Comparison of emergency cholecystectomy and delayed cholecystectomy after percutaneous transhepatic gallbladder drainage
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ORIGINAL ARTICLE
Comparison of emergency cholecystectomy and delayed cholecystectomy after percutaneous transhepatic gallbladder drainage in patients with acute cholecystitis: a systematic review and meta‑analysis Shao‑Zhuo Huang1 · Hao‑Qi Chen2 · Wei‑Xin Liao3 · Wen‑Ying Zhou4 · Jie‑Huan Chen5 · Wen‑Chao Li1 · Hui Zhou1 · Bo Liu1 · Kun‑Peng Hu1 Received: 24 April 2020 / Accepted: 28 September 2020 © The Author(s) 2020
Abstract Laparoscopic cholecystectomy and percutaneous transhepatic gallbladder drainage (PTGBD) are common treatments for patients with acute cholecystitis. However, the safety and efficacy of emergency laparoscopic cholecystectomy (ELC) and delayed laparoscopic cholecystectomy (DLC) after PTGBD in patients with acute cholecystitis remain unclear. The PubMed, EMBASE, and Cochrane Library databases were searched through October 2019. The quality of the included nonrandomized studies was assessed using the Methodological Index for Nonrandomized Studies (MINORS). The meta-analysis was performed using STATA version 14.2. A random-effects model was used to calculate the outcomes. A total of fifteen studies involving 1780 patients with acute cholecystitis were included in the meta-analysis. DLC after PTGBD was associated with a shorter operative time (SMD − 0.51; 95% CI − 0.89 to − 0.13; P = 0.008), a lower conversion rate (RR 0.43; 95% CI 0.26 to 0.69; P = 0.001), less intraoperative blood loss (SMD − 0.59; 95% CI − 0.96 to − 0.22; P = 0.002) and longer time of total hospital stay compared to ELC (SMD 0.91; 95% CI 0.57–1.24; P 7
Jia
2018
China
48/38
2013–2015
7
SD standard deviation, PTGBD percutaneous transhepatic gallbladder drainage, LC laparoscopic cholecystectomy, ELC emergency laparoscopic cholecystectomy, DLC delayed laparoscopic cholecystectomy *Kim① and Kim② came from the same study that split into two groups according to the time between PTGBD and LC
Study characteristics and quality
Operative time of LC
The characteristics of the 15 included studies are shown in Table 2. Of the 15 included studies, 8 were conducted in Korea, 4 in China, and 2 in Japan, and the remaining study was conducted in Egypt. In addition, patients in six studies underwent LC after PTGBD within 7 days. Patients in eight studies underwent LC after PTGBD after 7 days. Specifically, one of the studies included both of these groups, so we split it into two groups: Kim① and Kim②. Based on the quality assessment of MINORS, ten studies [3, 4, 10, 17, 28–33] scored 20 points, two studies [15, 34] scored 19 points, and three studies [6, 16, 35] scored 18 points. All studies had a nonrandomized design.
All 15 studies [3, 4, 6, 10, 15–17, 28–35] reported the operative time of LC. All of these studies were analyzed by the mean with standard deviation. As shown in Fig. 2, 799 patients underwent LC after PTGBD, and 981 underwent ELC. According to the random-effects model, the pooled operative time of LC in the PTGBD group was shorter than that in the ELC group (SMD − 0.51; 95% CI − 0.89 to − 0.13; P = 0.008). There was
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