Effectiveness of laparoscopic surgery for gallstones and common bile duct lithiasis: A systematic overview

Carlos Manterola, Viviana Pineda, Montserrat Tort, Eduardo Targarona, Román Villegas Portero, Pablo Alonso

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1 Citation (Scopus)

Abstract

The aim of the present study was to evaluate the available evidence on the effectiveness of laparoscopic surgery for treating gallstones and common bile duct lithiasis (CBDL). A systematic overview was performed. Medline, EMBASE and The Cochrane Library were searched (1998-2008). Systematic reviews (SR), clinical practice guidelines (CPG), randomised clinical trials (RCT) and observational studies were included. Internal validity and overall quality of the evidence were assessed. The available evidence was classified according to the Oxford Centre for Evidence Based Medicine proposal. 87 studies were included in this review (12 SR, 23 RCT, 3 CPG, 13 cohort studies, 3 cross-sectional studies, 2 case and control studies and 31 case series). Compared with open cholecystectomy, laparoscopic cholecystectomy (LC) is associated with shorter operating time, shorter hospital stay and better quality of life (high quality evidence). The use of antibiotic prophylaxis does not appear to reduce the infection rate in low-risk patients (high quality evidence). Although many techniques have been advocated to perform LC their effectiveness is as yet inconclusive (low-quality evidence). Two-stage surgery is the most appropriate strategy for high-risk patients with CBDL (high-quality evidence). Mortality is similar to open surgery, as the effectiveness is similar to that of endoscopic treatment (high-quality evidence). As a conclusion we can state that the evidence concerning the effectiveness of laparoscopic surgery for gallstones and CBDL is scarce and of low methodological quality and that better quality studies are warranted to assess these techniques more adequately.
Original languageEnglish
Pages (from-to)729-742
JournalInternational Journal of Morphology
Volume28
Issue number3
DOIs
Publication statusPublished - 1 Jan 2010

Keywords

  • Biomedical
  • Cholecystectomy
  • Cholecystolithiasis
  • Choledocholithiasis
  • Cholelithiasis
  • Gallstones
  • Laparoscopic
  • Laparoscopy
  • Technology assessment

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