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

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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.

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References

  1. Sauerland S, Agresta F, Bergamaschi R, Borzellino G, Budzynski A, Champault G, Fingerhut A, Isla A, Johansson M, Lundorff P, Navez B, Saad S, Neugebauer EA (2006) Laparoscopy for abdominal emergencies: evidence-based guidelines of the European Association for Endoscopic Surgery. Surg Endosc 20:14–29

    Article  PubMed  CAS  Google Scholar 

  2. Lo CM, Liu CL, Fan ST, Lai EC, Wong J (1998) Prospective randomized study of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Ann Surg 227:461–467

    Article  PubMed  CAS  Google Scholar 

  3. Lai PB, Kwong KH, Leung KL, Kwok SP, Chan AC, Chung SC, Lau WY (1998) Randomized trial of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg 85:764–767

    Article  PubMed  CAS  Google Scholar 

  4. Chandler CF, Lane JS, Ferguson P, Thompson JE, Ashley SW (2000) Prospective evaluation of early versus delayed laparoscopic cholecystectomy for treatment of acute cholecystitis. Am Surg 66:896–900

    PubMed  CAS  Google Scholar 

  5. Johansson M, Thune A, Blomqvist A, Nelvin L, Lundell L (2003) Management of acute cholecystitis in the laparoscopic era: results of a prospective, randomized clinical trial. J Gastrointest Surg 7:642–645

    Article  PubMed  Google Scholar 

  6. Kolla SB, Aggarwal S, Kumar A, Kumar R, Chumber S, Parshad R, Seenu V (2004) Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a prospective randomized trial. Surg Endosc 18:1323–1327

    Article  PubMed  CAS  Google Scholar 

  7. Papi C, Catarci M, D’Ambrosio L, Gili L, Koch M, Grassi GB, Capurso L (2004) Timing of cholecystectomy for acute calculous cholecystitis: a meta-analysis. Am J Gastroenterol 99:147–155

    Article  PubMed  Google Scholar 

  8. Johansson M, Thune A, Nelvin L, Stiernstam M, Westman B, Lundell L (2005) Randomized clinical trial of open versus laparoscopic cholecystectomy in the treatment of acute cholecystitis. Br J Surg 92:44–49

    Article  PubMed  CAS  Google Scholar 

  9. Cox MR, Wilson TG, Luck AJ, Jeans PL, Padbury RT, Toouli J (1993) Laparoscopic cholecystectomy for acute inflammation of the gallbladder. Ann Surg 21:630–634

    Google Scholar 

  10. Eldar S, Sabo E, Ash E, Abrahamson J, Matter J (1998) Laparoscopic cholecystectomy for the various types of gallbladder inflammation. Surg Laparosc Endosc 8:200–207

    Article  PubMed  CAS  Google Scholar 

  11. Brodsky A, Matter I, Sabo E, Cohen A, Abrahamson J, Eldar S (2000) Laparoscopic cholecystectomy for acute cholecystitis: can the need for conversion and the probability of complications be predicted? A prospective study. Surg Endosc 14:755–760

    Article  PubMed  CAS  Google Scholar 

  12. Schäfer M, Krähenbühl L, Büchler MW (2001) Predictive factors for the type of surgery in acute cholecystitis. Am J Surg 182:291–297

    Article  PubMed  Google Scholar 

  13. Watanabe Y, Sato M, Abe Y, Iseki S, Sato N, Kimura S (1996) Preceding PTGBD decreases complications of laparoscopic cholecystectomy for patients with acute suppurative cholecystitis. J Laparoendosc Surg 6:161–165

    PubMed  CAS  Google Scholar 

  14. Ransom KJ (1998) Laparoscopic management of acute cholecystitis with subtotal cholecystectomy. Am Surg 64:955–957

    PubMed  CAS  Google Scholar 

  15. Borzellino G, de Manzoni G, Ricci F, Castaldini G, Guglielmi A, Cordiano C (1999) Emergency cholecystostomy and subsequent cholecystectomy for acute gallstone cholecystitis in the elderly. Br J Surg 86:1306–1311

    Article  Google Scholar 

  16. Tsumura H, Ichikawa T, Hiyama E, Kagawa T, Nishihara M, Murakami Y, Sueda T (2004) An evaluation of laparoscopic cholecystectomy after selective percutaneous transhepatic gallbladder drainage for acute cholecystitis. Gastrointest Endosc 59:839–844

