Review: Laparoscopic versus small-incision cholecystectomy for patients with symptomatic cholecystolithiasis Comparison: 2 LC versus SIC - high-quality and low-quality trials regarding allocation concealment Outcome: 4 Severe complications (without bile duct injuries)
Study or subgroup Laparoscopic (LC) Small-incision (SIC) Risk
Difference Weight Risk
Difference
n/N n/N
M-H,Random,95%
CI
M-H,Random,95%
CI 1 High-quality trials
Bruce 1999 0/11 0/11 1.9 % 0.0 [ -0.16, 0.16 ]
Grande 2002 0/18 0/22 4.6 % 0.0 [ -0.09, 0.09 ]
Keus 2006 6/120 1/137 11.3 % 0.04 [ 0.00, 0.08 ]
Majeed 1996 3/100 2/100 11.0 % 0.01 [ -0.03, 0.05 ]
McGinn 1995 8/155 0/155 12.3 % 0.05 [ 0.01, 0.09 ]
McMahon 1994 4/151 12/148 9.6 % -0.05 [ -0.11, 0.00 ]
Ros 2001 18/362 31/362 12.3 % -0.04 [ -0.07, 0.00 ]
Srivastava 2001 0/59 0/40 11.5 % 0.0 [ -0.04, 0.04 ]
Subtotal (95% CI) 976 975 74.4 % 0.00 [ -0.03, 0.03 ]
Total events: 39 (Laparoscopic (LC)), 46 (Small-incision (SIC)) Heterogeneity: Tau2= 0.00; Chi2= 21.76, df = 7 (P = 0.003); I2=68%
Test for overall effect: Z = 0.20 (P = 0.84) 2 Low-quality trials
Barkun 1992 1/37 0/25 5.6 % 0.03 [ -0.05, 0.11 ]
Coelho 1993 0/15 0/15 3.1 % 0.0 [ -0.12, 0.12 ]
Kunz 1992 2/50 1/50 7.2 % 0.02 [ -0.05, 0.09 ]
Secco 2002 4/86 1/86 9.7 % 0.03 [ -0.02, 0.08 ]
Subtotal (95% CI) 188 176 25.6 % 0.03 [ -0.01, 0.06 ]
Total events: 7 (Laparoscopic (LC)), 2 (Small-incision (SIC)) Heterogeneity: Tau2= 0.0; Chi2= 0.33, df = 3 (P = 0.95); I2=0.0%
Test for overall effect: Z = 1.52 (P = 0.13)
Total (95% CI) 1164 1151 100.0 % 0.01 [ -0.01, 0.03 ]
Total events: 46 (Laparoscopic (LC)), 48 (Small-incision (SIC)) Heterogeneity: Tau2= 0.00; Chi2= 23.23, df = 11 (P = 0.02); I2=53%
Test for overall effect: Z = 0.76 (P = 0.45)
-0.5 -0.25 0 0.25 0.5
Favours LC Favours SIC
Analysis 2.5. Comparison 2 LC versus SIC - high-quality and low-quality trials regarding allocation concealment, Outcome 5 Bile duct injuries.
