Abstract
BackgroundThe timing of laparoscopic cholecystectomy (LC) performed after the mild acute biliary pancreatitis (MABP) is still controversial. We conducted a review to compare same-admission laparoscopic cholecystectomy (SA-LC) and delayed laparoscopic cholecystectomy (DLC) after mild acute biliary pancreatitis (MABP).MethodsWe systematically searched several databases (PubMed, EMBASE, Web of Science, and the Cochrane Library) for relevant trials published from 1 January 1992 to 1 June 2018. Human prospective or retrospective studies that compared SA-LC and DLC after MABP were included. The measured outcomes were the rate of conversion to open cholecystectomy (COC), rate of postoperative complications, rate of biliary-related complications, operative time (OT), and length of stay (LOS). The meta-analysis was performed using Review Manager 5.3 software (The Cochrane Collaboration, Oxford, United Kingdom).ResultsThis meta-analysis involved 1833 patients from 4 randomized controlled trials and 7 retrospective studies. No significant differences were found in the rate of COC (risk ratio [RR] = 1.24; 95% confidence interval [CI], 0.78–1.97; p = 0.36), rate of postoperative complications (RR = 1.06; 95% CI, 0.67–1.69; p = 0.80), rate of biliary-related complications (RR = 1.28; 95% CI, 0.42–3.86; p = 0.66), or OT (RR = 1.57; 95% CI, − 1.58–4.72; p = 0.33) between the SA-LC and DLC groups. The LOS was significantly longer in the DLC group (RR = − 2.08; 95% CI, − 3.17 to − 0.99; p = 0.0002). Unexpectedly, the subgroup analysis showed no significant difference in LOS according to the Atlanta classification (RR = − 0.40; 95% CI, − 0.80–0.01; p = 0.05). The gallstone-related complications during the waiting time in the DLC group included gall colic, recurrent pancreatitis, acute cholecystitis, jaundice, and acute cholangitis (total, 25.39%).ConclusionThis study confirms the safety of SA-LC, which could shorten the LOS. However, the study findings have a number of important implications for future practice.
Highlights
The timing of laparoscopic cholecystectomy (LC) performed after the mild acute biliary pancreatitis (MABP) is still controversial
Previous studies have shown that the probability of recurrence of acute pancreatitis without cholecystectomy is as high as 33% [9]
According to the different criteria of MABP, the subgroup analysis showed no significant differences between the same-admission laparoscopic cholecystectomy (SA-LC) group (RR = 1.12; 95% confidence interval (CI), 0.77–1.62; p = 0.56) and delayed laparoscopic cholecystectomy (DLC) group (RR = 1.34; 95% CI, 0.57–3.14; p = 0.50) in the two subgroups (p = 0.70) (Fig. 2b)
Summary
The timing of laparoscopic cholecystectomy (LC) performed after the mild acute biliary pancreatitis (MABP) is still controversial. We conducted a review to compare same-admission laparoscopic cholecystectomy (SA-LC) and delayed laparoscopic cholecystectomy (DLC) after mild acute biliary pancreatitis (MABP). Cholecystectomy is considered to be effective in reducing the recurrence of acute gallstone pancreatitis [6,7,8]. Previous studies have shown that the probability of recurrence of acute pancreatitis without cholecystectomy is as high as 33% [9]. A primary concern in the treatment of mild acute biliary pancreatitis (MABP) is the optimal timing of LC. A previous review showed that delayed cholecystectomy can increase readmission [10,11,12]. LC can reduce the risk of recurrent biliary events [15]. The aim of this study was to compare SA-LC and DLC after MABP through analysis including recently studies
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