title: The efficacy and safety of different kinds of laparoscopic cholecystectomy: a network meta analysis of 43 randomized controlled trials.
abstract: OBJECTIVE
  We conducted a network meta analysis (NMA) to compare different kinds of laparoscopic cholecystectomy [LC] (single port [SPLC], two ports [2PLC], three ports [3PLC], and four ports laparoscopic cholecystectomy [4PLC], and four ports mini-laparoscopic cholecystectomy [mini-4PLC]).
  
  
  METHODS
  PubMed, the Cochrane library, EMBASE, and ISI Web of Knowledge were searched to find randomized controlled trials [RCTs]. Direct pair-wise meta analysis (DMA), indirect treatment comparison meta analysis (ITC) and NMA were conducted to compare different kinds of LC.
  
  
  RESULTS
  We included 43 RCTs. The risk of bias of included studies was high. DMA showed that SPLC was associated with more postoperative complications, longer operative time, and higher cosmetic score than 4PLC, longer operative time and higher cosmetic score than 3PLC, more postoperative complications than mini-4PLC. Mini-4PLC was associated with longer operative time than 4PLC. ITC showed that 3PLC was associated with shorter operative time than mini-4PLC, and lower postoperative pain level than 2PLC. 2PLC was associated with fewer postoperative complications and longer hospital stay than SPLC. NMA showed that SPLC was associated with more postoperative complications than mini-4PLC, and longer operative time than 4PLC.
  
  
  CONCLUSIONS
  The rank probability plot suggested 4PLC might be the worst due to the highest level of postoperative pain, longest hospital stay, and lowest level of cosmetic score. The best one might be mini-4PLC because of highest level of cosmetic score, and fewest postoperative complications, or SPLC because of lowest level of postoperative pain and shortest hospital stay. But more studies are needed to determine which will be better between mini-4PLC and SPLC.
authors.affiliation: The First Clinical College, Lanzhou University, Lanzhou, China ; Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.
authors.forename: Lun
authors.initials: L
authors.lastname: Li
authors.affiliation: Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.
authors.forename: Jinhui
authors.initials: J
authors.lastname: Tian
authors.affiliation: The First Clinical College, Lanzhou University, Lanzhou, China ; Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.
authors.forename: Hongliang
authors.initials: H
authors.lastname: Tian
authors.affiliation: Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.
authors.forename: Rao
authors.initials: R
authors.lastname: Sun
authors.affiliation: The First Clinical College, Lanzhou University, Lanzhou, China ; Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.
authors.forename: Quan
authors.initials: Q
authors.lastname: Wang
authors.affiliation: The First Clinical College, Lanzhou University, Lanzhou, China ; Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.
authors.forename: Kehu
authors.initials: K
authors.lastname: Yang
mesh_terms: D000328:Adult; D000368:Aged; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000379:methods*; D016206:Databases, Bibliographic; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010149:Postoperative Pain / Q000209:etiology / Q000503:physiopathology*; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology*; D017594:Publication Bias; D016032:Randomized Controlled Trials as Topic