Meta-Analysis
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. May 27, 2024; 16(5): 1407-1419
Published online May 27, 2024. doi: 10.4240/wjgs.v16.i5.1407
Evaluating effectiveness and safety of combined percutaneous transhepatic gallbladder drainage and laparoscopic cholecystectomy in acute cholecystitis patients: Meta-analysis
Yu Li, Wei-Ke Xiao, Xiao-Jun Li, Hui-Yuan Dong
Yu Li, Wei-Ke Xiao, Xiao-Jun Li, Hui-Yuan Dong, Department of General Surgery, No. 942 Hospital of PLA, Yinchuan 750004, Ningxia Hui Autonomous Region, China
Co-first authors: Yu Li and Wei-Ke Xiao.
Author contributions: Li Y and Xiao WK are co-first authors and contributed equally to this work, including design of the study, acquiring and analyzing data from experiments, and writing of the manuscript; Li Y, Xiao WK and Dong HY designed the experiments and conducted clinical data collection; Li Y, Xiao WK and Li XJ performed postoperative follow-up and recorded the data, conducted the collation and statistical analysis, and wrote the original manuscript and revised the paper; all authors read and approved the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: Https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yu Li, MD, Doctor, Department of General Surgery, No. 942 Hospital of PLA, No. 898 Shengli South Street, Xingqing District, Yinchuan 750004, Ningxia Hui Autonomous Region, China. leeyutougao@163.com
Received: January 19, 2024
Revised: February 29, 2024
Accepted: April 2, 2024
Published online: May 27, 2024
Processing time: 125 Days and 2.4 Hours
Abstract
BACKGROUND

Acute cholecystitis (AC) is a common disease in general surgery. Laparoscopic cholecystectomy (LC) is widely recognized as the "gold standard" surgical procedure for treating AC. For low-risk patients without complications, LC is the recommended treatment plan, but there is still controversy regarding the treatment strategy for moderate AC patients, which relies more on the surgeon's experience and the medical platform of the visiting unit. Percutaneous transhepatic gallbladder puncture drainage (PTGBD) can effectively alleviate gallbladder inflammation, reduce gallbladder wall edema and adhesion around the gallbladder, and create a "time window" for elective surgery.

AIM

To compare the clinical efficacy and safety of LC or PTGBD combined with LC for treating AC patients, providing a theoretical basis for choosing reasonable surgical methods for AC patients.

METHODS

In this study, we conducted a clinical investigation regarding the combined use of PTGBD tubes for the treatment of gastric cancer patients with AC. We performed searches in the following databases: PubMed, Web of Science, EMBASE, Cochrane Library, China National Knowledge Infrastructure, and Wanfang Database. The search encompassed literature published from the inception of these databases to the present. Subsequently, relevant data were extracted, and a meta-analysis was conducted using RevMan 5.3 software.

RESULTS

A comprehensive analysis was conducted, encompassing 24 studies involving a total of 2564 patients. These patients were categorized into two groups: 1371 in the LC group and 1193 in the PTGBD + LC group. The outcomes of the meta-analysis revealed noteworthy disparities between the PTGBD + LC group and the LC group in multiple dimensions: (1) Operative time: Mean difference (MD) = 17.51, 95%CI: 9.53-25.49, P < 0.01; (2) Conversion to open surgery rate: Odds ratio (OR) = 2.95, 95%CI: 1.90-4.58, P < 0.01; (3) Intraoperative bleeding loss: MD = 32.27, 95%CI: 23.03-41.50, P < 0.01; (4) Postoperative hospital stay: MD = 1.44, 95%CI: 0.14-2.73, P = 0.03; (5) Overall postoperative complication rate: OR = 1.88, 95%CI: 1.45-2.43, P < 0.01; (6) Bile duct injury: OR = 2.17, 95%CI: 1.30-3.64, P = 0.003; (7) Intra-abdominal hemorrhage: OR = 2.45, 95%CI: 1.06-5.64, P = 0.004; and (8) Wound infection: OR = 0. These findings consistently favored the PTGBD + LC group over the LC group. There were no significant differences in the total duration of hospitalization [MD = -1.85, 95%CI: -4.86-1.16, P = 0.23] or bile leakage [OR = 1.33, 95%CI: 0.81-2.18, P = 0.26] between the two groups.

CONCLUSION

The combination of PTGBD tubes with LC for AC treatment demonstrated superior clinical efficacy and enhanced safety, suggesting its broader application value in clinical practice.

Keywords: Acute cholecystitis, Laparoscopic cholecystectomy, Percutaneous transhepatic gallbladder drainage, Meta-analysis, Efficacy

Core Tip: Laparoscopic cholecystectomy (LC) is the standard surgical procedure for treating acute cholecystitis (AC), but postoperative complications and patient mortality are relatively high. Percutaneous transhepatic gallbladder drainage (PTGBD) can quickly drain infected bile, reduce gallbladder tension, and is often used in combination with delayed LC in clinical practice, but PTGBD is associated with more adverse long-term outcomes. The meta-analysis results of this study showed that the combination of PTGBD and LC for the treatment of AC has short surgical time, low conversion rate to open surgery, less intraoperative bleeding, and low overall incidence of complications, which is worthy of promotion.