Systematic review: open, small-incision or laparoscopic cholecystectomy for symptomatic cholecystolithiasis.
BACKGROUND
Laparoscopic cholecystectomy has become the method of choice for gallbladder removal, although evidence of superiority over open and small-incision cholecystectomy is lacking.


OBJECTIVE
To compare the effects of open, small-incision and laparoscopic cholecystectomy techniques for patients with symptomatic cholecystolithiasis.


METHODS
We conducted updated searches until January 2007 in multiple databases. We assessed bias risk.


RESULTS
Fifty-nine trials randomized 5556 patients. No significant differences in primary outcomes (mortality and complications) were found among all three techniques. Both minimal invasive techniques show advantages over open cholecystectomy in terms of convalescence. Small-incision cholecystectomy showed shorter operative time compared with laparoscopic cholecystectomy (random effects, weighted mean difference, 16.4 min; 95% confidence interval, 8.9-23.8), but the two techniques did not differ regarding hospital stay and conversions.


CONCLUSIONS
No significant differences in mortality and complications were found among all three techniques. Laparoscopic cholecystectomy and small-incision cholecystectomy are preferred over open cholecystectomy for quicker convalescence. Laparoscopic cholecystectomy and small-incision cholecystectomy show no clear differences on patient outcomes.
Keus
F
F
The Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. erickeus@hotmail.com
Gooszen
H G
HG
Van Laarhoven
C J H M
CJ
D002763:Cholecystectomy / Q000009:adverse effects / Q000379:methods*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000379:methods; D041761:Cholecystolithiasis / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome