Effectiveness of Laparoscopic Surgery for Gallstones and Common Bile Duct Lithiasis: a Systematic Overview Efectividad de la Cirug赤a Laparosc車pica para Colecistolitiasis y Coledocolitiasis: Revisi車n Global de la Evidencia

作者：Carlos Manterola; Viviana Pineda; Montserrat Tort; Eduardo Targarona

来源：International Journal of Morphology, 2010.

• Colelitiasis
• Colecistolitiasis
• Coledocolitiasis
• Calculos biliares
• Laparoscopia
• Colecistectomia laparoscopica
• Evaluacion de tecnologia sanitaria
• Cholecystolithiasis
• Choledocholithiasis
• Cholelithiasis
• Gallstones
• Laparoscopy
• Cholecystectomy
• Laparoscopic
• Technology Assessment
• Biomedical

The aim of the present study was to evaluate the available evidence on the effectiveness of laparoscopic surgery for treating gallstones and common bile duct lithiasis (CBDL). A systematic overview was performed. Medline, EMBASE and The Cochrane Library were searched (1998-2008). Systematic reviews (SR), clinical practice guidelines (CPG), randomised clinical trials (RCT) and observational studies were included. Internal validity and overall quality of the evidence were assessed. The available evidence was classified according to the Oxford Centre for Evidence Based Medicine proposal. 87 studies were included in this review (12 SR, 23 RCT, 3 CPG, 13 cohort studies, 3 cross-sectional studies, 2 case and control studies and 31 case series). Compared with open cholecystectomy, laparoscopic cholecystectomy (LC) is associated with shorter operating time, shorter hospital stay and better quality of life (high quality evidence). The use of antibiotic prophylaxis does not appear to reduce the infection rate in low-risk patients (high quality evidence). Although many techniques have been advocated to perform LC their effectiveness is as yet inconclusive (low-quality evidence). Two-stage surgery is the most appropriate strategy for high-risk patients with CBDL (high-quality evidence). Mortality is similar to open surgery, as the effectiveness is similar to that of endoscopic treatment (high-quality evidence). As a conclusion we can state that the evidence concerning the effectiveness of laparoscopic surgery for gallstones and CBDL is scarce and of low methodological quality and that better quality studies are warranted to assess these techniques more adequately. El objetivo del presente estudio fue evaluar la evidencia disponible respecto de la efectividad de la cirug赤a laparosc車pica en el tratamiento de la colelitiasis y la litiasis de la v赤a biliar (LVBP). Para ello, se realiz車 una revisi車n global de la evidencia disponible. Se realizaron b迆squedas en las bases de datos MEDLINE, EMBASE y The Cochrane Library (1998-2008). Se incluyeron gu赤as de pr芍ctica cl赤nica (GPC), revisiones sistem芍ticas (RS), ensayos cl赤nicos con asignaci車n aleatoria (EC) y estudios observacionales. Se valor車 la validez interna y la calidad global de los estudios. Los datos disponibles y la evidencia generada se clasificaron en base a la propuesta del Centro de Oxford de Medicina Basada en la Evidencia. 87 estudios fueron incluidos en esta revisi車n (3 GPC, 12 RS, 23 EC, 13 estudios de cohortes, 3 estudios transversales, 2 estudios de casos y de controles y 31 series de casos). En comparaci車n