Intervention Review

Small-incision versus open cholecystectomy for patients with symptomatic cholecystolithiasis

  1. Frederik Keus1,*,
  2. J de Jong2,
  3. Hein G Gooszen3,
  4. C JHM Laarhoven4

Editorial Group: Cochrane Hepato-Biliary Group

Published Online: 18 OCT 2006

Assessed as up-to-date: 10 AUG 2006

DOI: 10.1002/14651858.CD004788.pub2

How to Cite

Keus F, de Jong J, Gooszen HG, Laarhoven CJHM. Small-incision versus open cholecystectomy for patients with symptomatic cholecystolithiasis. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD004788. DOI: 10.1002/14651858.CD004788.pub2.

Author Information

  1. 1

    Diakonessenhuis, Surgery, Utrecht, Utrecht, Netherlands

  2. 2

    Maastro Clinic, Radiation Oncology, Maastricht, Netherlands

  3. 3

    University Medical Center, Department of Surgery G.04.228, GA Utrecht, Netherlands

  4. 4

    St. Elisabeth Hospital, Surgery, Tilburg, Netherlands

*Frederik Keus, Surgery, Diakonessenhuis, Bosboomstraat 1, Utrecht, Utrecht, 3582 KE, Netherlands. erickeus@hotmail.com.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 18 OCT 2006

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Cholecystectomy is one of the most frequently performed operations. Open cholecystectomy has been the gold standard for over 100 years. Small-incision cholecystectomy is a less frequently used alternative.

Objectives

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

Search methods

We searched The Cochrane Hepato-Biliary Group Controlled Trials Register (6 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All published and unpublished randomised trials in patients with symptomatic cholecystolithiasis comparing any kind of small-incision or other kind of minimal incision cholecystectomy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 if appropriate.

Main results

Seven trials randomised 571 patients. Bias risk was high in the included trials. No mortality was reported. The total complication proportions are respectively 9.9% and 9.3% in the small-incision and open group, which is not significantly different (risk difference all trials, random-effects 0.00, 95% confidence interval (CI) -0.06 to 0.07). There are also no significant differences considering severe complications and bile duct injuries. However, small-incision cholecystectomy has a shorter hospital stay (weighted mean difference, random-effects -2.8 days (95% CI -4.9 to -0.6)) compared to open cholecystectomy.

Authors' conclusions

Small-incision and open cholecystectomy seem to be equivalent regarding risks of complications, but the latter method is associated with a significantly longer hospital stay. The quicker recovery of small-incision cholecystectomy compared with open cholecystectomy confirms the existing preference of this technique over open cholecystectomy.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Small-incision cholecystectomy and open cholecystectomy seem equivalent considering complications, but small-incision cholecystectomy is associated with a shorter hospital stay

The classical open cholecystectomy and the minimally invasive small-incision cholecystectomy are two alternative operations for removal of the gallbladder. There seem to be no significant differences in mortality and complications between these two techniques. Hospital stay is shorter using the small-incision operation. This review shows that the small-incision and open cholecystectomy should be considered equal, apart from a shorter hospital stay using the small-incision technique.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

以小切口膽囊切除術或開腹膽囊切除術來治療症狀性膽囊結石病人的比較

膽囊切除術是最經常實施的手術之一。100多年以來,開腹膽囊切除已成為黃金標準。小切口膽囊切除術是一種較不經常使用的替代手術。

目標

比較小切口膽囊切除術對照開腹膽囊切除術來治療症狀性膽囊結石病人的利弊。

搜尋策略

我們搜尋The Cochrane HepatoBiliary Group Controlled Trials Register (2004年4月6日)、 Cochrane Library(2004年第1期),、MEDLINE (1966年 2004年1月)、EMBASE (1980 年−2004年1月)、Web of Science(1988年 2004年1月)和CINAHL (1982年−2004年1月) 以找出隨機試驗。

選擇標準

比較任何一種小切口膽囊切除術或微小切口膽囊切除術與任何一種開腹膽囊切除術,用來治療症狀性膽囊結石病人的所有已發表和未發表的隨機試驗。 沒有語言限制。

資料收集與分析

兩位作者獨立選擇試驗、摘錄數據。評估方法學上的品質包括分配順序的產生、分配方案的隱匿、盲法和後續追蹤等,以評估偏誤的風險。並且以治療意向為基礎進行分析。如果資料缺失,諮詢作者以獲取額外資訊。適當情況下,實施敏感性和亞組分析。

主要結論

共包括7個隨機試驗,571 位病人。試驗的偏誤風險偏高。沒有報導有死亡。小切口膽囊切除術組和開腹膽囊切除術組的總併發症比例分別是9.9% 和9.3%,統計學上沒有顯著差異(所有試驗的隨機效果風險差異為0.00, 95% 信賴區間 (CI) −0.06 – 0.07)。在嚴重併發症和膽管損傷方面,兩組也沒有顯著差異。 但是,小切口膽囊切除術組的住院日明顯低於開腹膽囊切除術組 (隨機效果的加權平均差−2.8 天 (95% CI −4.9 – 0.6))。

作者結論

小切口膽囊切除術和開腹膽囊切除術看似在併發症風險方面相當,但是後者與住院日明顯延長有關。比較開腹膽囊切除術,小切口膽囊切除術恢復更快,這樣就確認了該技術目前比開腹膽囊切除術更受青睞的事實。

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

小切口膽囊切除術和開腹膽囊切除術在併發症方面看似相當, 但是小切口膽囊切除術的住院日更短。傳統的開腹膽囊切除術和微創小切口膽囊切除術是兩種移除膽囊的手術方法。兩種技術在死亡率和併發症方面沒有顯著差異。小切口膽囊切除術的住院日較短。 本次文獻回顧指出除了小切口膽囊切除術具有較短的住院天數之外,小切口膽囊切除術和開腹膽囊切除術大致是相同的。