Percutaneous cholecystostomy as bridge to surgery vs surgery in unfit patients with acute calculous cholecystitis: A systematic review and meta-analysis.
Surgeon
; 21(4): e201-e223, 2023 Aug.
Article
de En
| MEDLINE
| ID: mdl-36577652
ABSTRACT
BACKGROUND:
Acute cholecystitis is one of the most common causes of acute abdomen. Early laparoscopic cholecystectomy is the gold standard treatment, still burdened by a risk of intraoperative biliary duct injury. An alternative strategy to manage patients with severe acute cholecystitis is the percutaneous gallbladder drainage (PGBD).METHODS:
The Italian Society of Emergency Surgery and Trauma performed a systematic review and meta-analysis with the aim to clarify controversies about the preoperative use of PGBD. We extracted 32 studies 9 Randomized Control Trial Studies (RCTs) and 23 no RCTs. RESULTS OF CRITICALOUTCOMES:
The incidence of post-operative complications was lower in the PGBD associated at LC than in the LC alone (RCTs RR 0.28, 95% CI 0.14 to 0.56, I2 = 63%). The incidence of the post-operative biliary leakage was higher in late PGBD' group (RCTs RR 0.18, 95% CI 0.04 to 0.80). RESULTS OF OTHEROUTCOMES:
The incidence of intraabdominal abscess, blood loss, conversion to open, subtotal cholecystectomy, operative time and wound infection was lower in PGBD' group. The total hospital stay was the same.CONCLUSION:
A strong recommendation is performed to the use of the PGBD + LC than upfront LC to reduce biliary leakage (recommendation "strong positive") in high risk acute cholecystitis especially in patients with higher perioperative risks or longstanding acute cholecystitis. For post-operative complications a recommendation "positive weak" suggests that PGBD + LC could be used than upfront LC to reduce the rate of post-operative complications.Mots clés
Texte intégral:
1
Collection:
01-internacional
Base de données:
MEDLINE
Sujet principal:
Cholécystostomie
/
Cholécystectomie laparoscopique
/
Cholécystite aigüe
Type d'étude:
Clinical_trials
/
Guideline
/
Systematic_reviews
Limites:
Humans
Langue:
En
Journal:
Surgeon
Année:
2023
Type de document:
Article