title: Open versus laparoscopic cholecystectomy in acute cholecystitis. Systematic review and meta-analysis.
abstract: BACKGROUND
  Laparoscopic cholecystectomy (LC) has become a popular alternative to open cholecystectomy (OC) in the treatment of acute cholecystitis (AC). Laparoscopic cholecystectomy (LC) is now considered the gold standard of therapy for symptomatic cholelithiasis and chronic cholecystitis. However no definitive data on its use in AC has been published. CIAO and CIAOW studies demonstrated 48.7% of AC were still operated with the open technique. The aim of the present meta-analysis is to compare OC and LC in AC.
  
  
  METHODS
  A systematic-review with meta-analysis and meta-regression of trials comparing open vs. laparoscopic cholecystectomy in patients with AC was performed. Electronic searches were performed using Medline, Embase, PubMed, Cochrane Central Register of Controlled Trials (CCTR), Cochrane Database of Systematic Reviews (CDSR) and CINAHL.
  
  
  RESULTS
  Ten trials have been included with a total of 1248 patients: 677 in the LC and 697 into the OC groups. The post-operative morbidity rate was half with LC (OR = 0.46). The post-operative wound infection and pneumonia rates were reduced by LC (OR 0.54 and 0.51 respectively). The post-operative mortality rate was reduced by LC (OR = 0.2). The mean postoperative hospital stay was significantly shortened in the LC group (MD = -4.74 days). There were no significant differences in the bile leakage rate, intraoperative blood loss and operative times.
  
  
  CONCLUSIONS
  In acute cholecystitis, post-operative morbidity, mortality and hospital stay were reduced by laparoscopic cholecystectomy. Moreover pneumonia and wound infection rate were reduced by LC. Severe hemorrhage and bile leakage rates were not influenced by the technique. Cholecystectomy in acute cholecystitis should be attempted laparoscopically first.
authors.affiliation: General Surgery Dept., Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy. Electronic address: federico.coccolini@gmail.com.
authors.forename: Federico
authors.initials: F
authors.lastname: Coccolini
authors.affiliation: Surgical Clinic, University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy.
authors.forename: Fausto
authors.initials: F
authors.lastname: Catena
authors.affiliation: General Surgery Dept., Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Pisano
authors.affiliation: Emergency Surgery Dept., Ospedale Maggiore, Viale Gramsci 14, 43126 Parma, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Gheza
authors.affiliation: Gastroenterology I Dept., Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Fagiuoli
authors.affiliation: General and Emergency Surgery Dept., Ospedale Maggiore, Bologna, Italy.
authors.forename: Salomone
authors.initials: S
authors.lastname: Di Saverio
authors.affiliation: Gastroenterology I Dept., IRCCS De Bellis Hospital, Castellana Grotte, 70013, Italy.
authors.forename: Gioacchino
authors.initials: G
authors.lastname: Leandro
authors.affiliation: General Surgery Dept., Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Montori
authors.affiliation: General Surgery Dept., Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Ceresoli
authors.affiliation: General Surgery Dept., Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Corbella
authors.affiliation: General Surgery Dept., Macerata Hospital, Macerata, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Sartelli
authors.affiliation: Letterkenny Hospital and the Donegal Clinical Research Academy, Donegal, Ireland; University College Hospital, Galway, Ireland.
authors.forename: Michael
authors.initials: M
authors.lastname: Sugrue
authors.affiliation: General Surgery Dept., Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Ansaloni
mesh_terms: D016063:Blood Loss, Surgical; D002763:Cholecystectomy / Q000379:methods* / Q000401:mortality; D041881:Cholecystitis, Acute / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology
keywords: Acute cholecystitis; Laparoscopic; Meta-analysis; Morbidity; Mortality; Open; Surgery; Treatment