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01-01-2008 | Review

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

Authors: Giuseppe Borzellino, Stefan Sauerland, Anna Maria Minicozzi, Giuseppe Verlato, Carlo Di Pietrantonj, Giovanni de Manzoni, Claudio Cordiano

Published in: Surgical Endoscopy | Issue 1/2008

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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Title: Laparoscopic cholecystectomy for severe acute cholecystitis. A meta-analysis of results
Authors: Giuseppe Borzellino
Stefan Sauerland
Anna Maria Minicozzi
Giuseppe Verlato
Carlo Di Pietrantonj
Giovanni de Manzoni
Claudio Cordiano
Publication date: 01-01-2008
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 1/2008
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-007-9511-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

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

Abstract

Objective

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objective

Background

Methods

Results

Conclusion

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