Endoscopic minimal invasive cholecystolithotomy vs laparoscopic cholecystectomy in treatment of cholecystolithiasis in China: a meta-analysis

Abstract

Introduction: Endoscopic minimal invasive cholecystolithotomy (EMIC) is recently popular in China which may offer advantages over laparoscopic cholecystectomy (LC). We try to find out the most favorable treatment for the patients underwent cholecystolithiasis.

Methods: Databases PubMed, Elsevier, Wiley Online Library, The Cochrane library, CNKI, WanFang Data, and Chongqing VIP were searched for randomized controlled trials (RCTs) and on EMIC vs LC from 2009 to 2013. Odds ratio (OR), risk difference (RD) and weight mean difference (WMD) were calculated with 95% confidence intervals (CI).

Results: 14 RCTs including 2030 patients were selected. No significant difference was present in operating time between EMIC and LC. EMIC shown significant less blood lost (WMD -23.45; 95% CI -30.34, -16.55; Z=6.66; P<0.00001) compared to LC. Shortened exhaust time (WMD -14.11; 95% CI -18.34, -9.88; Z=6.53; P<0.00001) and hospital stay (WMD -1.31; 95% CI -1.91, -0.71; Z=4.29; P<0.00001) were present in EMIC group. And EMIC shown decreased complication proportion (OR -0.14, 95% CI -0.09 to -0.21; Z=8.53; P<0.00001) in comparison with LC. There is no difference present in the recurrence of stones in two procedures but a significantly decreased recurrence rate of gallstones was present in EMIC compared to conventional cholecystolithotomy.

Conclusion: Patients treated with EMIC shown faster recovery and less complication which were superior to LC.

Keywords: Cholecystolithotomy; Gallbladder preserved; Laparoscopic cholecystectomy; Stone recurrence.