Review: Laparoscopic versus small-incision cholecystectomy for patients with symptomatic cholecystolithiasis Comparison: 2 LC versus SIC - high-quality and low-quality trials regarding allocation concealment Outcome: 5 Bile duct injuries
Study or subgroup Laparoscopic (LC) Small-incision (SIC) Risk
Difference Weight Risk
Difference
n/N n/N M-H,Fixed,95% CI M-H,Fixed,95% CI
1 High-quality trials
Bruce 1999 0/11 0/11 1.0 % 0.0 [ -0.16, 0.16 ]
Grande 2002 0/18 0/22 1.7 % 0.0 [ -0.09, 0.09 ]
Keus 2006 1/120 3/137 11.1 % -0.01 [ -0.04, 0.02 ]
Majeed 1996 1/100 0/100 8.7 % 0.01 [ -0.02, 0.04 ]
McGinn 1995 1/155 2/155 13.4 % -0.01 [ -0.03, 0.02 ]
McMahon 1994 4/151 3/148 13.0 % 0.01 [ -0.03, 0.04 ]
Ros 2001 6/362 7/362 31.4 % 0.00 [ -0.02, 0.02 ]
Srivastava 2001 1/59 5/40 4.1 % -0.11 [ -0.22, 0.00 ]
Subtotal (95% CI) 976 975 84.3 % -0.01 [ -0.02, 0.01 ]
Total events: 14 (Laparoscopic (LC)), 20 (Small-incision (SIC)) Heterogeneity: Chi2= 5.89, df = 7 (P = 0.55); I2=0.0%
Test for overall effect: Z = 1.14 (P = 0.25) 2 Low-quality trials
Barkun 1992 0/37 1/25 2.6 % -0.04 [ -0.14, 0.06 ]
Coelho 1993 0/15 0/15 1.3 % 0.0 [ -0.12, 0.12 ]
Kunz 1992 0/50 1/50 4.3 % -0.02 [ -0.07, 0.03 ]
Secco 2002 0/86 0/86 7.5 % 0.0 [ -0.02, 0.02 ]
Subtotal (95% CI) 188 176 15.7 % -0.01 [ -0.04, 0.01 ]
Total events: 0 (Laparoscopic (LC)), 2 (Small-incision (SIC)) Heterogeneity: Chi2= 1.56, df = 3 (P = 0.67); I2=0.0%
Test for overall effect: Z = 0.88 (P = 0.38)
Total (95% CI) 1164 1151 100.0 % -0.01 [ -0.02, 0.00 ]
Total events: 14 (Laparoscopic (LC)), 22 (Small-incision (SIC)) Heterogeneity: Chi2= 7.22, df = 11 (P = 0.78); I2=0.0%
Test for overall effect: Z = 1.39 (P = 0.16)
-0.5 -0.25 0 0.25 0.5
Favours LC Favours SIC
Analysis 2.6. Comparison 2 LC versus SIC - high-quality and low-quality trials regarding allocation concealment, Outcome 6 Total complications.
Review: Laparoscopic versus small-incision cholecystectomy for patients with symptomatic cholecystolithiasis Comparison: 2 LC versus SIC - high-quality and low-quality trials regarding allocation concealment Outcome: 6 Total complications
Study or subgroup Laparoscopic (LC) Small-incision (SIC) Risk
Difference Weight Risk
Difference
n/N n/N
M-H,Random,95%
CI
M-H,Random,95%
CI 1 High-quality trials
Bruce 1999 0/11 0/11 6.3 % 0.0 [ -0.16, 0.16 ]
Grande 2002 0/18 0/22 8.9 % 0.0 [ -0.09, 0.09 ]
Keus 2006 21/120 16/137 9.2 % 0.06 [ -0.03, 0.14 ]
Majeed 1996 13/100 14/100 8.8 % -0.01 [ -0.10, 0.08 ]
McGinn 1995 14/155 4/155 10.5 % 0.06 [ 0.01, 0.12 ]
McMahon 1994 27/151 34/148 9.0 % -0.05 [ -0.14, 0.04 ]
Ros 2001 211/362 159/362 9.8 % 0.14 [ 0.07, 0.22 ]
Srivastava 2001 1/59 17/40 6.4 % -0.41 [ -0.56, -0.25 ]
Subtotal (95% CI) 976 975 68.8 % -0.01 [ -0.09, 0.07 ]
Total events: 287 (Laparoscopic (LC)), 244 (Small-incision (SIC)) Heterogeneity: Tau2= 0.01; Chi2= 46.43, df = 7 (P<0.00001); I2=85%
Test for overall effect: Z = 0.27 (P = 0.79) 2 Low-quality trials
Barkun 1992 1/37 2/25 7.8 % -0.05 [ -0.17, 0.07 ]
Coelho 1993 0/15 1/15 6.0 % -0.07 [ -0.23, 0.10 ]
Kunz 1992 2/50 2/50 9.6 % 0.0 [ -0.08, 0.08 ]
Secco 2002 20/86 15/86 7.8 % 0.06 [ -0.06, 0.18 ]
Subtotal (95% CI) 188 176 31.2 % -0.01 [ -0.06, 0.05 ]
Total events: 23 (Laparoscopic (LC)), 20 (Small-incision (SIC)) Heterogeneity: Tau2= 0.0; Chi2= 2.75, df = 3 (P = 0.43); I2=0.0%
Test for overall effect: Z = 0.23 (P = 0.82)
Total (95% CI) 1164 1151 100.0 % -0.01 [ -0.07, 0.05 ]
Total events: 310 (Laparoscopic (LC)), 264 (Small-incision (SIC)) Heterogeneity: Tau2= 0.01; Chi2= 50.92, df = 11 (P<0.00001); I2=78%
Test for overall effect: Z = 0.29 (P = 0.77)
-0.5 -0.25 0 0.25 0.5
Favours LC Favours SIC
Analysis 2.7. Comparison 2 LC versus SIC - high-quality and low-quality trials regarding allocation concealment, Outcome 7 Conversions.
