| Autor: |
Papi, Claudio, Catarci, Marco, D'Ambrosio, Letizia, Gili, Loredana, Koch, Maurizio, Grassi, Giovanni Battista, Capurso, Lucio |
| Předmět: |
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| Zdroj: |
American Journal of Gastroenterology (Springer Nature); Jan2004, Vol. 99 Issue 1, p147-155, 9p |
| Abstrakt: |
OBJECTIVES: To compare early with delayed cholecystectomy for the treatment of acute lithiasic cholecystitis: a meta-analysis of prospective randomized trials.METHODS: Pertinent studies were selected from the Medline, Embase, Cancerlit, HealthSTAR and Cochrane Library Databases, references from published articles, and reviews. Twelve prospective randomized trials (9 addressing open cholecystectomy and 3 laparoscopic cholecystectomy) were selected. Conventional meta-analysis according to the DerSimonian and Laird method was used for the pooling of the results. The rate difference (RD) (95% CI) and the number needed to treat (NNT) were used as a measure of the therapeutic effect.RESULTS: Cumulative operative and perioperative mortality and morbidity were 0.9% and 17.8%, respectively, for open cholecystectomy and 0% and 13.1%, respectively, for laparoscopic cholecystectomy. The pooled RD for operative complications in early surgery was 1.37% (95% CI=−3.78% to 6.53%;p= 0.2) for open cholecystectomy and 3.11% (95% CI=−15.10% to 8.87%;p= 0.6) for laparoscopic cholecystectomy. In laparoscopic cholecystectomy the cumulative conversion rate to open cholecystectomy was 21.5%. The pooled RD for conversion rate in early laparoscopic cholecystectomy was−7.99% (95% CI=−18.46% to 2.47%;p= 0.1; NNT= 13). Total hospital stay (mean± SD) was significantly shorter in the early surgery group (9.6± 2.5 daysvs17.8± 5.8 days;p<0.0001). More than 20% of patients referred to delayed surgery fail to respond to conservative management or suffer recurrent cholecystitis in the interval period.CONCLUSIONS: Early operation (open or laparoscopic) does not carry a higher risk of mortality and morbidity compared to delayed operation and should be the preferred surgical approach for patients with acute lithiasic cholecystitis. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
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