The safety, feasibility, and cost-effectiveness of early laparoscopic cholecystectomy for patients with mild acute biliary pancreatitis: A meta-analysis.
Surgeon
; 19(5): 287-296, 2021 Oct.
Article
em En
| MEDLINE
| ID: mdl-32709425
ABSTRACT
BACKGROUND:
It remains controversial on the optimal timing of cholecystectomy for patients with mild acute biliary pancreatitis. This study aimed at comparing the safety, feasibility, and cost-effectiveness of early laparoscopic cholecystectomy (ELC, within 72 h after admission) versus delayed laparoscopic cholecystectomy (DLC, beyond 72 h after admission) for patients with mild acute biliary pancreatitis.METHODS:
We performed a systematic search in the following databases PubMed, Embase, Web of Science, and Cochrane library. We only included articles from RCTs which designed to evaluate the complications, conversion to open cholecystectomy, recurrence of acute pancreatitis, the length of hospital stay, and costs between patients undergoing ELC and those undergoing DLC. We schemed to analyze data using STATA 15.0 with both the random-effects and the fixed-effect models. We computed relative risk (RR) and weighted mean difference (WMD) with 95% confidence intervals (CI) based on the intention-to-treat (ITT) analysis.RESULTS:
A total of 4 studies involving 439 (215 vs 224) patients were included. The difference of complication rate [3.3% vs 3.2%; RR 1.03 (0.35, 3.01), P = 0.961] and rate of conversion to open cholecystectomy [3.8% vs 3.3%; RR 1.13 (0.37, 3.43), P = 0.830] are insignificant between patients who underwent ELC and ones who underwent DLC. The difference of rate of recurrence of acute pancreatitis is significant between ELC and DLC (2.17% vs 8.99%; RR 0.24 (0.08-0.70), P = 0.009). ELC does not shorten the length of hospital stay (random-effects modelanalysis:
WMD -1.09 days (-2.67, 0.48), P = 0.173; fixed-effect modelanalysis:
WMD -0.62 days (-1.00, -0.24), P = 0.001).CONCLUSION:
Compared to DLC, ELC is equally safe and feasible both in complication rate and rate of conversion to open procedure, and significantly reduces the recurrence rate of acute pancreatitis. PROSPERO REGISTRATION NUMBER CRD42018116239.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Pancreatite
/
Colecistectomia Laparoscópica
/
Colecistite Aguda
Tipo de estudo:
Etiology_studies
/
Health_economic_evaluation
/
Prognostic_studies
/
Systematic_reviews
Limite:
Humans
Idioma:
En
Ano de publicação:
2021
Tipo de documento:
Article