Review: Laparoscopic versus small-incision cholecystectomy for patients with symptomatic cholecystolithiasis Comparison: 2 LC versus SIC - high-quality and low-quality trials regarding allocation concealment Outcome: 7 Conversions
Study or subgroup Laparoscopic (LC) Small-Incision (SIC) Risk
Difference Weight Risk
Difference
n/N n/N
M-H,Random,95%
CI
M-H,Random,95%
CI 1 High-quality trials
Keus 2006 14/120 22/137 11.2 % -0.04 [ -0.13, 0.04 ]
Majeed 1996 20/100 22/100 8.4 % -0.02 [ -0.13, 0.09 ]
McGinn 1995 20/155 6/155 14.0 % 0.09 [ 0.03, 0.15 ]
McMahon 1994 15/151 14/148 13.2 % 0.00 [ -0.06, 0.07 ]
Ros 2001 69/362 101/362 13.9 % -0.09 [ -0.15, -0.03 ]
Srivastava 2001 0/59 1/40 13.9 % -0.03 [ -0.09, 0.04 ]
Subtotal (95% CI) 947 942 74.7 % -0.01 [ -0.07, 0.04 ]
Total events: 138 (Laparoscopic (LC)), 166 (Small-Incision (SIC)) Heterogeneity: Tau2= 0.00; Chi2= 19.25, df = 5 (P = 0.002); I2=74%
Test for overall effect: Z = 0.43 (P = 0.67) 2 Low-quality trials
Barkun 1992 1/37 0/25 11.5 % 0.03 [ -0.05, 0.11 ]
Secco 2002 5/91 4/90 13.7 % 0.01 [ -0.05, 0.07 ]
Subtotal (95% CI) 128 115 25.3 % 0.02 [ -0.03, 0.07 ]
Total events: 6 (Laparoscopic (LC)), 4 (Small-Incision (SIC)) Heterogeneity: Tau2= 0.0; Chi2= 0.11, df = 1 (P = 0.75); I2=0.0%
Test for overall effect: Z = 0.66 (P = 0.51)
Total (95% CI) 1075 1057 100.0 % 0.00 [ -0.05, 0.04 ]
Total events: 144 (Laparoscopic (LC)), 170 (Small-Incision (SIC)) Heterogeneity: Tau2= 0.00; Chi2= 21.07, df = 7 (P = 0.004); I2=67%
Test for overall effect: Z = 0.20 (P = 0.84)
-0.5 -0.25 0 0.25 0.5
Favours LC Favours SIC
Analysis 2.8. Comparison 2 LC versus SIC - high-quality and low-quality trials regarding allocation concealment, Outcome 8 Operative time (minutes).
