Laparoscopic hepatectomy provides better outcomes for hepatolithiasis as compared to its open counterpart: a...

Laparoscopic hepatectomy (LH) is used more commonly for hepatolithiasis, but high-level evidence is still scarce. This meta-analysis aimed to compare the short-term outcomes between LH and open hepatectomy (OH) for hepatolithiasis using data collected from randomized controlled trials (RCTs) and propensity score-matched (PSM) studies.

We searched the EMBASE, Web of Science, Scopus, PubMed, and Cochrane Library databases for RCTs and PSM studies comparing LH and OH. Risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated.

Ten studies encompassing 2 RCTs and 8 PSM studies were included, with a total of 1898 patients (LH group: 936 patients; OH group: 962 patients). Compared with OH, LH was associated with a lower overall morbidity (RR, 0.59), major complications (RR, 0.57), wound infection (RR, 0.27), intestinal obstruction (RR, 0.43), stone recurrence (RR, 0.49) and blood transfusion rates (RR, 0.74), less blood loss (MD, -65.97 mL), shorter length of stay (MD, -3.22 days), time to first flatus (MD, -0.76 days), time to oral intake (MD, -1.21 days), and time to ambulation (MD, -0.90 days). No significant differences were observed between LH and OH in initial stone clearance (RR, 1.03), final stone clearance (RR, 1.00), mortality (RR, 1.63), or operative time (MD, 16.90 min).

Although LH and OH had similar surgical outcomes, LH had the perioperative advantage over OH in decreasing overall morbidity, major complications, wound infection, intestinal obstruction, stone recurrence, blood transfusion rates, blood loss, length of stay, time to first flatus, time to oral intake, and time to ambulation. Further RCTs evaluating the potential advantages of LH over OH are warranted.