title: Laparoscopic vs. open cholecystectomy for cirrhotic patients: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To compare the safety and effectiveness of laparoscopic cholecystectomy (LC) versus open cholecystectomy (OC) for cirrhotic patients.
  
  
  METHODS
  The Cochrane Library, MEDLINE, Science Citation Index Expanded, EMBASE and CBM (Chinese Biomedical Database) were searched until August 2011 to indentify relevant and eligible studies.
  
  
  RESULTS
  Twenty three articles with 1316 cirrhotic patients were included. All patients were allocated to the LC group (n=694) or the OC group (n=622). They were primarily in Child-Pugh class A (n=957, 72.7%) and class B (n=343, 26.1%). Meta-analysis of 5 randomized controlled trials (n=284) indicated LC group was associated with the following advantages: significant lower surgery-related morbidity, less postoperative complications (e.g. incision hernia, wound infection), shorter hospital stay and less loss of blood. There were no significant differences in the intra-hospital mortality and total operative time between the two groups. Meta-analysis of 19 non-randomized studies (n=1082) showed similar results in favour of LC group. In addition, it showed significant lower intra-hospital mortality and less total operative time in the LC group than the OC group.
  
  
  CONCLUSIONS
  LC is safe and offers various significant benefits over OC. Thus, it should be recommended for compensated cirrhotic patients.
authors.affiliation: Department of Bile Duct Surgery, West China Hospital, Sichuan University, Sichuan Province, China.
authors.forename: Yao
authors.initials: Y
authors.lastname: Cheng
authors.forename: Xian-Ze
authors.initials: XZ
authors.lastname: Xiong
authors.forename: Si-Jia
authors.initials: SJ
authors.lastname: Wu
authors.forename: Yi-Xin
authors.initials: YX
authors.lastname: Lin
authors.forename: Nan-Sheng
authors.initials: NS
authors.lastname: Cheng
mesh_terms: D016009:Chi-Square Distribution; D002763:Cholecystectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016017:Odds Ratio; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome