Comparing The Safety Of LSC And LC In The Treatment Of Complicated Cholecystitis:a Meta-analysis

Objective:Through meta analysis,including previous related studies,a comparative study was conducted on the safety of laparoscopic subtotal cholecystectomy(LSC)and laparoscopic cholecystectomy(LC),aiming to provide a reference for a more scientific and reasonable choice of surgical methods in the face of complex cholecystitis in clinical practice.Methods:The documents with the time from the establishment of the database to 2022 are retrieved by computer.The retrieved databases are CNKI,VIP,Wanfang,PubMed,The Cochrane Library,and Embase databases,and the last retrieval time was September 4,2022.According to the standards of the inclusion and exclusion,the literatures about the safety of laparoscopic subtotal cholecystectomy and laparoscopic cholecystectomy in the treatment of complex cholecystitis were searched.The mode of combining subject words with free words was adopted to search the literatures.The quality of the selected literatures was evaluated by using the NOS literature quality evaluation scale,and then the meta-analysis of the included literatures was carried out by using the Review Manager 5.3 and the StataMP 17.The observation indicators included operation time,hospital stay,intraoperative blood loss,postoperative abdominal drainage volume,postoperative drainage time,conversion rate to laparotomy,surgical incision infection rate,postoperative bile leakage rate,bile duct injury rate,and total incidence of surgical complications.Results:A total of 589 articles were retrieved from the database,including 461 Chinese articles and 128 English articles.After screening,23 articles were included in the final study,including 22 Chinese articles and 1 English article,with a total of 2251 patients.The results showed that the operation time of the LSC group was shorter than that of the LC group,and the difference was statistically significant(MD=-18.53,95%CI:-23.56～-13.49;P<0.01).The length of hospital stay was shorter in the LSC group,and the difference was statistically significant(MD=-2.14,95%CI:-3.35～-0.93;P<0.01).The amount of intraoperative blood loss in the LC group was more than that in the LSC group,and the difference was statistically significant(MD=-22.40,95%CI:-30.42～-14.37;P<0.01).The LSC group had less postoperative abdominal drainage,and the difference was statistically significant(MD=-30.81,95%CI:-52.67～-8.94;P<0.01).There was no significant difference in postoperative abdominal drainage tube indwelling time between the two groups(MD=-0.10,95%CI:-0.51～-0.32;P>0.01).Postoperative incision infection was more likely to occur in the LC group,and the difference was statistically significant(OR=0.28,95%CI:0.17～0.46;P<0.01).Compared with the LSC group,the rate of conversion to laparotomy in the LC group was higher,and the difference was statistically significant(OR=0.16,95%CI:0.08～0.35;P<0.01).There was no significant difference in the incidence of postoperative bile leakage between the LSC group and the LC group(OR=0.31,95%CI:0.12～0.86;P>0.01).Bile duct injury was more likely to occur in the LC group,and the difference was statistically significant(OR=0.17,95%CI:0.09～0.34;P<0.01).Compared with the LSC group,the total incidence of surgical complications in the LC group was higher,and the difference was statistically significant(OR=0.12,95%CI:0.07～0.22;P<0.01).Conclusions:For complex cholecystitis,laparoscopic subtotal cholecystectomy is safe for patients,with less risk of complications and greater economic benefits.However,due to the high heterogeneity of some research results of this study,more research is still needed in the future.