Evaluating effectiveness and safety of combined percutaneous transhepatic gallbladder drainage and laparoscopic cholecystectomy in acute cholecystitis patients: Meta-analysis

Abstract

Background: Acute cholecystitis (AC) is a common disease in general surgery. Laparoscopic cholecystectomy (LC) is widely recognized as the "gold standard" surgical procedure for treating AC. For low-risk patients without complications, LC is the recommended treatment plan, but there is still controversy regarding the treatment strategy for moderate AC patients, which relies more on the surgeon's experience and the medical platform of the visiting unit. Percutaneous transhepatic gallbladder puncture drainage (PTGBD) can effectively alleviate gallbladder inflammation, reduce gallbladder wall edema and adhesion around the gallbladder, and create a "time window" for elective surgery.

Aim: To compare the clinical efficacy and safety of LC or PTGBD combined with LC for treating AC patients, providing a theoretical basis for choosing reasonable surgical methods for AC patients.

Methods: In this study, we conducted a clinical investigation regarding the combined use of PTGBD tubes for the treatment of gastric cancer patients with AC. We performed searches in the following databases: PubMed, Web of Science, EMBASE, Cochrane Library, China National Knowledge Infrastructure, and Wanfang Database. The search encompassed literature published from the inception of these databases to the present. Subsequently, relevant data were extracted, and a meta-analysis was conducted using RevMan 5.3 software.

Results: A comprehensive analysis was conducted, encompassing 24 studies involving a total of 2564 patients. These patients were categorized into two groups: 1371 in the LC group and 1193 in the PTGBD + LC group. The outcomes of the meta-analysis revealed noteworthy disparities between the PTGBD + LC group and the LC group in multiple dimensions: (1) Operative time: Mean difference (MD) = 17.51, 95%CI: 9.53-25.49, P < 0.01; (2) Conversion to open surgery rate: Odds ratio (OR) = 2.95, 95%CI: 1.90-4.58, P < 0.01; (3) Intraoperative bleeding loss: MD = 32.27, 95%CI: 23.03-41.50, P < 0.01; (4) Postoperative hospital stay: MD = 1.44, 95%CI: 0.14-2.73, P = 0.03; (5) Overall postoperative complication rate: OR = 1.88, 95%CI: 1.45-2.43, P < 0.01; (6) Bile duct injury: OR = 2.17, 95%CI: 1.30-3.64, P = 0.003; (7) Intra-abdominal hemorrhage: OR = 2.45, 95%CI: 1.06-5.64, P = 0.004; and (8) Wound infection: OR = 0. These findings consistently favored the PTGBD + LC group over the LC group. There were no significant differences in the total duration of hospitalization [MD = -1.85, 95%CI: -4.86-1.16, P = 0.23] or bile leakage [OR = 1.33, 95%CI: 0.81-2.18, P = 0.26] between the two groups.

Conclusion: The combination of PTGBD tubes with LC for AC treatment demonstrated superior clinical efficacy and enhanced safety, suggesting its broader application value in clinical practice.

Keywords: Acute cholecystitis; Efficacy; Laparoscopic cholecystectomy; Meta-analysis; Percutaneous transhepatic gallbladder drainage.

Figure 1

Flow diagram depicting the screening and inclusion process of the studies. CNKI: China National Knowledge Infrastructure.

Figure 2

Forest plot depicting comparison between the percutaneous transhepatic gallbladder puncture drainage + laparoscopic cholecystectomy group and the laparoscopic cholecystectomy group. A: Forest plot depicting the operation time comparison between the percutaneous transhepatic gallbladder puncture drainage (PTGBD) + laparoscopic cholecystectomy (LC) group and the LC group; B: Forest plot illustrating the comparison of the conversion rate to open surgery between the PTGBD + LC group and the LC group; C: Forest plot illustrating the comparison of intraoperative bleeding between the PTGBD + LC group and the LC group; D: Forest plot depicting the comparison of overall hospital stay between the PTGBD + LC group and the LC group; E: Forest plot depicting the comparison of postoperative hospital stay between the PTGBD + LC group and the LC group; F: Forest plot illustrating the comparison of postoperative complications between the PTGBD + LC group and the LC group; G: Forest plot illustrating the comparison of bile leakage rates between the PTGBD + LC group and the LC group; H: Forest plot depicting the comparison of wound infection rates between the PTGBD + LC group and the LC group; I: Forest plot depicting intraperitoneal hemorrhage in the PTGBD + LC group compared to the LC group; J: Forest plot comparing bile duct injury incidence between the PTGBD + LC group and the LC group. PTGBD: Percutaneous transhepatic gallbladder puncture drainage; LC: Laparoscopic cholecystectomy.

Figure 3

Funnel plots of each outcome. A: Operative time; B: Conversion rate to open surgery; C: Intraoperative bleeding; D: Overall hospital stay; E: Postoperative hospital stay; F: Postoperative complications; G: Bile leakage; H: Wound infection; I: Intraperitoneal hemorrhage; J: Bile duct injury. MD: Mean difference; OR: Odds ratio.