Review: Laparoscopic versus small-incision cholecystectomy for patients with symptomatic cholecystolithiasis Comparison: 2 LC versus SIC - high-quality and low-quality trials regarding allocation concealment Outcome: 8 Operative time (minutes)
Study or subgroup Laparoscopic (LC) Small-incision (SIC) Mean
Difference Weight Mean
Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
1 High-quality trials
Grande 2002 18 42.95 (24) 22 32 (8) 9.8 % 10.95 [ -0.63, 22.53 ]
Keus 2006 120 71.85 (25.83) 137 60.41 (18.29) 12.2 % 11.44 [ 5.90, 16.98 ]
Majeed 1996 100 69.2 (24.6) 100 45.4 (19.8) 11.9 % 23.80 [ 17.61, 29.99 ]
McMahon 1994 151 71 (20) 148 57 (24) 12.3 % 14.00 [ 8.99, 19.01 ]
Ros 2001 362 108 (45) 362 94 (45) 11.8 % 14.00 [ 7.44, 20.56 ]
Srivastava 2001 59 54.2 (20.93) 40 57.2 (17.85) 11.4 % -3.00 [ -10.69, 4.69 ]
Subtotal (95% CI) 810 809 69.4 % 12.13 [ 5.60, 18.65 ]
Heterogeneity: Tau2= 53.26; Chi2= 29.00, df = 5 (P = 0.00002); I2=83%
Test for overall effect: Z = 3.64 (P = 0.00027) 2 Low-quality trials
Barkun 1992 37 85.9 (32) 25 73.1 (24.5) 8.7 % 12.80 [ -1.29, 26.89 ]
Kunz 1992 50 102 (35) 50 102 (32) 9.1 % 0.0 [ -13.14, 13.14 ]
Secco 2002 86 35.7 (11.2) 86 37.6 (5.7) 12.9 % -1.90 [ -4.56, 0.76 ]
Subtotal (95% CI) 173 161 30.6 % 1.55 [ -6.30, 9.41 ]
Heterogeneity: Tau2= 26.41; Chi2= 4.08, df = 2 (P = 0.13); I2=51%
Test for overall effect: Z = 0.39 (P = 0.70)
Total (95% CI) 983 970 100.0 % 9.20 [ 2.06, 16.35 ]
Heterogeneity: Tau2= 101.35; Chi2= 92.52, df = 8 (P<0.00001); I2=91%
Test for overall effect: Z = 2.52 (P = 0.012)
-100 -50 0 50 100
Favours LC Favours SIC
Analysis 2.9. Comparison 2 LC versus SIC - high-quality and low-quality trials regarding allocation concealment, Outcome 9 Hospital stay (days).
Review: Laparoscopic versus small-incision cholecystectomy for patients with symptomatic cholecystolithiasis Comparison: 2 LC versus SIC - high-quality and low-quality trials regarding allocation concealment Outcome: 9 Hospital stay (days)
Study or subgroup Laparoscopic (LC) Small-incision (SIC) Mean
Difference Weight Mean
Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
1 High-quality trials
Grande 2002 18 3.18 (1.07) 22 5.2 (1.1) 13.8 % -2.02 [ -2.69, -1.35 ]
Keus 2006 120 2.38 (4.58) 137 3.08 (12.37) 4.1 % -0.70 [ -2.93, 1.53 ]
Majeed 1996 100 3.6 (2.3) 100 3.5 (2.1) 14.4 % 0.10 [ -0.51, 0.71 ]
Ros 2001 362 2.6 (3.3) 362 3.2 (5.1) 14.3 % -0.60 [ -1.23, 0.03 ]
Srivastava 2001 59 1.2 (1.33) 40 1.62 (1.25) 15.3 % -0.42 [ -0.94, 0.10 ]
Subtotal (95% CI) 659 661 61.8 % -0.72 [ -1.48, 0.04 ]
Heterogeneity: Tau2= 0.56; Chi2= 22.42, df = 4 (P = 0.00017); I2=82%
Test for overall effect: Z = 1.85 (P = 0.064) 2 Low-quality trials
Kunz 1992 50 3.8 (2.3) 50 5.6 (3.1) 10.1 % -1.80 [ -2.87, -0.73 ]
Secco 2002 86 3.6 (1.3) 86 4 (1) 16.8 % -0.40 [ -0.75, -0.05 ]
Tate 1993 11 1.45 (0.69) 11 2.82 (1.4) 11.4 % -1.37 [ -2.29, -0.45 ]
Subtotal (95% CI) 147 147 38.2 % -1.09 [ -2.01, -0.16 ]
Heterogeneity: Tau2= 0.50; Chi2= 8.76, df = 2 (P = 0.01); I2=77%
Test for overall effect: Z = 2.30 (P = 0.021)
Total (95% CI) 806 808 100.0 % -0.85 [ -1.35, -0.34 ]
Heterogeneity: Tau2= 0.37; Chi2= 31.18, df = 7 (P = 0.00006); I2=78%
Test for overall effect: Z = 3.26 (P = 0.0011)
-4 -2 0 2 4
Favours LC Favours SIC
Analysis 2.10. Comparison 2 LC versus SIC - high-quality and low-quality trials regarding allocation concealment, Outcome 10 Convalescence: work leave (days).
