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Safety of transvaginal hybrid NOTES cholecystectomy: a systematic review and meta-analysis

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Abstract

Background

Despite increasing data regarding clinical outcomes following transvaginal hybrid NOTES cholecystectomy (TVC), a consensus regarding safety based on comparative studies has yet to be reached. The aim of this systematic review and meta-analysis was to compare safety and clinical outcomes of TVC with conventional laparoscopic cholecystectomy (CLC) for the treatment of benign gallstone disease.

Methods

A comprehensive search for published studies comparing TVC and CLC was performed. Review of each study was conducted and data were extracted. All pooled outcome measures were determined using random-effects models.

Results

Data were retrieved from 14 studies describing 1,145 patients. There was no difference in total complications (POR = 0.68; 95 % CI 0.40–1.14; P = 0.14), incidence of bile duct injury (POR = 1.33; 95 % CI 0.31–5.66; P = 0.70), Clavien–Dindo Grade II (POR = 0.48; 95 % CI 0.14–1.60; P = 0.23) or Grade III (POR = 0.63; 95 % CI 0.24–1.65; P = 0.34) complications between TCV and CLC. Time of return to normal activities was significantly reduced in the TVC group (WMD = −4.86 days; 95 % CI −9.33 to −0.39; P = 0.03), and there was a non-significant reduction in postoperative pain on days 1 (WMD = −0.80; 95 % CI −1.60 to 0.01; P = 0.05) and 3 (WMD = −0.89; 95 % CI −1.77 to −0.01; P = 0.05).

Conclusions

TVC is safe when performed by appropriately trained surgeons and may be associated with a faster return to normal activities and decreased postoperative pain.

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Disclosure

Drs. Sodergren, Markar, Pucher, Badran, Jiao and Darzi have no conflicts of interest or financial ties to disclose. All authors have read and approved the final manuscript.

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Authors and Affiliations

  1. Department of Surgery and Cancer, St Mary’s Hospital, Imperial College London, London 10th Floor QEQM Building, St. Mary’s Hospital South Wharf Road, London, W2 1NY, UK

    Mikael H. Sodergren, Sheraz Markar, Philip H. Pucher, Ismail A. Badran, Long R. Jiao & Ara Darzi

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  1. Mikael H. Sodergren
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  2. Sheraz Markar
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  3. Philip H. Pucher
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  4. Ismail A. Badran
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  5. Long R. Jiao
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  6. Ara Darzi
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Correspondence to Mikael H. Sodergren.

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Sodergren, M.H., Markar, S., Pucher, P.H. et al. Safety of transvaginal hybrid NOTES cholecystectomy: a systematic review and meta-analysis. Surg Endosc 29, 2077–2090 (2015). https://doi.org/10.1007/s00464-014-3915-x

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  • DOI: https://doi.org/10.1007/s00464-014-3915-x

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