-018-0445-9