Review: Laparoscopic versus small-incision cholecystectomy for patients with symptomatic cholecystolithiasis Comparison: 2 LC versus SIC - high-quality and low-quality trials regarding allocation concealment Outcome: 10 Convalescence: work leave (days)
Study or subgroup Laparoscopic (LC) Small-incision (SIC) Mean
Difference Weight Mean
Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
1 High-quality trials
Keus 2006 120 25.48 (18.41) 137 24.71 (13.44) 30.9 % 0.77 [ -3.22, 4.76 ]
Majeed 1996 100 35 (18.2) 100 32.2 (17.5) 26.4 % 2.80 [ -2.15, 7.75 ]
Ros 2001 362 12.7 (10.3) 362 16 (9.9) 42.6 % -3.30 [ -4.77, -1.83 ]
Subtotal (95% CI) 582 599 100.0 % -0.43 [ -4.37, 3.51 ]
Heterogeneity: Tau2= 8.91; Chi2= 8.10, df = 2 (P = 0.02); I2=75%
Test for overall effect: Z = 0.21 (P = 0.83) 2 Low-quality trials
Subtotal (95% CI) 0 0 Not estimable
Heterogeneity: not applicable Test for overall effect: not applicable
Total (95% CI) 582 599 100.0 % -0.43 [ -4.37, 3.51 ]
Heterogeneity: Tau2= 8.91; Chi2= 8.10, df = 2 (P = 0.02); I2=75%
Test for overall effect: Z = 0.21 (P = 0.83)
-10 -5 0 5 10
Favours LC Favours SIC
Analysis 2.11. Comparison 2 LC versus SIC - high-quality and low-quality trials regarding allocation concealment, Outcome 11 Convalescence: normal activity (at home) (days).
Review: Laparoscopic versus small-incision cholecystectomy for patients with symptomatic cholecystolithiasis Comparison: 2 LC versus SIC - high-quality and low-quality trials regarding allocation concealment Outcome: 11 Convalescence: normal activity (at home) (days)
Study or subgroup Laparoscopic (LC) Small-incision (SIC) Mean
Difference Weight Mean
Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
1 High-quality trials
Majeed 1996 100 30.1 (26.6) 100 25.2 (13.3) 16.3 % 4.90 [ -0.93, 10.73 ]
Ros 2001 362 8.6 (7.7) 362 10.7 (7.2) 38.4 % -2.10 [ -3.19, -1.01 ]
Subtotal (95% CI) 462 462 54.7 % 0.79 [ -5.96, 7.55 ]
Heterogeneity: Tau2= 19.92; Chi2= 5.35, df = 1 (P = 0.02); I2=81%
Test for overall effect: Z = 0.23 (P = 0.82) 2 Low-quality trials
Barkun 1992 37 11.9 (9.1) 25 20.2 (16.5) 12.6 % -8.30 [ -15.40, -1.20 ]
Secco 2002 86 12.2 (7) 86 16.6 (8.5) 32.7 % -4.40 [ -6.73, -2.07 ]
Subtotal (95% CI) 123 111 45.3 % -4.85 [ -7.28, -2.41 ]
Heterogeneity: Tau2= 0.34; Chi2= 1.05, df = 1 (P = 0.31); I2=4%
Test for overall effect: Z = 3.90 (P = 0.000096)
Total (95% CI) 585 573 100.0 % -2.50 [ -5.54, 0.55 ]
Heterogeneity: Tau2= 5.96; Chi2= 11.81, df = 3 (P = 0.01); I2=75%
Test for overall effect: Z = 1.61 (P = 0.11)
-10 -5 0 5 10
Favours LC Favours SIC
Analysis 3.1. Comparison 3 LC versus SIC - high-quality and low-quality trials regarding blinding, Outcome 1 Mortality.
