Mortality and complications associated with laparoscopic cholecystectomy. A meta-analysis

Area of Science:

• Surgical Outcomes Research
• Gastrointestinal Surgery
• Comparative Effectiveness Research

Background:

• Laparoscopic cholecystectomy (LC) has numerous published reports since its US introduction, often claiming advantages over open cholecystectomy (OC).
• Existing studies vary significantly in scope and quality.
• Sufficient data from large case-series now allow for comparative analysis of key outcomes.

Purpose of the Study:

• To conduct a meta-analysis of large laparoscopic cholecystectomy (LC) case-series.
• To compare LC outcomes, specifically bile duct injury (BDI) rates, against those reported for open cholecystectomy (OC).

Main Methods:

• MEDLINE database search for relevant cholecystectomy case-series.
• Evaluation of articles based on standard criteria.
• Abstraction and summarization of data on patient demographics, study methodologies, and surgical outcomes.

Main Results:

• Analysis included 78,747 patients from 98 LC studies and 12,973 patients from 28 OC studies.
• LC demonstrated a lower mortality rate but a higher common bile duct injury rate compared to OC.
• Other complication rates for LC were generally low; most conversions were due to intraoperative findings, not injury.

Conclusions:

• Significant variability exists in data reporting and patient comparability across studies.
• LC is comparable in safety to OC, with the exception of a higher rate of common bile duct injury.