Perbandingan Efektivitas dan Keamanan Early dengan Delayed Kolesistektomi Laparoskopik untuk Kolesistitis Akut: Systematic Review dan Meta-Analisis dari 18 RCT

Abstrak

Pendahuluan. Secara teoritis, pada tata laksana kolesistitis akut, kolesistektomi laparoskopik lebih menguntungkan dibandingkan kolesistektomi konvensional. Namun, masih terdapat perdebatan mengenai perbedaan efektivitas dan keamanan antara early laparoscopic cholecystectomy (ELC) dengan delayed laparoscopic cholecystectomy (DLC). Metode: Meta-analisis evidence based dibuat pada November 2019 untuk menilai dan membandingkan efektivitas dan keamanan dari keduanya, menggunakan artikel di PubMed, Science Direct, Cochrane Library, ClinicalTrial.gov, dan Research Gate. Prosedur meta-analisis sesuai diagram dan alur PRISMA guideline, dilakukan dan diolah dengan program RevMan V.5.3. Hasil: Total 1.010 kasus ELC dan 1.072 kasus DLC dari 18 penelitian. Didapatkan perbedaan yang signifikan pada total lama perawatan di rumah sakit (MD 3,27 hari; 95% CI –4,32 hingga –2,23; p < 0,00001). Tidak didapatkan perbedaan signifikan pada durasi operasi (MD 8,36 menit; 95 % CI –0,15 hingga 16,88; p = 0,05) dan konversi menjadi operasi terbuka (RR 0,97; 95% CI 0,77 hingga 1,22; p = 0,80). Untuk komplikasi kebocoran bilier (OR 1,23; 95% CI 0,71 hingga 2,14; p = 0,46), perforasi kandung empedu (OR 1,14; 95% CI 0,64 hingga 2,06; p = 0,65), dan infeksi luka pasca-operasi (OR 0,99; 95% CI 0,60 hingga 1,63; p = 0,96) tidak didapatkan perbedaan signifikan. Hanya injuri duktus bilier yang memiliki perbedaan signifikan (OR 0,34; 95% CI 0,15 hingga 0,78; p = 0,01) Simpulan: Untuk tata laksana kolesistitis akut, ELC memiliki efektivitas dan keamanan lebih baik dibandingkan DLC ditinjau dari total lama perawatan di rumah sakit dan injuri duktus bilier.   Introduction: Theoretically, in the management of acute cholecystitis, laparoscopic cholecystectomy has advantages compared to conventional cholecystectomy. However, there is still discussion on the appropriate timing of laparascopic cholecystectomy. Meta-analysis was made on the effectiveness and safety of early laparoscopic cholecystectomy (ELC) compared to delayed laparoscopic cholecystectomy (DLC). Method: A systematic review and meta-analysis was conducted in November 2019 from PubMed, Science Direct, Cochrane Library, ClinicalTrial.gov, and Research Gate to compare the effectiveness and safety of both treatments. The meta-analysis procedure was in accordance with the PRISMA flow and diagram guidelines, and processed with the RevMan V.5.3 program. Results: A total of 1010 ELC cases and 1072 DLC cases from 18 studies were included. Significant difference was found in total duration of hospital stay (MD –3.27 days, 95% CI –4.32 to –2.23, p <0.00001). No significant difference was found for operation time (MD 8.36 minutes, 95% CI –0.15 to 16.88, p = 0.05) and conversion to open surgery (RR 0.97, 95% CI 0.77 to 1.22, p = 0.80). No significant difference was found for complications such as bile leakage (OR 1.23, 95% CI 0.71 to 2.14, p = 0.46), gallbladder perforation (OR 1.14, 95% CI 0.64 to 2.06, p = 0.65), and wound infection (OR 0.99, 95 % CI 0.60 to 1.63, p = 0.96). The only significant difference was found in bile duct injury complication (OR 0.34, 95% CI 0.15 to 0.78, p = 0.01). Conclusion: In the management of acute cholecystitis, ELC has better effectiveness and safety compared to DLC in terms of total hospital stay and bile duct injury.