Meta-Analysis of Laparoscopic versus Open Hepatectomy for Live Liver Donors.

Jun Xu,Shu-Sen Zheng,Wei-Lin Wang,Song Ye,Mang-Li Zhang,Hua-Li Cao,Chen Hu,Salvatore Gruttadauria

doi:10.1371/journal.pone.0165319

Abstract

ObjectiveTo document the safety and efficacy of laparoscopic living donor hepatectomy in comparison with open liver resection for living donor liver transplantation.MethodsMedline database, EMASE and Cochrane library were searched for original studies comparing laparoscopic living donor hepatectomy (LLDH) and open living donor hepatectomy (OLDH) by January 2015. Meta-analysis was performed to evaluate donors’ perioperative outcomes.ResultsNine studies met selection criteria, involving 1346 donors of whom 318 underwent LLDH and 1028 underwent OLDH. The Meta analysis demonstrated that LLDH group had less operative blood loss [patients 1346; WMD: -56.09 mL; 95%CI: -100.28-(-11.90) mL; P = 0.01], shorter hospital stay [patients 737; WMD: -1.75 d; 95%CI: -3.01-(-0.48) d; P = 0.007] but longer operative time (patients 1346; WMD: 41.05 min; 95%CI: 1.91–80.19 min; P = 0.04), compared with OLDH group. There were no significant difference in other outcomes between LLDH and OLDH groups, including overall complication, bile leakage, postoperative bleeding, pulmonary complication, wound complication, time to dietary intake and period of analgesic use.ConclusionsLLDH appears to be a safe and effective option for LDLT. It improves donors’ perioperative outcomes as compared with OLDH.

Highlights

Living donor liver transplantation(LDLT) has developed rapidly over the couple decades since the first treatment in 1989 in children[1]
The Meta analysis demonstrated that Laparoscopic living donor hepatectomy (LLDH) group had less operative blood loss [patients 1346; weighted mean differences (WMD): -56.09 mL; 95%confidence intervals (CIs): -100.28-(-11.90) mL; P = 0.01], shorter hospital stay [patients 737; WMD: -1.75 d; 95%CI: -3.01-(-0.48) d; P = 0.007] but longer operative time, compared with open living donor hepatectomy (OLDH) group
There were no significant difference in other outcomes between LLDH and OLDH groups, including overall complication, bile leakage, postoperative bleeding, pulmonary complication, wound complication, time to dietary intake and period of analgesic use

Summary

Introduction

Living donor liver transplantation(LDLT) has developed rapidly over the couple decades since the first treatment in 1989 in children[1]. LDLT serves as an established treatment for patients with end-stage liver disease (ESLD) when a deceased donor liver is not available. Partial hepatic allografts from live donors, compared with deceased donors, have been found to reduce the risk of the recipient dying on the waiting list. The recipient survival is comparable to that in cadaveric liver transplantation[5,6,7,8,9]. The method of open living donor hepatectomy (OLDH) has been nowadays challenged by less invasive techniques, the most majority of procedures are still conventional open donor partial hepatectomy. Laparoscopic living donor hepatectomy (LLDH) are being increasingly performed in experienced centers[10]

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Results

Conclusion