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Surgical Endoscopy

, Volume 21, Issue 8, pp 1294–1300 | Cite as

Laparoscopic cholecystectomy versus mini-laparotomy cholecystectomy: a meta-analysis of randomised control trials

  • Sanjay Purkayastha
  • Henry S. Tilney
  • Panagiotis Georgiou
  • Thanos Athanasiou
  • Paris P. Tekkis
  • Ara W. DarziEmail author
Original Article

Abstract

Aims

To use meta-analytic techniques to compare peri-operative and short term post-operative outcomes for patients undergoing cholecystectomy via the laparoscopic or mini-open approach.

Methods

Randomised control trials published between 1992 and 2005, cited in the literature of elective laparoscopic (LC) versus mini-open cholecystectomy (MoC) for symptomatic gallstone disease were included. End points evaluated were adverse events, operative and functional outcomes. A random effects meta-analytical model was used and between-study heterogeneity assessed. Subgroup analysis was performed to evaluate the difference in results for study size and quality and data reported from 2000.

Results

Nine randomised studies of 2032 patients were included in the analysis. There was considerable variation in the size and type of incision used for MoC in the studies. There was a significantly longer operating time for the LC group, by 14.14 minutes (95% CI 2.08, 26.19; p < 0.0001). Length of stay was reduced in the LC group by 0.37 days (95% CI −0.53, −0.21; p < 0.0001), with no significant heterogeneity for either outcome. For all other operative and post-operative outcomes, there was no significant difference between the two groups.

Conclusion

MoC appeared to have similar outcomes compared to LC, however LC did reduce the length of hospital stay. MoC is a viable and safe option for healthcare providers without the financial resources for laparoscopic equipment and appropriately trained surgical teams.

Keywords

Cholecystectomy Laparoscopy Mini-laparotomy Randomised trial Meta-analysis 

Notes

Acknowledgments

The authors would like to thank Mr. Alex von Roon, Miss Rosamund Jacklin and Mr. Jesus Muñoz for their invaluable help in translating the foreign language papers included in this study.

