Transvaginal cholecystectomy vs conventional laparoscopiccholecystectomy for gallbladder disease： A meta-analysis
摘要
AIM To compare the results of transvaginal cholecystectomy（TVC） and conventional laparoscopiccholecystectomy （CLC） for gallbladder disease.METHODS： We performed a literature search ofPubMed, EMBASE, Ovid, Web of Science, CochraneLibrary, Google Scholar, MetaRegister of ControlledTrials, Chinese Medical Journal database and WanfangData for trials comparing outcomes between TVCand CLC. Data were extracted by two authors. Meandifference （MD）, standardized mean difference（SMD）, odds ratios and risk rate with 95%CIs werecalculated using fixed- or random-effects models.Statistical heterogeneity was evaluated with the χ 2test. The fixed-effects model was used in the absenceof statistically significant heterogeneity. The randomeffectsmodel was chosen when heterogeneity wasfound.RESULTS： There were 730 patients in nine controlledclinical trials. No significant difference was foundregarding demographic characteristics （P 〉 0.5）,including anesthetic risk score, age, body mass index,and abdominal surgical history between the TVCand CLC groups. Both groups had similar mortality,morbidity, and return to work after surgery. Patients inthe TVC group had a lower pain score on postoperativeday 1 （SMD： -0.957, 95%CI： -1.488 to -0.426, P 〈0.001）, needed less postoperative analgesic medication（SMD： -0.574, 95%CI： -0.807 to -0.341, P 〈 0.001）and stayed for a shorter time in hospital （MD： -1.004d, 95%CI： -1.779 to 0.228, P = 0.011）, but had longeroperative time （MD： 17.307 min, 95%CI： 6.789 to27.826, P = 0.001）. TVC had no significant influenceon postoperative sexual function and quality of life.Better cosmetic results and satisfaction were achievedin the TVC group.CONCLUSION： TVC is safe and effective for gallbladderdisease. However, vaginal injury might occur, and further trials are needed to compare TVC with CLC.