    Article  PubMed  Google Scholar 

  17. Ghahreman A, McCall JL, Windsor JA (1999) Cholecystostomy: a review of recent experience. Aust N Z J Surg 69:837–840

    Article  PubMed  CAS  Google Scholar 

  18. Spira RM, Nissan A, Zamir O, Cohen T, Fields SI, Freund HR (2002) Percutaneous transhepatic cholecystostomy and delayed laparoscopic cholecystectomy in critically ill patients with acute calculus cholecystitis. Am J Surg 183:62–66

    Article  PubMed  Google Scholar 

  19. Borzellino G, Tasselli S, Zerman G, Castaldini G, de Manzoni G (2002) Results of surgical treatment of acute cholecystitis. Prospective study of 280 cases. G Chir 23:79–84

    PubMed  CAS  Google Scholar 

  20. Chikamori F, Kuniyoshi N, Shibuya S, Takase Y (2002) Early scheduled laparoscopic cholecystectomy following percutaneous transhepatic gallbladder drainage for patients with acute cholecystitis. Surg Endosc 16:1704–1707

    Article  PubMed  CAS  Google Scholar 

  21. Lee KT, Wong SR, Cheng JS, Ker CG, Sheen PC, Liu YE (1998) Ultrasound-guided percutaneous cholecystostomy as an initial treatment for acute cholecystitis in elderly patients. Dig Surg 15:328–332

    Article  PubMed  Google Scholar 

  22. Indar AA, Beckingham IJ (2002) Acute cholecystitis. BMJ 325:639–643

    Article  PubMed  Google Scholar 

  23. Miller RE, Kimmelstiel FM (1993) Laparoscopic cholecystectomy for acute cholecystitis. Surg Endosc 7:296–299

    Article  PubMed  CAS  Google Scholar 

  24. Wilson RG, Macintyre IM, Nixon SJ, Saunders JH, Varma JS, King PM (1992) Laparoscopic cholecystectomy as a safe and effective treatment for severe acute cholecystitis. BMJ 305:394–396

    PubMed  CAS  Google Scholar 

  25. Fabre JM, Fagot H, Domergue J, Guillon F, Balmes M, Zaragosa C, Baumel H (1994) Laparoscopic cholecystectomy in complicated cholelithiasis. Surg Endosc 8:1198–1201

    Article  PubMed  CAS  Google Scholar 

  26. Bonatsos G, Leandros E, Dourakis N, Birbas C, Delibaltadakis G, Golematis B (1995) Laparoscopic cholecystectomy. Intraoperative findings and postoperative complications. Surg Endosc 9:889–893

    PubMed  CAS  Google Scholar 

  27. Al-Abassi AA, Farghaly MM, Ahmed HL, Mobasher LL, Al-Manee MS (2001) Infection after laparoscopic cholecystectomy: effect of infected bile and infected gallbladder wall. Eur J Surg 167:268–273

    Article  PubMed  CAS  Google Scholar 

  28. Koperna T, Kisser M, Schulz F (1999) Laparoscopic versus open treatment of patients with acute cholecystitis. Hepatogastroenterology 46:753–757

    PubMed  CAS  Google Scholar 

  29. Araujo-Teixeira JP, Rocha-Reis J, Costa-Cabral A, Barros H, Saraiva AC, Araujo-Teixeira AM (1999) Laparoscopie ou laparatomie dans la cholécystite aigue (200 cas). Comparaison des résultats et facteurs prédisposants à la conversion. Chirurgie 124:529–535

    Article  PubMed  CAS  Google Scholar 

  30. Jacobs M, Verdeja JC, Goldstein HS (1991) Laparoscopic cholecystectomy in acute cholecystitis. J Laparoendosc Surg 1:175–177

    PubMed  CAS  Google Scholar 

  31. Lee HK, Han HS, Min SK, Lee JH (2005) Sex-based analysis of the outcome of laparoscopic cholecystectomy for acute cholecystitis. Br J Surg 92:463–466

    Article  PubMed  CAS  Google Scholar 

  32. Teixeira JP, Saraiva AC, Cabral AC, Barros H, Reis JR, Teixeira A (2000) Conversion factors in laparoscopic cholecystectomy for acute cholecystitis. Hepatogastroenterology 47:626–630

