Comparison of Efficacy and Safety of Laparoscopic Holmium laser Lithotripsy and Laparoscopic Bile Duct Exploration for Bile Duct Stones: A Systematic Review and Meta-Analysis.
World J Surg
; 47(7): 1809-1820, 2023 07.
Article
em En
| MEDLINE
| ID: mdl-37041308
ABSTRACT
BACKGROUND:
Laparoscopic holmium laser lithotripsy (LHLL) has been used to treat bile duct stones with unclear outcomes. A meta-analysis was conducted to investigate the LHLL and laparoscopic bile duct exploration (LBDE) efficacy and safety in treating bile duct stones.METHODS:
The correlational studies were searched databases, such as PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang, and VIP, to identify eligible studies from inception to July 2022. The dichotomous and continuous outcomes were evaluated using odds ratio (OR), risk difference (RD) and weighted mean difference (WMD) with 95% confidence intervals (CIs). Stata 15.0 and Review Manager 5.3 software helped in data analyses.RESULTS:
A total of 23 studies with 1,890 patients, primarily from China, were included. The results indicated that operation time (WMD = - 26.94; 95% CI(- 34.30, - 19.58); P < 0.00001), estimated blood loss (WMD = - 17.97; 95% CI (- 22.94, - 13.00); P = 0.002), rate of residual stone (OR = 0.15, 95%CI (0.10, 0.23); P < 0.00001), length of hospital stay (WMD = - 2.88; 95% CI(- 3.80, - 1.96); P < 0.00001) and time to bowel function recovery (WMD = - 0.59; 95% CI (- 0.76, - 0.41); P < 0.00001) had statistically significant differences between the two groups. In postoperative complications, biliary leakage (RD = -0.03; 95% CI (- 0.05, -0.00); P = 0.02), infection (RD = - 0.06; 95% CI (- 0.09,- 0.03); P < 0.00001) and Hepatic injury (RD = - 0.06; 95% CI (- 0.11, - 0.01); P = 0.02) revealed statistically significant differences. However, no significant differences were observed in biliary damage (RD = - 0.03; 95% CI (- 0.06, 0.00); P = 0.06) and hemobilia (RD = - 0.03; 95% CI (- 0.06, 0.00); P = 0.08).CONCLUSION:
The current meta-analysis indicated that LHLL could be more effective and safer than LBDC. However, these results should be confirmed with a larger sample size and rigorously designed randomized controlled trials.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Cálculos Biliares
/
Colecistectomia Laparoscópica
/
Laparoscopia
/
Litotripsia a Laser
/
Coledocolitíase
Tipo de estudo:
Clinical_trials
/
Systematic_reviews
Limite:
Humans
Idioma:
En
Revista:
World J Surg
Ano de publicação:
2023
Tipo de documento:
Article
País de afiliação:
China