Abstract
Aim
Compare outcomes of early laparoscopic cholecystectomy (ELC) and percutaneous trans-hepatic drainage of gallbladder (PTGBD) as an initial intervention for AC and to compare operative outcomes of ELC and delayed laparoscopic cholecystectomy (DLC).
Methods
English-language studies published until December 2020 were searched. Randomised controlled trials (RCTs) and observational studies compared EC and PTGBD with delayed cholecystectomy for patients presented with acute cholecystitis were considered. Main outcomes were mortality, conversion to open, complications and length of hospital stay.
Results
Out of 1347 records,14 studies were included. 205,361(94.7%) patients had EC and 11,565 (5.3%) patients had PTGBD as an initial intervention for AC. Mortality was higher in PTGBD; HR,95% CI: [3.68 (2.13, 6.38)]. In contrast, complication rate was significantly higher in EC group (47%) vs PTGBD group (8.7%) in patients admitted to ICU; P-value=0.011. Patients who had ELC were at higher risk of post-operative complications compared to DLC; RR [95% CI]: 2.88 [1.78, 4.65]. Risk of bile duct injury was six folds more in ELC; RR [95% CI]: 6.07 [1.67, 21.99].
Conclusion
ELC may be a preferred treatment option over PTGBD in AC. However, patient and disease specific factors should be considered to avoid unfavourable outcomes with ELC.
Within the constraints of comparing emergency with elective procedure, ELC is associated with less total hospital stay but more intra-operative blood loss and post-operative complications compared to DLC following PTGBD. Future high-quality studies are needed to assess different management strategies in high-risk surgical patients with complicated AC.
Compare outcomes of early laparoscopic cholecystectomy (ELC) and percutaneous trans-hepatic drainage of gallbladder (PTGBD) as an initial intervention for AC and to compare operative outcomes of ELC and delayed laparoscopic cholecystectomy (DLC).
Methods
English-language studies published until December 2020 were searched. Randomised controlled trials (RCTs) and observational studies compared EC and PTGBD with delayed cholecystectomy for patients presented with acute cholecystitis were considered. Main outcomes were mortality, conversion to open, complications and length of hospital stay.
Results
Out of 1347 records,14 studies were included. 205,361(94.7%) patients had EC and 11,565 (5.3%) patients had PTGBD as an initial intervention for AC. Mortality was higher in PTGBD; HR,95% CI: [3.68 (2.13, 6.38)]. In contrast, complication rate was significantly higher in EC group (47%) vs PTGBD group (8.7%) in patients admitted to ICU; P-value=0.011. Patients who had ELC were at higher risk of post-operative complications compared to DLC; RR [95% CI]: 2.88 [1.78, 4.65]. Risk of bile duct injury was six folds more in ELC; RR [95% CI]: 6.07 [1.67, 21.99].
Conclusion
ELC may be a preferred treatment option over PTGBD in AC. However, patient and disease specific factors should be considered to avoid unfavourable outcomes with ELC.
Within the constraints of comparing emergency with elective procedure, ELC is associated with less total hospital stay but more intra-operative blood loss and post-operative complications compared to DLC following PTGBD. Future high-quality studies are needed to assess different management strategies in high-risk surgical patients with complicated AC.
| Original language | English |
|---|---|
| Pages (from-to) | 1622-1633 |
| Number of pages | 11 |
| Journal | HPB |
| Volume | 24 |
| Issue number | 10 |
| Early online date | 18 Oct 2022 |
| DOIs | |
| Publication status | Published - Oct 2022 |
Bibliographical note
FundingThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Acknowledgement
With thanks to Helen Fulbright, PhD, MA, PGDip LIS, BA (Hons), MCLIP, Information Specialist, Royal College of Surgeons of England Library and Archives Team, for conducting the literature searches.
Data Availability Statement
Supplementary dataSupplementary data to this article can be found online at https://doi.org/10.1016/j.hpb.2022.04.010.