    PubMed  CAS  Google Scholar 

  33. Limbosch JM, Druart ML, Puttemans T, Melot C (2000) Guidelines to laparoscopic management of acute cholecystitis. Acta Chir Belg 100:198–204

    PubMed  CAS  Google Scholar 

  34. Bender JS, Duncan MD, Freeswick PD, Harmon JW, Magnuson TH (2002) Increased laparoscopic experience does not lead to improved results with acute cholecystitis. Am J Surg 184:591–594

    Article  PubMed  Google Scholar 

  35. Bickel A, Rappaport A, Kanievski V, Vaksman I, Haj M, Geron N, Eitan A (1996) Laparoscopic management of acute cholecystitis. Prognostic factors for success. Surg Endosc 10:1045–1049

    Article  PubMed  CAS  Google Scholar 

  36. Bedirli A, Sakrak O, Sozuer EM, Kerek M, Guler I (2001) Factors effecting the complications in the natural history of acute cholecystitis. Hepatogastroenterology 48:1275–1278

    PubMed  CAS  Google Scholar 

  37. Del Pin CA, Arthur KS, Honig C, Silverman EM (2002) Laparoscopic cholecystectomy: relationship of pathology and operative time. JSLS 6:149–154

    PubMed  Google Scholar 

  38. Chang YC (2005) A proposed inflammation grading system for laparoscopic cholecystectomy. Hepatogastroenterology 52:33–36

    PubMed  Google Scholar 

  39. Mo LR, Yau MP, Tsai CC, Lin RC, Kuo JY, Chan KK, Lin YW, Lin CC, Hwang MH (1995) Ultrasound-guided percutaneous transhepatic gallbladder drainage followed by laparoscopic cholecystectomy: a new trial in the treatment of severe acute suppurative cholecystitis. Hepatogastroenterology 42:51–54

    PubMed  CAS  Google Scholar 

  40. Ubiali P, Invernizzi R, Prezzati F (2002) Laparoscopic surgery in very acute cholecystitis. JSLS 6:159–162

    PubMed  Google Scholar 

  41. Hunt DR, Chu FC (2000) Gangrenous cholecystitis in the laparoscopic era. Aust NZ J Surg 70:428–430

    Article  CAS  Google Scholar 

  42. Habib FA, Kolachalam RB, Khilnani R, Preventza O, Mittal VK (2001) Role of laparoscopic cholecystectomy in the management of gangrenous cholecystitis. Am J Surg 181:71–75

    Article  PubMed  CAS  Google Scholar 

  43. Bingener J, Stefanidis D, Richards ML, Schwesinger WH, Sirinek KR (2005) Early conversion for gangrenous cholecystitis: impact on outcome. Surg Endosc 19:1139–1141

    Article  PubMed  CAS  Google Scholar 

  44. Sinha R, Sharma N (2002) Acute cholecystitis and laparoscopic cholecystectomy. JSLS 6:65–68

    PubMed  Google Scholar 

  45. Michalowski K, Bornman PC, Krige JE, Gallagher PJ, Terblanche J (1998) Laparoscopic subtotal cholecystectomy in patients with complicated acute cholecystitis or fibrosis. Br J Surg 85:904–906

    Article  PubMed  CAS  Google Scholar 

  46. Beldi G, Glattli A (2003) Laparoscopic subtotal cholecystectomy for severe cholecystitis. Surg Endosc 17:1437–1439

    Article  PubMed  CAS  Google Scholar 

  47. Prakash K, Jacob G, Lekha V, Venugopal A, Venugopal B, Ramesh H (2002) Laparoscopic cholecystectomy in acute cholecystitis. Surg Endosc 16:180–183

    Article  PubMed  CAS  Google Scholar 

  48. Ito K, Fujita N, Noda Y, Kobayashi G, Kimura K, Sugawara T, Horaguchi J (2004) Percutaneous cholecystostomy versus gallbladder aspiration for acute cholecystitis: a prospective randomized controlled trial. AJR 183:193–196

    PubMed  Google Scholar 

  49. Chopra S, Dodd GD 3rd, Mumbower AL, Chintapalli KN, Schwesinger WH, Sirinek KR, Dorman JP, Rhim H (2001) Treatment of acute cholecystitis in non-critically ill patients at high surgical risk: comparison of clinical outcomes after gallbladder aspiration and after percutaneous cholecystostomy. AJR 176:1025–1031

