Abstract
Background and ObjectiveWe conducted a network meta analysis (NMA) to compare different kinds of laparoscopic cholecystectomy [LC] (single port [SPLC], two ports [2PLC], three ports [3PLC], and four ports laparoscopic cholecystectomy [4PLC], and four ports mini-laparoscopic cholecystectomy [mini-4PLC]).MethodsPubMed, the Cochrane library, EMBASE, and ISI Web of Knowledge were searched to find randomized controlled trials [RCTs]. Direct pair-wise meta analysis (DMA), indirect treatment comparison meta analysis (ITC) and NMA were conducted to compare different kinds of LC.ResultsWe included 43 RCTs. The risk of bias of included studies was high. DMA showed that SPLC was associated with more postoperative complications, longer operative time, and higher cosmetic score than 4PLC, longer operative time and higher cosmetic score than 3PLC, more postoperative complications than mini-4PLC. Mini-4PLC was associated with longer operative time than 4PLC. ITC showed that 3PLC was associated with shorter operative time than mini-4PLC, and lower postoperative pain level than 2PLC. 2PLC was associated with fewer postoperative complications and longer hospital stay than SPLC. NMA showed that SPLC was associated with more postoperative complications than mini-4PLC, and longer operative time than 4PLC.ConclusionThe rank probability plot suggested 4PLC might be the worst due to the highest level of postoperative pain, longest hospital stay, and lowest level of cosmetic score. The best one might be mini-4PLC because of highest level of cosmetic score, and fewest postoperative complications, or SPLC because of lowest level of postoperative pain and shortest hospital stay. But more studies are needed to determine which will be better between mini-4PLC and SPLC.
Highlights
Background and ObjectiveWe conducted a network meta analysis (NMA) to compare different kinds of laparoscopic cholecystectomy [Laparoscopic cholecystectomy (LC)]
Data analysis The outcomes we evaluated were postoperative pain using visual analogue scale (VAS) at the first day, the number of patients who needed additional analgesics, postoperative complications, intra-operative blood loss, cosmetic score, hospital stay and operative time
Mini-4PLC was associated with longer operative time than 4PLC
Summary
Background and ObjectiveWe conducted a network meta analysis (NMA) to compare different kinds of laparoscopic cholecystectomy [LC] (single port [SPLC], two ports [2PLC], three ports [3PLC], and four ports laparoscopic cholecystectomy [4PLC], and four ports mini-laparoscopic cholecystectomy [mini-4PLC]). Three ports laparoscopic cholecystectomy (3PLC) was developed [6,7]. It was thought that reduced size, smaller incision, and fewer ports for LC will improve cosmetic results, decrease pain, and minimize postoperative complication [8,9]. A mini-laparoscopic cholecystectomy (mini-PLC) with smaller ports and incisions was developed. Current guidelines recommend performing cholecystectomy via laparoscopy [13], we were not sure what kinds of LC will be the golden standard with minimizing morbidity, decreasing pain and improving cosmetic results. We conducted a network meta analysis [NMA] to compare different kinds of LC (SPLC, 2PLC, 3PLC, 4PLC, and four ports minilaparoscopic cholecystectomy (mini-4PLC))
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