Meta-Analysis
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 7, 2015; 21(17): 5393-5406
Published online May 7, 2015. doi: 10.3748/wjg.v21.i17.5393
Transvaginal cholecystectomy vs conventional laparoscopic cholecystectomy for gallbladder disease: A meta-analysis
Bin Xu, Bo Xu, Wen-Yan Zheng, Hai-Yan Ge, Li-Wei Wang, Zhen-Sun Song, Bin He
Bin Xu, Zhen-Sun Song, Department of Hepato-Biliary-Pancreatic Surgery, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai 200072, China
Bo Xu, Bin He, Department of Anesthesiology and SICU, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
Wen-Yan Zheng, Department of Surgical Intensive Care Unit, Zhongshan Hospital, Fudan University, Shanghai 200232, China
Hai-Yan Ge, Department of Gastrointestinal Surgery, East Hospital of Shanghai, Tongji University School of Medicine, Shanghai 200120, China
Li-Wei Wang, Department of Medical Informatics, School of Public Health, Jilin University, Changchun 130021, Jilin Province, China
Author contributions: Xu B and Xu B contributed equally to this work; Xu B, Xu B and He B designed the research; Ge HY, Wang LW and Song ZS performed the research; Xu B, Zheng WY checked the data analysis and reviewed the article; Xu B, Xu B and He B wrote the paper.
Supported by National Natural Science Foundation of China, No. 81001007, No. 81100826, and No. 81270003; Fudan University Youth Fund (2012); and the Scientific Research Foundation for the Returned Overseas Chinese Scholars, Chinese Ministry of Education.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Bin He, MD, PhD, Department of Anesthesiology and SICU, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, No. 1665 Kongjiang Road, Shanghai 200092, China. hebinicu@139.com
Telephone: +86-21-25078999
Received: August 20, 2014
Peer-review started: August 21, 2014
First decision: October 29, 2014
Revised: November 29, 2014
Accepted: January 5, 2015
Article in press: January 5, 2015
Published online: May 7, 2015
Abstract

AIM: To compare the results of transvaginal cholecystectomy (TVC) and conventional laparoscopic cholecystectomy (CLC) for gallbladder disease.

METHODS: We performed a literature search of PubMed, EMBASE, Ovid, Web of Science, Cochrane Library, Google Scholar, MetaRegister of Controlled Trials, Chinese Medical Journal database and Wanfang Data for trials comparing outcomes between TVC and CLC. Data were extracted by two authors. Mean difference (MD), standardized mean difference (SMD), odds ratios and risk rate with 95%CIs were calculated using fixed- or random-effects models. Statistical heterogeneity was evaluated with the χ2 test. The fixed-effects model was used in the absence of statistically significant heterogeneity. The random-effects model was chosen when heterogeneity was found.

RESULTS: There were 730 patients in nine controlled clinical trials. No significant difference was found regarding demographic characteristics (P > 0.5), including anesthetic risk score, age, body mass index, and abdominal surgical history between the TVC and CLC groups. Both groups had similar mortality, morbidity, and return to work after surgery. Patients in the TVC group had a lower pain score on postoperative day 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: -1.004 d, 95%CI: -1.779 to 0.228, P = 0.011), but had longer operative time (MD: 17.307 min, 95%CI: 6.789 to 27.826, P = 0.001). TVC had no significant influence on postoperative sexual function and quality of life. Better cosmetic results and satisfaction were achieved in the TVC group.

CONCLUSION: TVC is safe and effective for gallbladder disease. However, vaginal injury might occur, and further trials are needed to compare TVC with CLC.

Keywords: Transvaginal cholecystectomy, Conventional laparoscopic cholecystectomy, Natural orifice, Endoscopic surgery, Meta-analyses

Core tip: Transvaginal cholecystectomy (TVC) is a new surgical method for gallbladder disease. We compared TVC and conventional laparoscopic cholecystectomy for gallbladder disease. Patients in the TVC group had a lower pain score on postoperative day 1, needed less postoperative analgesic medication, stayed in hospital for a shorter time, but had longer operative time. TVC had no significant influence on postoperative sexual function and quality of life. Better cosmetic results and satisfaction were achieved in the TVC group. TVC is safe and effective for gallbladder disease.