Intervention Review

Laparoscopic versus small-incision cholecystectomy for patients with symptomatic cholecystolithiasis

  1. Frederik Keus1,*,
  2. Jeroen de Jong2,
  3. Hein G Gooszen3,
  4. CHJM van Laarhoven4

Editorial Group: Cochrane Hepato-Biliary Group

Published Online: 18 OCT 2006

Assessed as up-to-date: 10 AUG 2006

DOI: 10.1002/14651858.CD006229


How to Cite

Keus F, de Jong J, Gooszen HG, van Laarhoven CHJM. Laparoscopic versus small-incision cholecystectomy for patients with symptomatic cholecystolithiasis. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD006229. DOI: 10.1002/14651858.CD006229.

Author Information

  1. 1

    Diakonessenhuis, Surgery, Utrecht, Utrecht, Netherlands

  2. 2

    University Medical Center, Utrecht, Netherlands

  3. 3

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

  4. 4

    University Medical Centre St Radboud Nijmegen, Department of Surgery, Nijmegen, 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. Laparoscopic cholecystectomy was introduced in the 1980s.

Objectives

To compare the beneficial and harmful effects of laparoscopic versus small-incision 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All published and unpublished randomised trials in patients with symptomatic cholecystolithiasis comparing any kind of laparoscopic cholecystectomy versus small-incision or other kind of minimal incision 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

Thirteen trials randomised 2337 patients. Methodological quality was relatively high considering the four quality criteria. Total complications of laparoscopic and small-incision cholecystectomy are high: 26.6% versus 22.9%. Total complications (risk difference, random-effects -0.01, 95% confidence interval (CI) -0.07 to 0.05), hospital stay (weighted mean difference (WMD), random-effects -0.72 days, 95% CI -1.48 to 0.04), and convalescence were not significantly different. High-quality trials show a quicker operative time for small-incision cholecystectomy (WMD, high-quality trials 'blinding', random-effects 16.4 minutes, 95% CI 8.9 to 23.8) while low-quality trials show no significant difference.

Authors' conclusions

Laparoscopic and small-incision cholecystectomy seem to be equivalent. No differences could be observed in mortality, complications, and postoperative recovery. Small-incision cholecystectomy has a significantly shorter operative time. Complications in elective cholecystectomy are prevalent.

 

Plain language summary

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

Laparoscopic and small-incision cholecystectomy seem equivalent in complications and recovery, but small-incision cholecystectomy is quicker to perform

The laparoscopic and the small-incision cholecystectomy are two alternative minimally invasive techniques for removal of the gallbladder. There are no significant differences in mortality and complications between the two minimal invasive procedures. The laparoscopic and the small-incision operation should be considered equal apart from a quicker operative time using the small-incision technique. The complications in both techniques are common.

 

摘要

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

背景

比較症狀性膽囊結石病人使用的腹腔鏡膽囊切除術和小切口膽囊切除術

膽囊切除術是最常見的手術之一,而剖腹膽囊切除術(Open cholecystectomy)100多年來為其黃金標準。 小切口膽囊切除術是一種不太經常使用的替代手術。腹腔鏡膽囊切除術在20世紀80年代引入。

目標

比較症狀性膽囊結石病人使用腹腔鏡和小切口膽囊切除術(cholecystectomy)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) 等資料庫,以找出隨機試驗。

選擇標準

所有發表和未發表的對症狀性膽囊結石病人使用任意一種腹腔鏡膽囊切除術比較小切口或其他小切口開腹膽囊切除術的隨機試驗。沒有語言限制。

資料收集與分析

兩位作者單獨選擇試驗,摘錄數據。從分配順序的生成,分配方案的隱匿、盲法和後續追蹤等幾個方面評估研究方法學品質。以治療意向評估偏誤風險。對於缺失資料,透過諮詢作者以獲得額外資訊。適當的情況下,實施敏感性和亞組分析。

主要結論

納入13個隨機試驗,共2337 位病人。因依照上述四項品質之標準來評估試驗品質,其方法學品質相對較高。腹腔鏡和小切口膽囊切除術的總體併發症都很高: 26.6% 對照22.9%。總體併發症 (風險差異、隨機效果 −0.01, 95% 信賴區間 (CI) −0.07 0.05)、住院日 (加權平均差(WMD)、隨機效果 −0.72 天, 95% CI −1.48  0.04)和恢復期沒有顯著差異。高品質的試驗指出小切口膽囊切除術的手術時間更短(WMD, 高品質試驗 ‘盲法’、隨機效果16.4 分鐘 95% CI 8.9 – 23.8) ,低品質試驗顯示兩者沒有顯著差異。

作者結論

腹腔鏡和小切口膽囊切除術似乎差異不大。在死亡率、併發症和術後恢復方面,並無差異。小切口膽囊切除術的手術時間明顯更短。併發症在選擇性的膽囊切除術中較多。

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

腹腔鏡和小切口膽囊切除術似乎在併發症和恢復方面相當,但是小切口膽囊切除術的手術時間更短。腹腔鏡和小切口膽囊切除術是兩種膽囊切除的替代性微創技術。兩種微創技術在死亡率和併發症方面沒有顯著差異。除了使用小切口技術的手術時間快以外,腹腔鏡和小切口手術應認為是相當的。兩種手術皆常發生併發症。