Abstract
Laparoscopic cholecystectomy and percutaneous transhepatic gallbladder drainage (PTGBD) are common treatments for patients with acute cholecystitis. However, the safety and efficacy of emergency laparoscopic cholecystectomy (ELC) and delayed laparoscopic cholecystectomy (DLC) after PTGBD in patients with acute cholecystitis remain unclear. The PubMed, EMBASE, and Cochrane Library databases were searched through October 2019. The quality of the included nonrandomized studies was assessed using the Methodological Index for Nonrandomized Studies (MINORS). The meta-analysis was performed using STATA version 14.2. A random-effects model was used to calculate the outcomes. A total of fifteen studies involving 1780 patients with acute cholecystitis were included in the meta-analysis. DLC after PTGBD was associated with a shorter operative time (SMD − 0.51; 95% CI − 0.89 to − 0.13; P = 0.008), a lower conversion rate (RR 0.43; 95% CI 0.26 to 0.69; P = 0.001), less intraoperative blood loss (SMD − 0.59; 95% CI − 0.96 to − 0.22; P = 0.002) and longer time of total hospital stay compared to ELC (SMD 0.91; 95% CI 0.57–1.24; P < 0.001). There was no difference in the postoperative complications (RR 0.68; 95% CI 0.48–0.97; P = 0.035), biliary leakage (RR 0.65; 95% CI 0.34–1.22; P = 0.175) or mortality (RR 1.04; 95% CI 0.39–2.80; P = 0.933). Compared to ELC, DLC after PTGBD had the advantages of a shorter operative time, a lower conversion rate and less intraoperative blood loss.
Highlights
Acute cholecystitis (AC), an inflammatory condition of the gallbladder, is a common disease that involves hospitalization and surgical treatment [1]
After percutaneous transhepatic gallbladder drainage (PTGBD) in AC patients remain unclear. We conducted this meta-analysis to better understand and compare the safety and efficacy of emergency laparoscopic cholecystectomy (ELC) and PTGBD followed by delayed laparoscopic cholecystectomy (DLC) in AC patients in terms of the operative time, rate of conversion to open surgery, length of hospital stay, intraoperative blood loss, postoperative complications, biliary leakage and mortality
Several studies have endorsed the usefulness of PTGBD for AC with a high success rate of efficacious drainage and a low complication rate, making it is a suitable treatment for AC patients [29, 30, 36]
Summary
Acute cholecystitis (AC), an inflammatory condition of the gallbladder, is a common disease that involves hospitalization and surgical treatment [1]. In most AC patients, laparoscopic cholecystectomy can rapidly attenuate inflammatory symptoms and signs. LC may precipitate certain complications, such as biliary leakage, bile duct injury and intraabdominal abscess [6, 7], especially in elderly AC patients who undergo emergency laparoscopic cholecystectomy, Vol.:(0123456789). Which may cause high morbidity and mortality rates [8]. Several studies have documented that LC is associated with a high rate of conversion to open cholecystectomy and a long length of hospital stay [9, 10]
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