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Surgical Endoscopy

, Volume 22, Issue 1, pp 8–15 | Cite as

Laparoscopic cholecystectomy for severe acute cholecystitis. A meta-analysis of results

  • Giuseppe BorzellinoEmail author
  • Stefan Sauerland
  • Anna Maria Minicozzi
  • Giuseppe Verlato
  • Carlo Di Pietrantonj
  • Giovanni de Manzoni
  • Claudio Cordiano
Review

Abstract

Objective

The aim of this review was to evaluate surgical outcomes of laparoscopic cholecystectomy for gangrenous and empyematous acute cholecystitis defined as severe acute cholecystitis.

Background

It is not known to what extent surgical outcomes of laparoscopic cholecystectomy for severe acute cholecystitis differ from those for the nonsevere acute form, making it questionable whether urgent laparoscopic cholecystectomy is the best approach even in severe acute cases.

Methods

Literature searches were conducted to identify: (1) comparative studies which reported laparoscopic surgical outcomes separately for severe acute and nonsevere acute cholecystitis; (2) studies comparing such an approach with open cholecystectomy, subtotal laparoscopic cholecystectomy or cholecystostomy in severe acute cholecystitis. Results were pooled by standard meta-analytic techniques.

Results

Seven studies with a total of 1,408 patients undergoing laparoscopic cholecystectomy were found. The risks of conversion (RR 3.2, 95% CI 2.5 to 4.2) and overall postoperative complications (RR 1.6, 95% CI 1.2–2.2) were significantly higher in severe acute cholecystitis with respect to the nonsevere acute forms. However, no difference was detected as regards to local postoperative complications. No studies comparing open cholecystectomy or cholecystostomy with urgent laparoscopy were found.

Conclusion

A lower feasibility of laparoscopic cholecystectomy has been found for severe cholecystitis. A lower threshold of conversion is recommended since this may allow to reduce local postoperative complications. Literature data lack valuable comparative studies with other treatment modalities, which therefore need to be investigated.

Keywords

Cholecystectomy Statistical Technical Complications 

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Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Giuseppe Borzellino
    • 1
    • 5
    Email author
  • Stefan Sauerland
    • 2
  • Anna Maria Minicozzi
    • 1
  • Giuseppe Verlato
    • 3
  • Carlo Di Pietrantonj
    • 4
  • Giovanni de Manzoni
    • 1
  • Claudio Cordiano
    • 1
  1. 1.1st Department of General Surgery, OCM Borgo Trento HospitalUniversity of VeronaVeronaItaly
  2. 2.Institute for Research in Operative MedicineUniversity of Witten/HerdeckeWittenGermany
  3. 3.Department of Medical StatisticsUniversity of VeronaVeronaItaly
  4. 4.Regional department of EpidemiologyAlessandriaItaly
  5. 5.Chirurgia Clinicizzata, Ospedale di Borgo TrentoVeronaItalia

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