Comparison Of Laparoscopic Versus Open Hepatectomy For Hepatolithiasis:A Meta-Analysis

Objective:To evaluate the effectiveness and safety of laparoscopic versus open hepatectomy for patients with hepatolithiasis.Methods:A comprehensive search of Pub Med, Embase,CBMdisk,the Cochrane Library, VIP Chinese Scientific Journals database, CNKI and Wanfang data was performed,and by reference to find the related documents, the retrieval time until January 2016.Search more laparoscopic hepatectomy compared with open hepatectomy in the treatment of hepatolithiasis of random or non randomized control study.Newcastle-Ottawa scale was used to evaluate the quality of the included studies.Outcomes evaluated were stone clearance rate, calculi recurrence rateoperation time,intraoperative blood loss, postoperative hospital stay and postoperative complications. The Meta-analysis was conducted with Revman 5.3 software.Results:Thirteen studies were included involving 1255 patients of whom 589 underwent LH and 666 underwent OH. The NOS score of included studies ranged from 5~7,suggesting that their reliability is better.The results of meta-analysis suggested that there were no significant differences in operation time [SMD=0.06,95%CI(-0.56~ 0.67),P=0.86]and intraoperative blood loss[MD=-33.58,95%CI(-93.67~26.50), P=0.27] between LH and OH. Compared with OH, LH had shorter postoperative hospitalization days[MD=-3.30,95%CI(-4.31~-2.29),P<0.00001],and lower postoperative complications[OR=0.56,95%CI(0.41~0.77),P=0.0003].But there wereno differences between the 2 groups in instant calculi clearance rate,the calculi final clearance rate and calculi recurrence rate(all P>0.05).Conclusion:Comparing to OH,LH can reduce the postoperative hospital stay and the incidence of postoperative complications,especially the wound complication,but does not increase the operative time and intraoperative blood loss, and have equivalent clinical effects with similar calculi clearance rate and calculi recurrence rate.Therefore,LH is safe and feasible for the treatment of hepatolithiasis when its indications were grasped.Large sample, high quality, multi center clinical randomized controlled study will be needed to evaluate the efficacy and safety of laparoscopic liver resection in the future.