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Meta-Analysis
. 2018 Nov 29;18(1):111.
doi: 10.1186/s12893-018-0445-9.

Same-admission versus delayed cholecystectomy for mild acute biliary pancreatitis: a systematic review and meta-analysis

Yun-Xiao Lyu  1 , Yun-Xiao Cheng  2 , Hang-Fei Jin  2 , Xin Jin  2 , Bin Cheng  2 , Dian Lu  2
Affiliations
Meta-Analysis

Same-admission versus delayed cholecystectomy for mild acute biliary pancreatitis: a systematic review and meta-analysis

Yun-Xiao Lyu et al. BMC Surg. .

Abstract

Background: 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).

Methods: We 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).

Results: This 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%).

Conclusion: This 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.

Keywords: Cholecystectomy; Laparoscopic; Meta-analysis; Pancreatitis; Review.

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Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Flow diagram of the published articles evaluated for inclusion in this meta-analysis
Fig. 2
Fig. 2
Forest plot of the meta-analysis comparing SA-LC and DLC regarding the incidence of COC (a. all;b. subgroup of MABP criteria).
Fig. 3
Fig. 3
Forest plot of the meta-analysis comparing SA-LC and DLC regarding the incidence of postoperative complication (a. all; b. subgroup of MABP criteria).
Fig. 4
Fig. 4
Forest plot of the subgroup meta-analysis of the incidence of biliary-related complication (a. all;b. subgroup of MABP criteria).
Fig. 5
Fig. 5
Forest plot of the meta-analysis comparing SA-LC and DLC regarding the incidence of operative time (a. all;b. subgroup of MABP criteria).
Fig. 6
Fig. 6
Forest plot of the meta-analysis comparing SA-LC and DLC regarding the incidence of length of hospital stay (a. all;b. subgroup of MABP criteria)
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