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Laparoscopic versus open cholecystectomy for patients with symptomatic cholecystolithiasis

  • Review
  • Intervention

Authors


Abstract

Background

Cholecystectomy is one of the most frequently performed operations. Open cholecystectomy has been the gold standard for over 100 years. Laparoscopic cholecystectomy was introduced in the 1980s.

Objectives

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

Search methods

We searched The Cochrane Hepato-Biliary Group Controlled Trials Register (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All published and unpublished randomised trials in patients with symptomatic cholecystolithiasis comparing any kind of laparoscopic cholecystectomy versus any kind of open cholecystectomy.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 when appropriate.

Main results

Thirty-eight trials randomised 2338 patients. Most of the trials had high bias risk. There was no significant difference regarding mortality (risk difference 0,00, 95% confidence interval (CI) -0.01 to 0.01). Meta-analysis of all trials suggests less overall complications in the laparoscopic group, but the high-quality trials show no significant difference ('allocation concealment' high-quality trials risk difference, random effects -0.01, 95% CI -0.05 to 0.02). Laparoscopic cholecystectomy patients have a shorter hospital stay (weighted mean difference (WMD), random effects -3 days, 95% CI -3.9 to -2.3) and convalescence (WMD, random effects -22.5 days, 95% CI -36.9 to -8.1) compared to open cholecystectomy.

Authors' conclusions

No significant differences were observed in mortality, complications and operative time between laparoscopic and open cholecystectomy. Laparoscopic cholecystectomy is associated with a significantly shorter hospital stay and a quicker convalescence compared with the classical open cholecystectomy. These results confirm the existing preference for the laparoscopic cholecystectomy over open cholecystectomy.

摘要

背景

比較症狀性膽囊結石病人使用的腹腔鏡和剖腹膽囊切除術(Open cholecystectomy)

膽囊切除術是最常見的手術之一。剖腹膽囊切除術為100多年以來的黃金標準。 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剖腹膽囊切除術的利弊。

搜尋策略

我們搜尋The Cochrane HepatoBiliary Group Controlled Trials Register (2004年4月), 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)以及 CINAHL (1982 年 2004年1月),以找出隨機試驗。

選擇標準

所有發表和未發表的隨機試驗,來比較症狀性膽囊結石病人使用任何種類的腹腔鏡和剖腹膽囊切除術。沒有語言限制。

資料收集與分析

兩位作者單獨選擇試驗、提取資料。從分配順序的生成、分配方案的隱藏、盲法和追蹤等方面評估研究方法學品質。同時評估偏誤風險。 分析以治療意向為基礎。對於缺失的資料,我們詢問作者獲取更多的資訊。適當情況下,實施敏感性和亞組分析。

主要結論

共納入38個隨機試驗,共2338位病人。多數試驗具有較高的偏誤風險。死亡率上沒有顯著差異 (風險差異 0,00, 95% 信賴區間 (CI) −0.01 0.01)。所有試驗的統合分析指出,腹腔鏡組整體的併發症較少,但是高品質的試驗指出沒有顯著差異 (‘分配方案的隱藏’ 高品質試驗,風險差異,隨機效果 −0.01, 95% CI −0.05 0.02)。 比起腹膽囊切除術的病人,接受腹腔鏡膽囊切除術的病人的住院日(加權平均差(WMD),隨機效果−3天, 95% CI −3.9 2.3)和恢復期較短 (WMD, 隨機效果 −22.5 天, 95% CI −36.9 – 8.1) 。

作者結論

腹腔鏡和剖腹膽囊切除術在死亡率,併發症和手術時間沒有存在顯著差異。 和傳統的剖腹膽囊切除術相比,腹腔鏡膽囊切除術的住院日明顯較短和恢復更快。 這些結果確認,比起剖腹膽囊切除術,目前更傾向於腹腔鏡膽囊切除術。

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

腹腔鏡和剖腹膽囊切除術看似在併發症和手術時間方面不相上下,但是腹腔鏡膽囊切除術的恢復較快。傳統的剖腹膽囊切除術和微創腹腔鏡膽囊切除術是膽囊切除的兩種替代手術。 腹腔鏡和剖腹膽囊切除術在死亡率和併發症方面沒有顯著差異,但前者在住院日時間和恢復期方面優於後者。

Plain language summary

Laparoscopic and open cholecystectomy seem equivalent considering complications and operative time, but laparoscopic cholecystectomy is associated with quicker recovery

The classical open cholecystectomy and the minimally invasive laparoscopic cholecystectomy are two alternative operations for removal of the gallbladder. There are no significant differences in mortality and complications between the laparoscopic and the open techniques. The laparoscopic operation has advantages over the open operation regarding duration of hospital stay and convalescence.

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