Same-admission versus delayed cholecystectomy for mild acute biliary pancreatitis: a systematic review and meta-analysis

摘要

The timing of laparoscopic cholecystectomy (LC) performed after the mild acute biliary pancreatitis (MABP) is still controversial. We conducted a review to compare same-admission laparoscopic cholecystectomy (SA-LC) and delayed laparoscopic cholecystectomy (DLC) after mild acute biliary pancreatitis (MABP). We systematically searched several databases (PubMed, EMBASE, Web of Science, and the Cochrane Library) for relevant trials published from 1 January 1992 to 1 June 2018. Human prospective or retrospective studies that compared SA-LC and DLC after MABP were included. The measured outcomes were the rate of conversion to open cholecystectomy (COC), rate of postoperative complications, rate of biliary-related complications, operative time (OT), and length of stay (LOS). The meta-analysis was performed using Review Manager 5.3 software (The Cochrane Collaboration, Oxford, United Kingdom). This meta-analysis involved 1833 patients from 4 randomized controlled trials and 7 retrospective studies. No significant differences were found in the rate of COC (risk ratio [RR]?=?1.24; 95% confidence interval [CI], 0.78–1.97; p?=?0.36), rate of postoperative complications (RR?=?1.06; 95% CI, 0.67–1.69; p?=?0.80), rate of biliary-related complications (RR?=?1.28; 95% CI, 0.42–3.86; p?=?0.66), or OT (RR?=?1.57; 95% CI, ??1.58–4.72; p?=?0.33) between the SA-LC and DLC groups. The LOS was significantly longer in the DLC group (RR?=???2.08; 95% CI, ??3.17 to ??0.99; p?=?0.0002). Unexpectedly, the subgroup analysis showed no significant difference in LOS according to the Atlanta classification (RR?=???0.40; 95% CI, ??0.80–0.01; p?=?0.05). The gallstone-related complications during the waiting time in the DLC group included gall colic, recurrent pancreatitis, acute cholecystitis, jaundice, and acute cholangitis (total, 25.39%). This study confirms the safety of SA-LC, which could shorten the LOS. However, the study findings have a number of important implications for future practice.