Sustavni pregled i meta-analiza randomiziranih studija za usporedbu laparoskopske kolecistektomije kroz jedan rez i standardne laparoskopske kolecistektomije

master's thesis

• Title (english): Single incision versus standard multiport laparoscopic cholecystectomy : up-dated systematic review and meta-analysis of randomized trials
• Author: Mate Milas
• Mentor: VLADIMIR TRKULJA (mentor)
• Committee member: Jelka Petrak (predsjednik povjerenstva)
• Committee member: Tomislav Meštrović (član povjerenstva)
• Committee member: VLADIMIR TRKULJA (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Pharmacology); Zagreb
• Defense date and country: 2014-05-30, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Clinical Pharmacology and Toxicology

Abstract

Cilj: Usporedba klinički relevantnih ishoda u odraslih nakon laparoskopske kolecistektomije
kroz jedan rez (SILC) u odnosu na standardnu multiport tehniku (MLC). ---- Metode: Sustavni pregled i meta-analiza randomiziranih kliničkih pokusa. ---- Rezultati: Identificirano je 30 studija (SILC N=1209, MLC N=1202) većinom umjerene do
niske kvalitete. Trajanje operacije (30 studija): duže u SILC skupini (WMD=12.4 min, 95%
CI=9.3-15.5 min; p<0.001), međutim razlika se smanjuje s iskustvom – u 10 velikih studija
(1321 pacijent) WMD=5,9 min (-1.3, 13.1; p=0.105). Intraoperativni gubitak krvi (12 studija,
1201 pacijent): veći u SILC skupini, ali je razlika praktički beznačajna (WMD=1.29 mL, 95%
CI=0.24-2.35 mL; p=0.017). Stopa konverzije (27 studija, 2277 pacijenata): češća u SILC
skupini (OR=13.9, 95% CI=4.34-44.7; p<0.001), ali općenito rijetka (ukupna incidencija u
SILC skupini 4.39%) i gotovo se isključivo odnosi na dodatni troakar. Jačina postoperativne
boli (29 studija) i duljina boravka u bolnici (22 studije): nema razlike. Komplikacije (30
studija): rijetke (ukupna incidencija u SILC skupini 5.35%) i bez razlike u učestalosti između
SILC i MLC skupina. Incizijska hernija (19 studija, 1676 pacijenata): vrlo mala učestalost
(SILC N=15, MLC N=4), ali statistički značajno veća u SILC skupini (OR=4.94, 95% CI=1.26-
19.4; p=0.025). Zadovoljstvo kozmetskim ishodom (16 studija, 11 s podacima od 1-3
mjeseca): u 5 studija sa nezaslijepljenim pacijentima (N=513) u korist SILC-a (SMD=1.83,
95% CI=0.13-3.52; p=0.037), ali u 6 studija sa zaslijepljenim pacijentima (N=719) razlika je
mala i beznačajna (SMD=0.42, 95% CI=-1.12-1.96; p=0.548). ---- Rasprava: Ishodi SILC-a jako ovise o vještini operatera, ali bez obzira na to, kad se usporedi
sa MLC-om, SILC traje nešto duže, rizik incizijske hernije je veći (ali sveukupno jako nizak)
te je rana kozmetska korist umjerena. ---- Zaključak: Sa stajališta (ne)pogodnosti i sigurnosti, SILC je prihvatljiva alternativa MLC-u sa
umjerenom kozmetskom koristi.

Abstract (english)

Background and purpose: We aimed to compare single incision laparoscopic
cholecystectomy (SILC) to the standard multiport technique (MLC) for clinically relevant
outcomes in adults. ---- Methods: Systematic review and random-effects meta-analysis of randomized trials. ---- Results: We identified 30 trials (SILC N=1209, MLC N=1202) mostly of moderate to low
quality. Operating time (30 trials): longer with SILC (WMD=12.4 min, 95%CI 9.3, 15.5;
p<0.001), but difference reduced with experience – in 10 large trials (1321 patients)
WMD=5.9 (-1.3, 13.1; p=0.105). Intra-operative blood loss (12 trials, 1201 patients): greater
with SILC, but difference practically irrelevant (WMD=1.29 mL, 0.24-2.35; p=0.017).
Procedure failure (27 trials, 2277 patients): more common with SILC (OR=13.9, 4.34-44.7;
p<0.001), but overall infrequent (SILC pooled incidence 4.39%) and almost exclusively
addition of a trocar. Post-operative pain (29 trials) and hospital stay (22 trials): no difference.
Complications (30 trials): infrequent (SILC pooled incidence 5.35%) with no overall SILC vs.
MLC difference. Incisional hernia (19 trials, 1676 patients): very rare (15 vs. 4 cases), but
odds significantly higher with SILC (OR=4.94, 1.26-19.4; p=0.025). Cosmetic satisfaction (16
trials, 11 with data at 1-3 months): in 5 trials with non-blinded patients (N=513) in favour of
SILC (SMD=1.83, 0.13, 3.52; p=0.037), but in 6 trials with blinded patients (N=719)
difference small and insignificant (SMD=0.42, -1.12, 1.96; p=0.548). ---- Discussion: SILC outcomes largely depend on surgeon’s skill, but regardless of it, when
compared to MLC, SILC requires somewhat longer operating time, risk of incisional hernia is
higher (but overall very low) and early cosmetic benefit is modest. ----- Conclusion: From the (in)convenience and safety standpoint, SILC is an acceptable
alternative to MLC with a modest cosmetic benefit.

• Keywords: laparoskopska kolecistektomija; SILC; MLC; meta-analiza
• Keywords (english): laparoscopic cholecystectomy; single incision; multiport; meta-analysis
• Language: croatian
• URN:NBN: urn:nbn:hr:105:439829
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Access restricted to students and staff of home institution
• Created on: 2015-12-16 08:57:50