    PubMed  CAS  Google Scholar 

  50. Tseng LJ, Tsai CC, Mo LR, Lin RC, Kuo JY, Chang KK, Jao YT (2000) Palliative percutaneous transhepatic gallbladder drainage of gallbladder empyema before laparoscopic cholecystectomy. Hepatogastroenterology 47:932–936

    PubMed  CAS  Google Scholar 

  51. Kiviluoto T, Siren J, Luukkonen P, Kivilaakso E (1998) Randomised trial of laparoscopic versus open cholecystectomy for acute and gangrenous cholecystitis. Lancet 351:321–325

    Article  PubMed  CAS  Google Scholar 

  52. Singer JA, McKeen RV (1994) Laparoscopic cholecystectomy for acute or gangrenous cholecystitis. Am Surg 60:326–328

    PubMed  CAS  Google Scholar 

  53. Lo CM, Fan ST, Liu CL, Lai EC, Wong J (1997) Early decision for conversion of laparoscopic to open cholecystectomy for treatment of acute cholecystitis. Am J Surg 173:513–517

    Article  PubMed  CAS  Google Scholar 

  54. Merriam LT, Kanaan SA, Dawes LG, Angelos P, Prystowsky JB, Rege RV, Joehl RJ (1999) Gangrenous cholecystitis: analysis of risk factors and experience with laparoscopic cholecystectomy. Surgery 126:680–685

    PubMed  CAS  Google Scholar 

  55. Navez B, Mutter D, Russier Y, Vix M, Jamali F, Lipski D, Cambier E, Guiot P, Leroy J, Marescaux J (2001) Safety of laparoscopic approach for acute cholecystitis: retrospective study of 609 cases. World J Surg 25:1352–1356

    Article  PubMed  CAS  Google Scholar 

  56. Gharaibeh KI, Qasaimeh GR, Al-Heiss H, Ammari F, Bani-Hani K, Al-Jaberi TM, Al-Natour S (2002) Effect of timing of surgery, type of inflammation, and sex on outcome of laparoscopic cholecystectomy for acute cholecystitis. J Laparoendosc Adv Surg Tech A 12:193–198

    Article  PubMed  Google Scholar 

  57. DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188

    Article  PubMed  CAS  Google Scholar 

  58. Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21:1539–1558

    Article  PubMed  Google Scholar 

  59. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560

    Article  PubMed  Google Scholar 

  60. Bickel A, Rappaport A, Kanievski V, Vaksman I, Haj M, Geron N, Eitan A (1996) Laparoscopic management of acute cholecystitis. Prognostic factors for success. Surg Endosc 10:1045–1049

    Article  PubMed  CAS  Google Scholar 

  61. Arvieux-Barthelemy C, Mestrallet J, Bouchard F, Delannoy P, Radmanesh O, Zattara A, Naud G, Faucheron JL, Eymard P, Dupre A, Leto C (1999) Traitement chirurgical de la cholécystite aigue. Ann Chir 53:472–481

    PubMed  CAS  Google Scholar 

  62. Mallen C, Peat G, Croft P (2006) Quality assessment of observational studies is not commonplace in systematic reviews. J Clin Epidemiol. 59:765–769

    Article  PubMed  Google Scholar 

  63. Colonval P, Navez B, Cambier E, Richir C, de Pierpont B, Scohy JJ, Guiot P (1997) Is laparoscopic cholecystectomy effective and reliable in acute cholecystitis? Results of a prospective study of 221 pathologically documented cases. Ann Chir 51:689–696

    PubMed  CAS  Google Scholar 

  64. Aguayo Albasini JL, Martinez Gomez DA, Martin Diaz L, Lopez Conesa A, Mansilla Molina D (1992) Results of surgical treatment for gallbladder empyema may be analogous to those of the remaining types of acute cholecystitis. Dig Surg 9:303–307

    Article  Google Scholar 

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Correspondence to Giuseppe Borzellino.

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Borzellino, G., Sauerland, S., Minicozzi, A.M. et al. Laparoscopic cholecystectomy for severe acute cholecystitis. A meta-analysis of results. Surg Endosc 22, 8–15 (2008). https://doi.org/10.1007/s00464-007-9511-6

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