Postoperative pulmonary function in open versus laparoscopic cholecystectomy: a meta-analysis of the Tiffenau index

BACKGROUND: Available scientific literature about open cholecystectomy (OC) and laparoscopic cholecystectomy (LC) does not show univocal results in terms of postoperative pulmonary function. A meta-analysis was carried out to evaluate the postoperative pulmonary function after OC and LC focusing on the Tiffenau index. METHODS: Electronic databases were consulted (Cochrane Library, Embase and Pubmed). Standardized mean difference (SMD) with 95% CI was calculated for the Tiffenau Index. The kappa test was performed to evaluate agreement between the reviewers regarding the quality of the selected studies. A sensitivity analysis was carried out to assess the robustness of our study. Heterogeneity among studies was tested by using a chi(2) test at 0.05 significance level. A random effects model meta-analysis was performed. RESULTS: Meta-analysis of the 13 articles included, resulted in a SMD of 53% (95% CI 0.04, 1.02) for the Tiffenau Index in favor of laparoscopic cholecystectomy. The chi(2) test analysis showed the presence of heterogeneity among studies (Tiffenau index chi(2) = 99.97, p = 0.03). The sensitivity analysis confirms the validity of our results. CONCLUSIONS: Postoperative pulmonary function is better preserved after laparoscopic cholecystectomy than open cholecystectomy.