Abstract
Background
Currently, there is no consensus on whether laparoscopic cholecystectomy (LC) performed as day-surgery is safe and effective and can be considered as the standard for the management of symptomatic gallbladder disease. We conducted a meta-analysis of randomized controlled trials (RCTs) to evaluate the safety and effectiveness of this intervention based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
Methods
We conducted a systematic search of several databases from their inception to November 10, 2016 for entries on the mortality, morbidity after discharge, readmission, postoperative morbidity, and patient satisfaction at 1 week of day-surgery LC. Pooled risk ratio (RR) with 95% confidence intervals (CI) was calculated using the fixed-effects model. Rare outcomes were presented as the Peto odds ratio (Peto OR). Meta-analysis was performed by using the RevMan 5.1 software, and the level of evidence was assessed by using the GRADE guideline and GRADEpro GDT software.
Results
Eight RCTs totaling 624 participants were included. The result showed no intergroup difference in short-term mortality. Compared to overnight-stay surgery, day-surgery did not show any clear evidence of reduced morbidity after discharge (Peto OR 0.89; 95% CI 0.39–2.02), lower readmission rate (Peto OR 0.68; 95% CI 0.23–2.05), or higher postoperative morbidity rates (RR 1.28; 95% CI 0.81–2.02). However, the results suggested that day-surgery may improve patient satisfaction at 1 week (RR 1.17; 95% CI 1.03–1.33). Evaluation by the GRADE approach revealed that the quality of evidence for each outcome was of low to very low quality due to the risk of bias, imprecision, and inconsistency.
Conclusion
Our meta-analysis shows that the safety and effectiveness of day-surgery LC is still uncertain. Additional well-designed and adequately powered RCTs are required before the procedure can be recommended as the standard for clinical practice.
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References
Reynolds W Jr (2001) The first laparoscopic cholecystectomy. JSLS 5:89–94
Sain AH (1996) Laparoscopic cholecystectomy is the current “gold standard” for the treatment of gallstone disease. Ann Surg 224:689–690
Hendolin HI, Pääkönen ME, Alhava EM, Tarvainen R, Kemppinen T, Lahtinen P (2000) Laparoscopic or open cholecystectomy: a prospective randomised trial to compare postoperative pain, pulmonary function, and stress response. Eur J Surg 166:394–399
Reddick EJ, Olsen DO (1990) Outpatient laparoscopic laser cholecystectomy. Am J Surg 160:485–487. (discussion 488–489)
Enochsson L, Thulin A, Osterberg J, Sandblom G, Persson G (2013) The Swedish Registry of Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (GallRiks): a nationwide registry for quality assurance of gallstone surgery. JAMA Surg 148:471–478
Keulemans Y, Eshuis J, de Haes H, de Wit LT, Gouma DJ (1998) Laparoscopic cholecystectomy: day surgery versus clinical observation. Ann Surg 228:734–740
Hollington P, Toogood GJ, Padbury RT (1999) A prospective randomized trial of day-stay only versus overnight-stay laparoscopic cholecystectomy. Aust N Z J Surg 69:841–843
Dirksen CD, Schmitz RF, Hans KM, Nieman FH, Hoogenboom LJ, Go PM (2001) Ambulatory laparoscopic cholecystectomy is as effective as hospitalization and from a social perspective less expensive: a randomized study. Ned Tijdschr Geneeskd 145:2434–2439
Young J, O’Connell B (2001) Recovery following laparoscopic cholecystectomy in either a 23 hour or an 8 hour facility. J Qual Clin Pract 21:2–7. (discussion 8)
Curet MJ, Contreras M, Weber DM, Albrecht R (2002) Laparoscopic cholecystectomy. Surg Endosc 16:453–457
Johansson M, Thune A, Nelvin L, Lundell L (2006) Randomized clinical trial of day surgery versus overnight-stay laparoscopic cholecystectomy. Br J Surg 93:40–45
Barthelsson C, Anderberg B, Ramel S, Björvell C, Giesecke K, Nordström G (2008) Outpatient versus inpatient laparoscopic cholecystectomy: a prospective randomized study of symptom occurrence, symptom distress and general state of health during the first post-operative week. J Eval Clin Pract 14:577–584
Fleming WR, Michell I, Douglas M (2000) Audit of outpatient laparoscopic cholecystectomy. Universities of Melbourne HPB Group. Aust N Z J Surg 70:423–427
Topal B, Peeters G, Verbert A, Penninckx F (2007) Outpatient laparoscopic cholecystectomy: clinical pathway implementation is efficient and cost effective and increases hospital bed capacity. Surg Endosc 21:1142–1146
Salleh AA, Affirul CA, Hairol O, Zamri Z, Azlanudin A, Hilmi MA, Razman J (2015) Randomized controlled trial comparing daycare and overnight stay laparoscopic cholecystectomy. Clin Ter 166:e165–e168. doi:10.7417/T.2015.1848
Planells Roig M, Sánchez Salas A, Sanahuja Santafé A, Bueno Lledó J, Serralta Serra A, García Espinosa R, Arnal Bertomeu C (2002) Total quality management in laparoscopic cholecystectomy. Quality of care and quality perception in ambulatory laparoscopic cholecystectomy. Rev Esp Enferm Dig 94:319–331
