Efficacy and safety of laparoscopic holmium laser lithotripsy in the treatment of complicated biliary calculus A PRISMA-compliant systematic reviews and meta-analysis

Backgroud: The aim of this study was to assess the efficacy and safety of laparoscopic holmium laser lithotripsy (LHLL) in the treatment of complicated biliary calculus. Methods: We systematically searched the electronic database (PubMed, EMBASE, Cochrane library, Web of science, and Chinese Biomedical Literature Database) up to May 2018 to identify case-controlled studies that compared LHLL with laparoscopic bile duct exploration (LBDE) for complicated biliary calculus. Results: Five case-controlled studies were included, with 541 patients (273 in the LHLL group and 268 in the LBDE group). Compared with LBDE, LHLL was associated with shorter operative time (weighted mean difference [WMD]=-40.04, P<. 001) and lower estimated blood loss (EBL) (WMD=-56.42, P<.001), lesser duration of hospitalization (WMD=-3.93, P<.001) and lower rate of residual stone (OR=0.13, P<. 001). There was no statistically significant differences in bile leakage (OR=0.48, P =. 23) and hemobilia (OR=0.49, 0.41). Conclusion: Current evidence suggests that the efficacy of LHLL is superior to that of LBDE but they are similarly safe for the treatment of complicated biliary calculus. Limited by the quantity and quality of the studies included, these conclusions need to be verified by more high-quality studies.