The Efficacy and Safety of Different Kinds of Laparoscopic Cholecystectomy: A Network Meta Analysis of 43 Randomized Controlled Trials

<div><p>Background and Objective</p><p>We conducted a network meta analysis (NMA) to compare different kinds of laparoscopic cholecystectomy [LC] (single port [SPLC], two ports [2PLC], three ports [3PLC], and four ports laparoscopic cholecystectomy [4PLC], and four ports mini-laparoscopic cholecystectomy [mini-4PLC]).</p><p>Methods</p><p>PubMed, the Cochrane library, EMBASE, and ISI Web of Knowledge were searched to find randomized controlled trials [RCTs]. Direct pair-wise meta analysis (DMA), indirect treatment comparison meta analysis (ITC) and NMA were conducted to compare different kinds of LC.</p><p>Results</p><p>We included 43 RCTs. The risk of bias of included studies was high. DMA showed that SPLC was associated with more postoperative complications, longer operative time, and higher cosmetic score than 4PLC, longer operative time and higher cosmetic score than 3PLC, more postoperative complications than mini-4PLC. Mini-4PLC was associated with longer operative time than 4PLC. ITC showed that 3PLC was associated with shorter operative time than mini-4PLC, and lower postoperative pain level than 2PLC. 2PLC was associated with fewer postoperative complications and longer hospital stay than SPLC. NMA showed that SPLC was associated with more postoperative complications than mini-4PLC, and longer operative time than 4PLC.</p><p>Conclusion</p><p>The rank probability plot suggested 4PLC might be the worst due to the highest level of postoperative pain, longest hospital stay, and lowest level of cosmetic score. The best one might be mini-4PLC because of highest level of cosmetic score, and fewest postoperative complications, or SPLC because of lowest level of postoperative pain and shortest hospital stay. But more studies are needed to determine which will be better between mini-4PLC and SPLC.</p></div

Meta analysis for hospital stay and operative time.

<p>d: DMA, direct pair-wise meta analysis; i: ITC, indirect treatment comparison meta analysis; i(4): indirect treatment comparison meta analysis via 4PLC; i(1): indirect treatment comparison meta analysis via SPLC; i(p): pooled results of indirect treatment comparison meta analysis.</p><p># MD [95%CI]; & MD [95%CrI]; *:0.35 (–0.25 0.94)i(4); –0.31 (–0.81 0.19)i(1); **:0.47 (–0.23 1.19)i(4); –0.31 (–0.81 0.19)i(1); ***:4.89 (1.47 8.30)i(4); 17.97(8.58 27.36)i(1).</p

The flow chart.

<p>The flow chart.</p

Rank probability.

<p>Rank probability.</p

Characteristics of included studies.

<p>I: intervention group; C: control group; F: female; M: male.</p

Meta analysis for postoperative complications and cosmetic score.

<p>d: DMA, direct pair-wise meta analysis; i: ITC, indirect treatment comparison meta analysis; i(4): indirect treatment comparison meta analysis via 4PLC; i(1): indirect treatment comparison meta analysis via SPLC; i(p): pooled results of indirect treatment comparison meta analysis.</p><p># MD [95%CI]; & MD [95%CrI]; $: RR [95%CI]; @: RR [95%CrI];*: 0.20 (0.01 6.75)i(4); 0.07 (0.001 7.87)i(1).</p

Quality assessment results.

<p>M: mentioned; U: unclear; N: no; D: blinded to data collectors; P: blinded to patient; S: blinded to surgeon; Y: yes, adequately reported.</p

Fecal microbiota transplantation in patients with slow-transit constipation: A randomized, clinical trial

<div><p>Fecal microbiota transplantation has been proposed as a therapeutic approach for chronic constipation. This randomized, controlled trial aimed to compare the effects of conventional treatment alone (control) with additional treatment with FMT (intervention) in patients with slow-transit constipation (STC). Adults with STC were randomized to receive intervention or control treatment. The control group received education, behavioral strategies, and oral laxatives. The intervention group was additionally provided 6 days of FMT. The primary endpoint was the clinical cure rate (proportion of patients achieving a mean of ≥ three complete spontaneous bowel movements [CSBMs] per week]. Secondary outcomes and safety parameters were assessed throughout the study. Sixty patients were randomized to either conventional treatment alone (n = 30) or FMT (n = 30) through a nasointestinal tube. There were significant differences between the intervention group and control group in the clinical improvement rate (intention-to-treat [ITT]: 53.3% vs. 20.0%, <i>P</i> = 0.009), clinical cure rate (ITT: 36.7% vs. 13.3%, <i>P</i> = 0.04), mean number of CSBMs per week (ITT: 3.2 ± 1.4 vs. 2.1 ± 1.2, <i>P</i> = 0.001), and the Wexner constipation score (ITT: 8.6 ± 1.5 vs. 12.7 ± 2.5, <i>P</i> < 0.00001). Compared with the control group, the intervention group showed better results in the stool consistency score (ITT: 3.9 vs. 2.4, <i>P</i> < 0.00001) and colonic transit time (ITT: 58.5 vs. 73.6 h, <i>P</i> < 0.00001). The intervention group had more treatment-related adverse events than did the control group (50 vs. 4 cases). FMT was significantly more effective (30% higher cure rate) for treatment of STC than conventional treatment. No serious adverse events were observed.</p></div

CONSORT flow diagram.

<p>CONSORT flow diagram.</p

Treatment efficacy during the 12-week observation period: Control vs. FMT groups (intention-to-treat [ITT] and per-protocol [PP] analysis).

<p>Treatment efficacy during the 12-week observation period: Control vs. FMT groups (intention-to-treat [ITT] and per-protocol [PP] analysis).</p