MORTALITY AND COMPLICATIONS ASSOCIATED WITH LAPAROSCOPIC CHOLECYSTECTOMY - A METAANALYSIS

Objective The purpose of this study was to perform a meta-analysis of targe laparoscopic cholecystectomy case-series and compare results con cerning complications, particularly bile duct injury, to those reporte d in open cholecystectomy case-series. Summary Background Data Since t he introduction of laparoscopic cholecystectomy in the United States, hundreds of reports about the technique have been published, many incl uding statements about the advantages of laparoscopic cholecystectomy compared with those of open cholecystectomy. There is an unevenness in scope and quality of the studies. Nevertheless, enough data have accu mulated from large series to permit analyses of data regarding some of the most important issues. Methods Articles identified via a MEDLINE (the National Library of Medicine's computerized database) search were evaluated according to standard criteria. Data regarding the patient sample, study methods, and outcomes of cholecystectomy were abstracted and summarized across studies. Results Outcomes of laparoscopic chole cystectomy are examined for 78,747 patients reported on in 98 studies and compared with outcomes of open cholecystectomy for 12,973 patients reported on in 28 studies. Laparoscopic cholecystectomy appears to ha ve a higher common bile duct injury rate and a lower mortality rate. E stimated rates of other types of complications after laparoscopic chol ecystectomy generally were low. Most conversions followed operative di scoveries (e.g., dense adhesions) and were not the result of injury. C onclusions There is wide variability in the amount and type of data re ported within any single study, and patient populations may not be com parable across studies. Except for a higher common bile duct injury ra te, laparoscopic cholecystectomy appears to be at least as safe a proc edure as that of open cholecystectomy.