A Systematic Review and Meta-Analysis of the Outcomes of Laparoscopic Cholecystectomy Compared to the Open Procedure in Patients with Gallbladder Disease

Abstract

Background Conflicting evidence regarding the laparoscopic versus open cholecystectomy outcomes in scientific literature impacts the medical decision-making for patients with gallbladder disease. This study aimed to compare a range of primary and secondary outcomes between patients receiving laparoscopic cholecystectomy and those with open intervention. Methods Articles published from 1993 to 2023 were explored by utilizing advanced filters of PubMed Central/Medline, Web of Science, CINAHL, JSTOR, Cochrane Library, Scopus, and EBSCO. The gallbladder disease was determined by the presence of one or more of the following conditions: 1) Gangrenous cholecystitis, 2) acute cholecystitis, 3) chronic gallbladder diseases, and 4) cholelithiasis. The primary end-point was mortality, while the secondary outcome included (1) bile leakage, 2) common bile duct injury, 3) gangrene, 4) hospital stay (days), 5) major complications, 6) median hospital stay (days), (7) pneumonia, 8) sick leaves (days), and 9) wound infection. Results Statistically significant reductions were observed in mortality (odds ratio [OR]: 0.30, 95% confidence interval [CI]: 0.30, 0.45, p < 0.00001), mean hospital stay duration (mean difference: -2.68, 95% CI: -3.66, -1.70, p < 0.00001), major complications (OR: 0.35, 95% CI: 0.19, 0.64, p = 0.0005), post/intraoperative wound infection (OR: 0.29, 95% CI: 0.16, 0.51, p < 0.0001), and sick leaves (OR: 0.34, 95% CI: 0.14, 0.80, p = 0.01) in patients who underwent laparoscopic cholecystectomy compared with those with the open intervention. No statistically significant differences were recorded between the study groups for bile leakage, common bile duct injury, gangrene, median hospital stay days, and pneumonia ( p > 0.05). Conclusions The pooled outcomes favored the use of laparoscopic cholecystectomy over the open procedure in patients with gallbladder disease. The consolidated findings indicate the higher impact of laparoscopic cholecystectomy in improving patient outcomes, including safety episodes, compared with open cholecystectomy.

Keywords: cholecystectomy; gallbladder disease; laparoscopic cholecystectomy; open cholecystectomy.

Fig. 1

Mortality forest plot. ( A ) Bile Leakage forest plot. ( B ) common bile duct injury forest plot. ( C ) Gangrene forest plot ( D ) Hospital stay (days) forest plot ( E ) Major complications forest plot ( F ) Median hospital stay (days) forest plot. CI, confidence interval; IV, intravenous; LC, laparoscopic cholecystectomy; OC, open cholecystectomy; SD, standard deviation.

Fig. 2

Pneumonia forest plot. ( A ) Sick leaves (days) forest plot. ( B ) Wound infection forest plot. ( C ) Risk of bias in non-randomized studies of Interventions (ROBINS-I; Summary). ( D ) ROBINS-I (Graph). ( E ) ROB2 (Summary). ( F ) ROB2 (Graph). CI, confidence interval; LC, laparoscopic cholecystectomy; OC, open cholecystectomy.