Cirrhosis and cholelithiasis. Laparoscopic or open cholecystectomy?

Aims This meta-analysis aimed to define the perioperative risk of mortality in patients with alcoholic liver disease (ALD) undergoing extrahepatic gastrointestinal surgery. Methods Systematic searches of Embase, Medline and CENTRAL were undertaken to identify studies reporting about patients with ALD undergoing extrahepatic gastrointestinal surgery published since database inception to January 2019. Studies were only considered if they reported on mortality as an outcome. Pooled analysis of mortality was stratified as benign and malignant surgery and specific operative procedures where feasible. Results Of the 2899 studies identified, only five studies met inclusion criteria, representing cholecystectomy (one study), umbilical hernia repair surgery (one study) and oesophagectomy (three studies). The total number of patients with ALD in these studies was 172. Therefore, any study on liver disease patients undergoing extrahepatic surgery that crucially included a subset with alcohol aetiology was included as a secondary analysis even though they failed to stratify mortality by underlying aetiology. The total number of studies that met this expanded inclusion criteria was 62, reporting on 37,703 patients with liver disease of which 1735 (4.5%) had a definite diagnosis of ALD. Meta-analysis of proportions of in-hospital mortality in patients with ALD undergoing upper gastrointestinal cancer surgery (oesophagectomy) was 23% [95% confidence interval (CI) 14–35%, I2 = 0%]. In-hospital mortality following oesophagectomy in liver disease patients of all aetiologies was lower, 14% (95% CI 9–21%, I2 = 41.1%). Conclusion Postoperative in-hospital mortality is high in patients with liver disease and ALD in particular. However, the currently available evidence on ALD is limited and precludes definitive conclusions on postoperative mortality risk.

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Mortality After Extrahepatic Gastrointestinal and Abdominal Wall Surgery in Patients With Alcoholic Liver Disease: A Systematic Review and Meta-Analysis

Adiamah

Ban

Hammond

et al. 2020

Alcohol and Alcoholism

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A NOTES-ról és az általa létrehívott egyéb minimálisan invazív sebészeti technikákról (hibrid NOTES, NOTUS, SPS, SILS), valamint a sebészeti szemléletre gyakorolt hatásukrólr

Lukovich

Kempler

2009

MaSeb

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A new surgical technique--called Natural Orifice Translumenal Endoscopic Surgery (NOTES)--evolved in 2004. Although numerous problems arose regarding this method--and most of them are unresolved yet--several new articles about the human application have been published. In order to find solutions of a certain extent, new techniques have been developed (hybrid NOTES, NOTUS, SPS, SLIS, etc). Although these could not eliminate difficulties completely, they do provide some solutions in many cases. It is very important for the surgeon of modern days to be familiar with these techniques and analyze them in a critically. Application of these methods requires a review of principles of surgery and flexible endoscopy. Although in many cases these are considered axioms, there data exist in literature of different management principles, as well. It is fundamental that critically review of the basic questions of NOTES (which natural orifice is the best, how to close the viscerotomy, how to avoid infection, who should carry out the NOTES surgery) is carried out in relation of the complications of the original 'gold standard' methods (e.g. frequency of infection or hernia after laparoscopy). Based on human data there is minimal postoperative pain after the NOTES procedure, and patients in general will leave the hospital on the same day. Is such a short postoperative stay enough and can we entirely dismiss drainage after cholecystectomy? Results of the human procedures are adequate to draw further conclusions regarding the new technique. Retrospective analysis of problems occurring during the evolution of laparoscopy can make it possible to avoid mistakes that can be made in the development of NOTES.

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Cirrhosis and cholelithiasis. Laparoscopic or open cholecystectomy?

Cited by 2 publications

References 21 publications

Mortality After Extrahepatic Gastrointestinal and Abdominal Wall Surgery in Patients With Alcoholic Liver Disease: A Systematic Review and Meta-Analysis

Mortality After Extrahepatic Gastrointestinal and Abdominal Wall Surgery in Patients With Alcoholic Liver Disease: A Systematic Review and Meta-Analysis

A NOTES-ról és az általa létrehívott egyéb minimálisan invazív sebészeti technikákról (hibrid NOTES, NOTUS, SPS, SILS), valamint a sebészeti szemléletre gyakorolt hatásukrólr

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