Review: Laparoscopic versus small-incision cholecystectomy for patients with symptomatic cholecystolithiasis Comparison: 3 LC versus SIC - high-quality and low-quality trials regarding blinding
Outcome: 1 Mortality
Study or subgroup Laparoscopic (LC) Small-incision (SIC) Risk
Difference Weight Risk
Difference
n/N n/N M-H,Fixed,95% CI M-H,Fixed,95% CI
1 High-quality trials
Keus 2006 0/120 0/137 13.1 % 0.0 [ -0.02, 0.02 ]
Majeed 1996 0/100 0/100 10.3 % 0.0 [ -0.02, 0.02 ]
Ros 2001 0/362 0/362 37.2 % 0.0 [ -0.01, 0.01 ]
Subtotal (95% CI) 582 599 60.6 % 0.0 [ -0.01, 0.01 ]
Total events: 0 (Laparoscopic (LC)), 0 (Small-incision (SIC)) Heterogeneity: Chi2= 0.0, df = 2 (P = 1.00); I2=0.0%
Test for overall effect: Z = 0.0 (P = 1.0) 2 Low-quality trials
Barkun 1992 0/37 0/25 3.1 % 0.0 [ -0.06, 0.06 ]
Kunz 1992 0/50 0/50 5.1 % 0.0 [ -0.04, 0.04 ]
McGinn 1995 1/155 0/155 15.9 % 0.01 [ -0.01, 0.02 ]
McMahon 1994 0/151 1/148 15.3 % -0.01 [ -0.03, 0.01 ]
Subtotal (95% CI) 393 378 39.4 % 0.00 [ -0.01, 0.01 ]
Total events: 1 (Laparoscopic (LC)), 1 (Small-incision (SIC)) Heterogeneity: Chi2= 1.03, df = 3 (P = 0.79); I2=0.0%
Test for overall effect: Z = 0.00 (P = 1.0)
Total (95% CI) 975 977 100.0 % 0.00 [ -0.01, 0.01 ]
Total events: 1 (Laparoscopic (LC)), 1 (Small-incision (SIC)) Heterogeneity: Chi2= 1.03, df = 6 (P = 0.98); I2=0.0%
Test for overall effect: Z = 0.00 (P = 1.0)
-0.5 -0.25 0 0.25 0.5
Favours LC Favours SIC
Analysis 3.2. Comparison 3 LC versus SIC - high-quality and low-quality trials regarding blinding, Outcome 2 Intra-operative complications.
