Laparoscopic vs. Open Cholecystectomy for Cirrhotic Patients: A Systematic Review and Meta-Analysis

Background/Aims: To compare the safety and effectiveness of laparoscopic cholecystectomy (LC) versus open cholecystectomy (OC) for cirrhotic patients. Methodology: The Cochrane Library, MEDLINE, Science Citation Index Expanded, EM BASE and CBM (Chinese Biomedical Database) were searched until August 2011 to indentify relevant and eligible studies. Results: Twenty four articles with 1366 cirrhotic patients were included. All patients were allocated to the LC group (n=720) or the OC group (n=646). They were primarily in Child-Pugh class A (n=996, 72.9%) and class B (n=354, 25.9%). Meta-analysis of 5 randomized controlled trials (n=284) indicated LC group was associated with the following advantages: significant lower surgery-related morbidity, less postoperative complications (e.g. incision hernia, wound infection), shorter hospital stay and less loss of blood. There were no significant differences in the intra-hospital mortality and total operative time between the two groups. Meta-analysis of 19 non-randomized studies (n=1082) showed similar results in favour of LC group. In addition, it showed significant lower intra-hospital mortality and less total operative time in the LC group than the OC group. Conclusions: LC is safe and offers various significant benefits over OC. Thus, it should be recommended for compensated cirrhotic patients.