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Laparoscopic versus open cholecystectomy in pregnancy: a systematic review and meta-analysis

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Abstract

Background

The operative management of symptomatic cholelithiasis during pregnancy is either laparoscopic cholecystectomy (LC) or open cholecystectomy (OC). The aim of this systematic review and meta-analysis is to compare the outcomes of the laparoscopic and open approach for cholecystectomy during pregnancy.

Method

A literature search was conducted using MEDLINE, PubMed, EMBASE, Cochrane Library, Web of Science, CINAHL and Current Contents Connect using appropriate search terms. All comparative studies reporting maternal, fetal, and/or surgical complications were included.

Results

Eleven comparative studies, with a total of 10,632 patients, were included. The laparoscopic approach was performed at mean 18-week gestation and the open approach at mean 24-week gestation. LC was associated with decreased risks for fetal (OR 0.42; 95 % CI 0.28–0.63; p < 0.001), maternal (OR 0.42; 95 % CI 0.33–0.53; p < 0.001) and surgical (OR 0.45; 95 % CI 0.25–0.82, p = 0.01) complications. The average length of hospital stay (LOS) was: LC 3.2 days and OC 6.0 days (p = 0.02). The conversion rate from LC to OC was 3.8 %.

Conclusion

The results of this first meta-analysis suggest that LC is associated with fewer maternal and fetal complications than OC during pregnancy. However, 91 % of included patients were in the first or second trimester at the time of surgery. These findings do not account for gestational age during pregnancy, which may be a significant confounding factor. The results support intervention for symptomatic gallstones in the first and second trimester with a laparoscopic approach.

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Correspondence to Guy D. Eslick.

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Disclosures

Drs Negin Sedaghat and Amy Cao, Associate Professor Guy Eslick and Professor Michael Cox have no conflicts of interest or financial ties to disclose.

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Sedaghat, N., Cao, A.M., Eslick, G.D. et al. Laparoscopic versus open cholecystectomy in pregnancy: a systematic review and meta-analysis. Surg Endosc 31, 673–679 (2017). https://doi.org/10.1007/s00464-016-5019-2

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  • DOI: https://doi.org/10.1007/s00464-016-5019-2

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