Laparoscopic versus open cholecystectomy

Norah Ahmed Al Mallohi, Moatez Khalaf Almofarreh, Basil Abdalruhman Alfarrah, Mohammed Basheer Albalbisi, Abdulrahim Mohammed Alamoudi, Mohammed Nasser Sharahili, Hanan Mohammed Alsharif, Rayan Mubarak M. Alomaim, Faris Adnan Mohammed Baawad, Abdulaziz Osama Abukhodair


Background: Laparoscopic cholecystectomy has promptly emerged as a popular alternative to traditional open laparotomy and cholecystectomy. The Objective of the current meta-analysis is to evaluate the effect of Laparoscopic versus open cholecystectomy.

Methods: We conducted this meta-analysis using a comprehensive search of Cochrane database of systematic reviews, PubMed, Medline, EMBASE, and Cochrane central register of controlled trials till 15 March 2018 for studies that evaluated laparoscopic versus open cholecystectomy.

Results: Eleven studies have been included with a total of 80691 patients: 41485 in the laparoscopic and 39206 into the open cholecystectomy groups. Odds ratios were regularly on the side of laparoscopic operation, in terms of respiratory complications (OR=0.32, 95%CI: 0.34-2.64, p<0.0001), mortality (OR=0.19, 95%CI: 0.08-1.05, p<0.0001), and morbidity (OR=0.31, 95%CI: 0.11-0.45, p<0.0001).

Conclusions: Using laparoscopic cholecystectomy decreased morbidity, mortality, and respiratory complications rates. Large-scale and long-term randomized controlled trials in various populations must be carried out in future studies to deliver more significant evidence.


Laparoscopic cholecystectomy, Open cholecystectomy, Surgery, Meta-analysis, Morbidity, Mortality

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Potts JR 3rd. What are the indications for cholecystectomy? Cleve Clin J Med. 1990;57(1):40-7.

Litwin DE, Cahan MA. Laparoscopic cholecystectomy. Surg Clin North Am. 2008;88(6):1295-313.

Lillemoe KD, Lin JW, Talamini MA, Yeo CJ, Snyder DS, Parker SD. Laparoscopic cholecystectomy as a true outpatient procedure: initial experience in 130 consecutive patients. J Gastrointest Surg. 1999;3(1):44-9.

Sultan AM, El Nakeeb A, Elshehawy T, Elhemmaly M, Elhanafy E, Atef E. Risk Factors for Conversion during Laparoscopic Cholecystectomy: Retrospective Analysis of Ten Years' Experience at a Single Tertiary Referral Centre. Dig Surg. 2013;30(1):51-5.

Hunter JG. Acute cholecystitis revisited: get it while it's hot. Ann Surg. 1998;227(4):468-9.

Visser BC, Parks RW, Garden OJ. Open cholecystectomy in the laparoendoscopic era. Am J Surg. 2008;195(1):108-14.

Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2007;6(7):e1000097.

Higgins JP, Thompson SG, Deeks JJ. Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557-60.

Samkoff JS, Wu B. Laparoscopic and open cholecystectomy outcomes in Medicare beneficiaries in member states of the Large State PRO Consortium. Am J Med Qual. 1995;10:183–9.

Eldar S, Sabo E, Nash E, Abrahamson J, Matter I. Laparoscopic versus open cholecystectomy in acute cholecystitis, Surg Laparosc Endosc. 1997;7:407-14.

Kiviluoto T, Sirén J, Luukkonen P, Kivilaakso E. Randomised trial of laparoscopic versus open cholecystectomy for acute and gangrenous cholecystitis. Lancet. 1998;351(9099):321-5.

Tucker JJ, Yanagawa F, Grim R, Bell T, Ahuja V. Laparoscopic cholecystectomy is safe but underused in the elderly. Am Surg. 2011;77:1014–20.

Johansson M, Thune A, Blomqvist A, Nelvin L, Lundell L. Impact of choice of therapeutic strategy for acute cholecystitis on patient's health-related quality of life. Results of a randomized, controlled clinical trial. Dig Surg. 2004;21(5-6):359-62.

Chau CH, Tang CN, Siu WT, Ha JP, Li MK. Laparoscopic cholecystectomy versus open cholecystectomy in elderly patients with acute cholecystitis: retrospective study. Hong Kong Med J. 2002;8:394–9.

Pessaux P, Regenet N, Tuech JJ, Rouge C, Bergamaschi R, Arnaud JP. Laparoscopic versus open cholecystectomy: a prospective comparative study in the elderly with acute cholecystitis. Surg Laparosc Endosc Percutan Tech. 2001;11:252–5.

Huang SM, Wu CW, Lui WY, P’eng FK. A prospective randomised study of laparoscopic v. open cholecystectomy in aged patients with cholecystolithiasis. S Afr J Surg. 1996;34:177–9.

Lucier MR, Lee K. Trends in laparoscopic cholecystectomy in Indiana. Indiana Med. 1995;88:200–4.

Boo YJ, Kim WB, Kim J, Song TJ, Choi SY, Kim YC, et al. Systemic immune response after open versus laparoscopic cholecystectomy in acute cholecystitis: a prospective randomized study. Scand J Clin Lab Invest. 2007;67(2):207-14.

Catena F, Ansaloni L, Bianchi E, Di Saverio S, Coccolini F, Vallicelli C, et al. The ACTIVE (Acute Cholecystitis Trial Invasive Versus Endoscopic) Study: multicenter randomized, double-blind, controlled trial of laparoscopic versus open surgery for acute cholecystitis. Hepatogastroenterology. 2013;60(127):1552-6.

Sandblom G, Videhult P, Crona Guterstam Y, Svenner A, Sadr-Azodi O. Mortality after a cholecystectomy: a population-based study. HPB : Official J International Hepato Pancreato Biliary Assoc. 2015;17(3):239-43.

McMahon AJ, Fischbacher CM, Frame SH, MacLeod MC. Impact of laparoscopic cholecystectomy: a population-based study. Lancet. 2000;356(9242):1632-7.

Wang G, Jiang Z, Zhao K, Li G, Liu F, Pan H, et al. Immunologic response after laparoscopic colon cancer operation within an enhanced recovery program. J Gastrointest Surg. 2012;16:1379–88.

Schietroma M, Piccione F, Carlei F, Clementi M, Bianchi Z, de Vita F, et al. Peritonitis from perforated appendicitis: stress response after laparoscopic or open treatment. Am Surg. 2012;78:582–90.

Evers BM, Townsend CM, Thompson JC. Organ physiology of aging. Surg Clin North Am. 1994;74:23–39.

MacFadyen BV Jr, Vecchio R, Ricardo AE, Mathis CR. Bile duct injury after laparoscopic cholecystectomy. The United States experience. Surg Endosc. 1998;12(4):315-21.