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Comparison of Efficacy and Safety of Laparoscopic Holmium laser Lithotripsy and Laparoscopic Bile Duct Exploration for Bile Duct Stones: A Systematic Review and Meta-Analysis

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Abstract

Background

Laparoscopic holmium laser lithotripsy (LHLL) has been used to treat bile duct stones with unclear outcomes. A meta-analysis was conducted to investigate the LHLL and laparoscopic bile duct exploration (LBDE) efficacy and safety in treating bile duct stones.

Methods

The correlational studies were searched databases, such as PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang, and VIP, to identify eligible studies from inception to July 2022. The dichotomous and continuous outcomes were evaluated using odds ratio (OR), risk difference (RD) and weighted mean difference (WMD) with 95% confidence intervals (CIs). Stata 15.0 and Review Manager 5.3 software helped in data analyses.

Results

A total of 23 studies with 1,890 patients, primarily from China, were included. The results indicated that operation time (WMD = − 26.94; 95% CI:(− 34.30, − 19.58); P < 0.00001), estimated blood loss (WMD = − 17.97; 95% CI: (− 22.94, − 13.00); P = 0.002), rate of residual stone (OR = 0.15, 95%CI: (0.10, 0.23); P < 0.00001), length of hospital stay (WMD = − 2.88; 95% CI:(− 3.80, − 1.96); P < 0.00001) and time to bowel function recovery (WMD = − 0.59; 95% CI: (− 0.76, − 0.41); P < 0.00001) had statistically significant differences between the two groups. In postoperative complications, biliary leakage (RD = -0.03; 95% CI: (− 0.05, -0.00); P = 0.02), infection (RD = − 0.06; 95% CI: (− 0.09,− 0.03); P < 0.00001) and Hepatic injury (RD = − 0.06; 95% CI: (− 0.11, − 0.01); P = 0.02) revealed statistically significant differences. However, no significant differences were observed in biliary damage (RD = − 0.03; 95% CI: (− 0.06, 0.00); P = 0.06) and hemobilia (RD = − 0.03; 95% CI: (− 0.06, 0.00); P = 0.08).

Conclusion

The current meta-analysis indicated that LHLL could be more effective and safer than LBDC. However, these results should be confirmed with a larger sample size and rigorously designed randomized controlled trials.

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Data availability

All data are included in this manuscript.

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Acknowledgements

The authors thank Key Laboratory of Molecular Diagnostics and Precision Medicine for Surgical Oncology in Gansu Province, NHC Key Laboratory of Diagnosis and Therapy of Gastrointestinal Tumor and the DaVinci Surgery System Database (DSSD, www.davincisurgerydatabase.com) and for their help and support in the methodology and meta-analysis process.

Funding

This work was supported by grants from The 2021 Central- Guided Local Science and Technology Development Fund (ZYYDDFFZZJ-1), Key talent project of Gansu Province of the Organization Department of Gansu Provincial Party Committee (2020RCXM076), Gansu Provincial Youth Science and Technology Fund Program (22JR5RA706), Gansu Key Laboratory of Molecular Diagnosis and Precision Treatment of Surgical Tumors (18JR2RA033), Gansu Provincial Hospital project (NHCDP2022017) Gansu Province Excellent Doctor Fund Project (22JR5RA649).

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Author notes

  1. Bin Liu, Liangyin Fu and Tingting Lu have contributed equally to this work.

Authors and Affiliations

  1. The First School of Clinical Medicine, Lanzhou University, Lanzhou, 730000, Gansu Province, China

    Bin Liu, Xiaohua Dong & Hui Cai

  2. The First Clinical Medical College, Gansu University of Chinese Medicine, Lanzhou, 730000, Gansu Province, China

    Liangyin Fu & Guangming Zhang

  3. Institution of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou, 730000, Gansu Province, China

    Tingting Lu

  4. Key Laboratory of Molecular Diagnostics and Precision Medicine for Surgical Oncology in Gansu Province, Gansu Provincial Hospital, Lanzhou, 730000, Gansu Province, China

    Bin Liu, Xiaohua Dong, Qiqi Zhao, Miao Yu, Haizhong Ma & Hui Cai

  5. Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, Gansu Province, China

    Kehu Yang

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Contributions

LB, FLY, and CH designed the research; LB, LTT, and YM conducted the literature search; LB and ZGM collected and retrieved the data; LB, DXH, and ZQQ analyzed the data; LB wrote and revised the manuscript; All authors approved the final version.

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Correspondence to Hui Cai.

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Liu, B., Fu, L., Lu, T. et al. Comparison of Efficacy and Safety of Laparoscopic Holmium laser Lithotripsy and Laparoscopic Bile Duct Exploration for Bile Duct Stones: A Systematic Review and Meta-Analysis. World J Surg 47, 1809–1820 (2023). https://doi.org/10.1007/s00268-023-06995-6

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