Subtotal vs total cholecystectomy for difficult gallbladders: A systematic review and meta-analysis - 26/02/24
, Rohin J. Krishnan a, Kyle Ishikawa c, Masako Matsunaga c, Hyeong Jun Ahn c, Kenric M. Murayama a, b, Riley K. Kitamura a, bAbstract |
Introduction |
With severely inflamed gallbladders, laparoscopic cholecystectomy can be difficult and may require procedures like subtotal cholecystectomy (SC). Few studies exist comparing SC and total cholecystectomy (TC) in the setting of severe biliary inflammation. This meta-analysis aims to compare SC and TC for difficult gallbladders.
Methods |
Medline-OVID, Embase-OVID, and Cinahl were searched including only studies comparing SC to TC for difficult gallbladders. Primary outcome was CBD injury. Secondary outcomes included bile leak, duodenal injury, retained stone, bleeding, intraabdominal collection, wound infection, reoperation, and mortality.
Results |
Ten studies were included. Compared to TC, SC significantly lowered the risk for CBD injury (0 % vs. 1.6 %, RR 0.30, 95%CI 0.10–0.87) but increased risk of bile leaks (RR 3.5, 95%CI 1.79–6.84), postoperative ERCP (RR 2.86, 95%CI 1.53–5.35), intraabdominal collections (RR 2.55, 95%CI 1.32–4.93), and reoperation (RR 2.92, 95%CI 1.14–7.47).
Conclusion |
SC is a reasonable alternative to difficult gallbladders that may decrease the risk of CBD injuries. Knowing both approaches is crucial to manage the difficult gallbladder while minimizing harm. Further studies are needed to understand the value of SC for difficult cholecystectomy.
Le texte complet de cet article est disponible en PDF.Graphical abstract |
Highlights |
• | First SRMA to compare subtotal cholecystectomy (SC) and total cholecystectomy (TC) specifically in difficult gallbladders. |
• | SC may be associated with higher morbidity however associated with a decreased risk of common bile duct injuries. |
• | SC is an alternative approach to difficult gallbladders that may reduce the risk of common bile duct injuries. |
Keywords : Subtotal cholecystectomy, Total cholecystectomy, Difficult gallbladder, Systematic review and meta analysis
Plan
Vol 229
P. 145-150 - mars 2024 Retour au numéro
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