Ravendran Kapilraj, Elmoraly Ahmed, Kagiosi Eirini, Henry Casey S, Joseph Jenisa M, Kam Chloe
General Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, GBR.
Medicine, Gradscape, London, GBR.
Cureus. 2024 Jul 16;16(7):e64694. doi: 10.7759/cureus.64694. eCollection 2024 Jul.
Cholecystectomy is the standard treatment for symptomatic cholelithiasis and asymptomatic impending biliary obstruction, which is typically carried out laparoscopically. However, difficult gallbladders, due to distorted anatomy or increased risk of bleeding, can necessitate conversion to open surgery. This systematic review evaluates the advantages, disadvantages, complications, and outcomes of laparoscopic versus converted open cholecystectomy. We screened articles published from 2011 to 2024 by utilizing advanced filters of PubMed, Cochrane, and Scholar databases. Exclusion criteria included non-English language articles, duplicates, and animal studies. After analyzing relevant articles, 31 articles were included in this study. The total number of participants who underwent laparoscopic procedures was 28,054, of which 5,847 were converted from laparoscopic to open procedures. Conversions were primarily due to bleeding, adhesions, and obscured anatomy, with bile leakage being the most common short-term complication. Converted cases showed higher rates of long-term complications, increased hospital stays, and higher morbidity and mortality. Laparoscopic cholecystectomy remains safe and effective, but identifying high-risk patients for conversion is important. Preoperative identification of high-risk patients and recognizing predictive factors for conversion can enhance surgical outcomes and cost-effectiveness. While laparoscopic cholecystectomy is generally preferred, timely conversion to open surgery is essential for patient safety.
胆囊切除术是有症状胆结石和无症状即将发生胆道梗阻的标准治疗方法，通常通过腹腔镜进行。然而，由于解剖结构扭曲或出血风险增加，困难胆囊可能需要转为开放手术。本系统评价评估了腹腔镜胆囊切除术与转为开放胆囊切除术的优缺点、并发症及结局。我们利用PubMed、Cochrane和Scholar数据库的高级筛选器筛选了2011年至2024年发表的文章。排除标准包括非英语文章、重复文章和动物研究。在分析相关文章后，本研究纳入了31篇文章。接受腹腔镜手术的参与者总数为28,054人，其中5,847人从腹腔镜手术转为开放手术。转为开放手术主要是由于出血、粘连和解剖结构不清，胆漏是最常见的短期并发症。转为开放手术的病例显示长期并发症发生率更高、住院时间延长、发病率和死亡率更高。腹腔镜胆囊切除术仍然安全有效，但识别需要转为开放手术的高危患者很重要。术前识别高危患者并认识转为开放手术的预测因素可以提高手术效果和成本效益。虽然一般首选腹腔镜胆囊切除术，但为了患者安全，及时转为开放手术至关重要。
