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- Title
Percutaneous Transhepatic Gallbladder Drainage Combined with Laparoscopic Cholecystectomy: A Meta-Analysis of Randomized Controlled Trials.
- Authors
Hao-yang Tan; Dan-dan Jiang; Ji Li; Kun He; Kang Yang; Tan, Hao-Yang; Jiang, Dan-Dan; Li, Ji; He, Kun; Yang, Kang
- Abstract
<bold>Objective: </bold>To investigate the clinical effect of the laparoscopic cholecystectomy (LC) after percutaneous transhepatic gallbladder drainage (PTGD) in elder acute cholecystitis.<bold>Methods: </bold>The Cochrane Library, PubMed, China National Knowledge Infrastructure (CNKI), VIP, and Wanfang Databases were searched for randomized controlled trials (RCTs) on LC after PTGD in elder acute cholecystitis published from 1970 to July 2017. Two researchers selected RCTs, extracted data, and evaluated methodological quality independently, and RevMan 5.3 software was used for the meta-analysis. The chi-square test was used for heterogeneity analysis of RCTs included, and the funnel plots were used to evaluate publication bias.<bold>Results: </bold>A total of 9 RCTs with 1000 patients were included in this analysis. Compared with the direct LC Group, the PTGD Group has significant better effect in operative duration (minutes) [standard mean difference (SMD) = -1.37, 95% confidence interval (95% CI): -2.52 to -0.22, P = .02], the amount of intraoperative bleeding (mL) (SMD = -1.38, 95% CI: -2.11 to -0.65, P = .0002), conversion rate to laparotomy (%) [odds ratio (OR) = 0.16, 95% CI: 0.08 to 0.31, P < .00001], postoperative complication morbidity (%) (OR = 0.29, 95% CI: 0.17 to 0.51, P < .0001), and postoperative hospital stay (days) (SMD = -1.26, 95% CI: -1.94 to -0.59, P = .0003). The funnel plots were slightly asymmetric, which suggested the presence of publication bias.<bold>Conclusion: </bold>The PTGD before scheduled LC can effectively not only shorten operative duration, intraoperative bleeding less, and postoperative hospital stay but also decrease the rate to laparotomy and postoperative complication morbidity in elder acute cholecystitis, and it is recommended to be regarded as the preferred therapy of the elder patients.
- Subjects
PERCUTANEOUS transhepatic cholangiography; GALLBLADDER; RANDOMIZED controlled trials; LAPAROSCOPIC surgery; CHOLECYSTITIS; ANATOMY; DIAGNOSIS
- Publication
Journal of Laparoendoscopic & Advanced Surgical Techniques, 2018, Vol 28, Issue 3, p248
- ISSN
1092-6429
- Publication type
journal article
- DOI
10.1089/lap.2017.0514