References

  1. 1.
    Bittner R (2004) The standard of laparoscopic cholecystectomy. Langenbecks Arch Surg 389: 157–163PubMedCrossRefGoogle Scholar
  2. 2.
    Zacks SL, Sandler RS, Rutledge R, Brown RS Jr. (2002) A population-based cohort study comparing laparoscopic cholecystectomy and open cholecystectomy. Am J Gastroenterol 97: 334–340PubMedCrossRefGoogle Scholar
  3. 3.
    Keskin A (2005) Is laparoscopic cholecystectomy cheaper? Surg Laparosc Endosc Percutan Tech 15: 191–194; discussion 194PubMedCrossRefGoogle Scholar
  4. 4.
    Shea JA, Healey MJ, Berlin JA, Clarke JR, Malet PF, Staroscik RN, Schwartz JS, Williams SV (1996) Mortality and complications associated with laparoscopic cholecystectomy. A meta-analysis. Ann Surg 224: 609–620PubMedCrossRefGoogle Scholar
  5. 5.
    Basu S, Giri PS, Roy D (2006) Feasibility of same day discharge after mini-laparotomy cholecystectomy – a simulation study in a rural teaching hospital. Can J Rural Med 11: 93–98PubMedGoogle Scholar
  6. 6.
    Barkun JS, Barkun AN, Sampalis JS, Fried G, Taylor B, Wexler MJ, Goresky CA, Meakins JL (1992) Randomised controlled trial of laparoscopic versus mini cholecystectomy. The McGill Gallstone Treatment Group. Lancet 340: 1116–1119PubMedCrossRefGoogle Scholar
  7. 7.
    Harju J, Juvonen P, Eskelinen M, Miettinen P, Paakkonen M (2006) Minilaparotomy cholecystectomy versus laparoscopic cholecystectomy: a randomized study with special reference to obesity. Surg Endosc 20: 583–586PubMedCrossRefGoogle Scholar
  8. 8.
    Kunz R, Orth K, Vogel J, Steinacker JM, Meitinger A, Bruckner U, Beger HG (1992) Laparoscopic cholecystectomy versus mini-lap-cholecystectomy. Results of a prospective, randomized study. Chirurg 63: 291–295PubMedGoogle Scholar
  9. 9.
    Majeed AW, Troy G, Nicholl JP, Smythe A, Reed MW, Stoddard CJ, Peacock J, Johnson AG (1996) Randomised, prospective, single-blind comparison of laparoscopic versus small-incision cholecystectomy. Lancet 347: 989–994PubMedCrossRefGoogle Scholar
  10. 10.
    McGinn FP, Miles AJ, Uglow M, Ozmen M, Terzi C, Humby M (1995) Randomized trial of laparoscopic cholecystectomy and mini-cholecystectomy. Br J Surg 82: 1374–1377PubMedCrossRefGoogle Scholar
  11. 11.
    McMahon AJ, Russell IT, Baxter JN, Ross S, Anderson JR, Morran CG, Sunderland G, Galloway D, Ramsay G, O’Dwyer PJ (1994) Laparoscopic versus minilaparotomy cholecystectomy: a randomised trial. Lancet 343: 135–138PubMedCrossRefGoogle Scholar
  12. 12.
    Secco GB, Cataletti M, Bonfante P, Baldi E, Davini MD, Biasotti B, Ravera G, Ferraris R (2002) Laparoscopic versus mini-cholecystectomy: analysis of hospital costs and social costs in a prospective randomized study. Chir Ital 54: 685–692PubMedGoogle Scholar
  13. 13.
    Srivastava A, Srinivas G, Misra MC, Pandav CS, Seenu V, Goyal A (2001) Cost-effectiveness analysis of laparoscopic versus minilaparotomy cholecystectomy for gallstone disease. A randomized trial. Int J Technol Assess Health Care 17: 497–502PubMedGoogle Scholar
  14. 14.
    Ros A, Gustafsson L, Krook H, Nordgren CE, Thorell A, Wallin G, Nilsson E (2001) Laparoscopic cholecystectomy versus mini-laparotomy cholecystectomy: a prospective, randomized, single-blind study. Ann Surg 234: 741–749PubMedCrossRefGoogle Scholar
  15. 15.
    Moher D, Cook DJ, Eastwood S, Olkin I, Rennie D, Stroup DF (2000) Improving the Quality of Reports of Meta-Analyses of Randomised Controlled Trials: The QUOROM Statement. Onkologie 23: 597–602PubMedCrossRefGoogle Scholar
  16. 16.
    DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7: 177–188PubMedCrossRefGoogle Scholar
  17. 17.
    Mantel N, Haenszel W (1959) Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst 22: 719–748PubMedGoogle Scholar
  18. 18.
    Yusuf S, Peto R, Lewis J, Collins R, Sleight P (1985) Beta blockade during and after myocardial infarction: an overview of the randomized trials. Prog Cardiovasc Dis 27: 335–371PubMedCrossRefGoogle Scholar
  19. 19.
    Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, McQuay HJ (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17: 1–12PubMedCrossRefGoogle Scholar
  20. 20.
    Ezzo J, Berman B, Hadhazy VA, Jadad AR, Lao L, Singh BB (2000) Is acupuncture effective for the treatment of chronic pain? A systematic review. Pain 86: 217–225PubMedCrossRefGoogle Scholar
  21. 21.
    Egger M, Smith GD (1995) Misleading meta-analysis. BMJ 310: 752–754PubMedGoogle Scholar
  22. 22.
    Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315: 629–634PubMedGoogle Scholar
  23. 23.
    Lucena JR (2005) Laparoscopic versus mini-laparotomy cholecystectomy. Cir Esp 77: 332–336PubMedCrossRefGoogle Scholar
  24. 24.
    Makinen AM, Nordback IH (1995) Cholecystectomy: comparison of minilaparotomy and laparoscopy. Int Surg 80: 99–101PubMedGoogle Scholar
  25. 25.
    Oyogoa SO, Komenaka IK, Ilkhani R, Wise L (2003) Mini-laparotomy cholecystectomy in the era of laparoscopic cholecystectomy: a community-based hospital perspective. Am Surg 69: 604–607PubMedGoogle Scholar
  26. 26.
    Supe AN, Bapat VN, Pandya SV, Dalvi AN, Bapat RD (1996) Laparoscopic versus mini-lap cholecystectomy for gallstone disease. Indian J Gastroenterol 15: 94–96PubMedGoogle Scholar
  27. 27.
    Syrakos T, Antonitsis P, Zacharakis E, Takis A, Manousari A, Bakogiannis K, Efthimiopoulos G, Achoulias I, Trikoupi A, Kiskinis D (2004) Small-incision (mini-laparotomy) versus laparoscopic cholecystectomy: a retrospective study in a university hospital. Langenbecks Arch Surg 389: 172–177PubMedCrossRefGoogle Scholar
  28. 28.
    Nilsson E, Ros A, Rahmqvist M, Backman K, Carlsson P (2004) Cholecystectomy: costs and health-related quality of life: a comparison of two techniques. Int J Qual Health Care 16: 473–482PubMedCrossRefGoogle Scholar
  29. 29.
    Kratzer W, Mason RA, Kachele V (1999) Prevalence of gallstones in sonographic surveys worldwide. J Clin Ultrasound 27: 1–7PubMedCrossRefGoogle Scholar
  30. 30.
    Calvert NW, Troy GP, Johnson AG (2000) Laparoscopic cholecystectomy: a good buy? A cost comparison with small-incision (mini) cholecystectomy. Eur J Surg 166: 782–786PubMedCrossRefGoogle Scholar
  31. 31.
    Champault A, Vons C, Dagher I, Amerlinck S, Franco D (2002) Low-cost laparoscopic cholecystectomy. Br J Surg 89: 1602–1607PubMedCrossRefGoogle Scholar
  32. 32.
    Ros A, Nilsson E (2004) Abdominal pain and patient overall and cosmetic satisfaction one year after cholecystectomy: outcome of a randomized trial comparing laparoscopic and minilaparotomy cholecystectomy. Scand J Gastroenterol 39: 773–777PubMedCrossRefGoogle Scholar
  33. 33.
    McMahon AJ, Ross S, Baxter JN, Russell IT, Anderson JR, Morran CG, Sunderland GT, Galloway DJ, O’Dwyer PJ (1995) Symptomatic outcome 1 year after laparoscopic and minilaparotomy cholecystectomy: a randomized trial. Br J Surg 82: 1378–1382PubMedCrossRefGoogle Scholar
  34. 34.
    Finlayson SR, Birkmeyer JD, Laycock WS (2003) Trends in surgery for gastroesophageal reflux disease: the effect of laparoscopic surgery on utilization. Surgery 133: 147–153PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Sanjay Purkayastha
    • 1
  • Henry S. Tilney
    • 1
  • Panagiotis Georgiou
    • 1
  • Thanos Athanasiou
    • 1
  • Paris P. Tekkis
    • 1
  • Ara W. Darzi
    • 1
    Email author
  1. 1.Department of Biosurgery and Surgical TechnologyImperial College, St. Mary’s HospitalLondonUK

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