title: Transvaginal cholecystectomy vs conventional laparoscopic cholecystectomy for gallbladder disease: A meta-analysis.
abstract: OBJECTIVE
  To compare the results of transvaginal cholecystectomy (TVC) and conventional laparoscopic cholecystectomy (CLC) for gallbladder disease.
  
  
  METHODS
  We performed a literature search of PubMed, EMBASE, Ovid, Web of Science, Cochrane Library, Google Scholar, MetaRegister of Controlled Trials, Chinese Medical Journal database and Wanfang Data for trials comparing outcomes between TVC and CLC. Data were extracted by two authors. Mean difference (MD), standardized mean difference (SMD), odds ratios and risk rate with 95%CIs were calculated using fixed- or random-effects models. Statistical heterogeneity was evaluated with the χ(2) test. The fixed-effects model was used in the absence of statistically significant heterogeneity. The random-effects model was chosen when heterogeneity was found.
  
  
  RESULTS
  There were 730 patients in nine controlled clinical trials. No significant difference was found regarding demographic characteristics (P > 0.5), including anesthetic risk score, age, body mass index, and abdominal surgical history between the TVC and CLC groups. Both groups had similar mortality, morbidity, and return to work after surgery. Patients in the TVC group had a lower pain score on postoperative day 1 (SMD: -0.957, 95%CI: -1.488 to -0.426, P < 0.001), needed less postoperative analgesic medication (SMD: -0.574, 95%CI: -0.807 to -0.341, P < 0.001) and stayed for a shorter time in hospital (MD: -1.004 d, 95%CI: -1.779 to 0.228, P = 0.011), but had longer operative time (MD: 17.307 min, 95%CI: 6.789 to 27.826, P = 0.001). TVC had no significant influence on postoperative sexual function and quality of life. Better cosmetic results and satisfaction were achieved in the TVC group.
  
  
  CONCLUSIONS
  TVC is safe and effective for gallbladder disease. However, vaginal injury might occur, and further trials are needed to compare TVC with CLC.
authors.affiliation: Bin Xu, Zhen-Sun Song, Department of Hepato-Biliary-Pancreatic Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Xu
authors.affiliation: Bin Xu, Zhen-Sun Song, Department of Hepato-Biliary-Pancreatic Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Xu
authors.affiliation: Bin Xu, Zhen-Sun Song, Department of Hepato-Biliary-Pancreatic Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China.
authors.forename: Wen-Yan
authors.initials: WY
authors.lastname: Zheng
authors.affiliation: Bin Xu, Zhen-Sun Song, Department of Hepato-Biliary-Pancreatic Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China.
authors.forename: Hai-Yan
authors.initials: HY
authors.lastname: Ge
authors.affiliation: Bin Xu, Zhen-Sun Song, Department of Hepato-Biliary-Pancreatic Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China.
authors.forename: Li-Wei
authors.initials: LW
authors.lastname: Wang
authors.affiliation: Bin Xu, Zhen-Sun Song, Department of Hepato-Biliary-Pancreatic Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China.
authors.forename: Zhen-Sun
authors.initials: ZS
authors.lastname: Song
authors.affiliation: Bin Xu, Zhen-Sun Song, Department of Hepato-Biliary-Pancreatic Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China.
authors.forename: Bin
authors.initials: B
authors.lastname: He
mesh_terms: D016009:Chi-Square Distribution; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005705:Gallbladder Diseases / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D057605:Natural Orifice Endoscopic Surgery / Q000009:adverse effects; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology; D012307:Risk Factors; D016896:Treatment Outcome; D014621:Vagina
keywords: Conventional laparoscopic cholecystectomy; Endoscopic surgery; Meta-analyses; Natural orifice; Transvaginal cholecystectomy