Paquette IM, Smink D, Finlayson SR (2008) Outpatient cholecystectomy at hospitals versus freestanding ambulatory surgical centers. J Am Coll Surg 206:301–305
Shamiyeh A, Wayand W (2004) Laparoscopic cholecystectomy: early and late complications and their treatment. Langenbecks Arch Surg 389:164–171
Ahmad NZ, Byrnes G, Naqvi SA (2008) A meta-analysis of ambulatory versus inpatient laparoscopic cholecystectomy. Surg Endosc 22:1928–1934
Vaughan J, Gurusamy KS, Davidson BR (2013) Day-surgery versus overnight stay surgery for laparoscopic cholecystectomy. Cochrane Database Syst Rev. doi:10.1002/14651858.CD006798.pub4
Tang H, Dong A, Yan L (2015) Day surgery versus overnight stay laparoscopic cholecystectomy: a systematic review and meta-analysis. Dig Liver Dis 47:556–561
Schünemann H, Brożek J, Guyatt G, Oxman A (eds) GRADE handbook for grading quality of evidence and strength of recommendations. Updated October 2013. The GRADE Working Group, 2013. http://www.guidelinedevelopment.org/handbook. Accessed 10 Dec 2016
Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, Schünemann HJ, GRADE Working Group (2008) GRADE Working Group GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 336:924–926
Higgins JPT, Green S (eds) Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. www.cochrane-handbook.org. Accessed 10 Dec 2016
Review Manager (RevMan) [Computer program]. Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014
Higgins JPT, Deeks JJ, Altman DG (eds). Chapter 16: Special topics in statistics. In: Higgins JPT, Green S (eds). Cochrane handbook for systematic reviews of interventions. Version 5.0.1 [updated September 2008]. The Cochrane Collaboration, 2008. www.cochrane-handbook.org. Accessed 15 Dec 2016
Higgins JPT, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistencies in meta-analysis. BMJ 327:557–560
DeMets DL (1987) Methods for combining randomized clinical trials: strengths and limitations. Stat Med 6:341–350
DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188
Deeks JJ, Higgins JPT, Altman DG (eds). Chapter 9: Analysing data and undertaking Meta-analyses. In: Higgins JPT, Green S (eds). Cochrane handbook for systematic reviews of interventions. Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. www.cochrane-handbook.org. Accessed 15 Dec 2016
GRADEpro GDT: GRADEpro Guideline Development Tool [Software]. McMaster University, 2015 (developed by Evidence Prime, Inc.). www.gradepro.org. Accessed 15 Dec 2016
Neugarten BL, Havighurst RJ, Tobin SS (1961) The measurement of life satisfaction. J Gerontol 16:134–143
Carlomagno N, Tammaro V, Scotti A, Candida M, Calogero A, Santangelo ML (2016) Is day-surgery laparoscopic cholecystectomy contraindicated in the elderly? Results from a retrospective study and literature review. Int J Surg 33(Suppl 1):S103–S107
Thomas EJ, Brennan TA (2000) Incidence and types of preventable adverse events in elderly patients: population based review of medical records. BMJ 320:741–744
Voitk AJ (1997) Is outpatient cholecystectomy safe for the higher-risk elective patient? Surg Endosc 11:1147–1149
Lepner U, Grunthal V (2005) Intraoperative cholangiography can be safely omitted during laparoscopic cholecystectomy: a prospective study of 413 consecutive patients. Scand J Surg 94:197–200
Traverso LW (2006) Intraoperative cholangiography lowers the risk of bile duct injury during cholecystectomy. Surg Endosc 20:1659–1661
Jamal KN, Smith H, Ratnasingham K, Siddiqui MR, McLachlan G, Belgaumkar AP (2016) Meta-analysis of the diagnostic accuracy of laparoscopic ultrasonography and intraoperative cholangiography in detection of common bile duct stones. Ann R Coll Surg Engl 98:244–249
Vlek SL, van Dam DA, Rubinstein SM, de Lange-de Klerk ES, Schoonmade LJ, Tuynman JB, Meijerink WJ, Ankersmit M (2016) Biliary tract visualization using near-infrared imaging with indocyanine green during laparoscopic cholecystectomy: results of a systematic review. Surg Endosc. doi:10.1007/s00464-016-5318-7
Acknowledgements
We thank all the participants and clinical researchers who were involved in the publications we mentioned in this review. We thank Ping Zhu from Sichuan University for assistance in statistical analysis.
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Xiang-Yong Hao, Yan-Fei Shen, Yong-Gang Wei, Fei Liu, Hong-Yu Li, and Bo Li have no conflicts of interest or financial ties to disclose.
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Hao, XY., Shen, YF., Wei, YG. et al. Safety and effectiveness of day-surgery laparoscopic cholecystectomy is still uncertain: meta-analysis of eight randomized controlled trials based on GRADE approach. Surg Endosc 31, 4950–4963 (2017). https://doi.org/10.1007/s00464-017-5610-1
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DOI: https://doi.org/10.1007/s00464-017-5610-1