Review: Laparoscopic versus small-incision cholecystectomy for patients with symptomatic cholecystolithiasis Comparison: 3 LC versus SIC - high-quality and low-quality trials regarding blinding
Outcome: 2 Intra-operative complications
Study or subgroup Laparoscopic (LC) Small-incision (SIC) Risk
Difference Weight Risk
Difference
n/N n/N
M-H,Random,95%
CI
M-H,Random,95%
CI 1 High-quality trials
Keus 2006 4/120 2/137 9.5 % 0.02 [ -0.02, 0.06 ]
Majeed 1996 1/100 0/100 9.9 % 0.01 [ -0.02, 0.04 ]
Ros 2001 148/362 85/362 8.1 % 0.17 [ 0.11, 0.24 ]
Subtotal (95% CI) 582 599 27.4 % 0.07 [ -0.08, 0.21 ]
Total events: 153 (Laparoscopic (LC)), 87 (Small-incision (SIC)) Heterogeneity: Tau2= 0.02; Chi2= 81.12, df = 2 (P<0.00001); I2=98%
Test for overall effect: Z = 0.87 (P = 0.39) 2 Low-quality trials
Barkun 1992 0/37 0/25 8.2 % 0.0 [ -0.06, 0.06 ]
Bruce 1999 0/11 0/11 4.0 % 0.0 [ -0.16, 0.16 ]
Coelho 1993 0/15 0/15 5.4 % 0.0 [ -0.12, 0.12 ]
Grande 2002 0/18 0/22 6.7 % 0.0 [ -0.09, 0.09 ]
Kunz 1992 0/50 0/50 9.5 % 0.0 [ -0.04, 0.04 ]
McGinn 1995 0/155 0/155 10.2 % 0.0 [ -0.01, 0.01 ]
McMahon 1994 0/151 0/148 10.2 % 0.0 [ -0.01, 0.01 ]
Secco 2002 0/86 0/86 10.0 % 0.0 [ -0.02, 0.02 ]
Srivastava 2001 0/59 1/40 8.3 % -0.03 [ -0.09, 0.04 ]
Subtotal (95% CI) 582 552 72.6 % 0.00 [ -0.01, 0.01 ]
Total events: 0 (Laparoscopic (LC)), 1 (Small-incision (SIC)) Heterogeneity: Tau2= 0.0; Chi2= 0.79, df = 8 (P = 1.00); I2=0.0%
Test for overall effect: Z = 0.10 (P = 0.92)
Total (95% CI) 1164 1151 100.0 % 0.01 [ -0.03, 0.06 ]
Total events: 153 (Laparoscopic (LC)), 88 (Small-incision (SIC)) Heterogeneity: Tau2= 0.00; Chi2= 222.50, df = 11 (P<0.00001); I2=95%
Test for overall effect: Z = 0.71 (P = 0.48)
-0.5 -0.25 0 0.25 0.5
Favours LC Favours SIC
Analysis 3.3. Comparison 3 LC versus SIC - high-quality and low-quality trials regarding blinding, Outcome 3 Minor complications.
Review: Laparoscopic versus small-incision cholecystectomy for patients with symptomatic cholecystolithiasis Comparison: 3 LC versus SIC - high-quality and low-quality trials regarding blinding
Outcome: 3 Minor complications
Study or subgroup Laparoscopic (LC) Small-incision (SIC) Risk
Difference Weight Risk
Difference
n/N n/N
M-H,Random,95%
CI
M-H,Random,95%
CI 1 High-quality trials
Keus 2006 10/120 10/137 10.1 % 0.01 [ -0.06, 0.08 ]
Majeed 1996 8/100 12/100 7.6 % -0.04 [ -0.12, 0.04 ]
Ros 2001 39/362 36/362 14.5 % 0.01 [ -0.04, 0.05 ]
Subtotal (95% CI) 582 599 32.1 % 0.00 [ -0.03, 0.03 ]
Total events: 57 (Laparoscopic (LC)), 58 (Small-incision (SIC)) Heterogeneity: Tau2= 0.0; Chi2= 1.12, df = 2 (P = 0.57); I2=0.0%
Test for overall effect: Z = 0.05 (P = 0.96) 2 Low-quality trials
Barkun 1992 0/37 1/25 6.1 % -0.04 [ -0.14, 0.06 ]
Bruce 1999 0/11 0/11 2.7 % 0.0 [ -0.16, 0.16 ]
Coelho 1993 0/15 1/15 2.5 % -0.07 [ -0.23, 0.10 ]
Grande 2002 0/18 0/22 6.4 % 0.0 [ -0.09, 0.09 ]
Kunz 1992 0/50 0/50 16.0 % 0.0 [ -0.04, 0.04 ]
McGinn 1995 5/155 2/155 17.3 % 0.02 [ -0.01, 0.05 ]
McMahon 1994 19/151 19/148 8.6 % 0.00 [ -0.08, 0.07 ]
Secco 2002 16/86 14/86 4.8 % 0.02 [ -0.09, 0.14 ]
Srivastava 2001 0/59 11/40 3.4 % -0.28 [ -0.41, -0.14 ]
Subtotal (95% CI) 582 552 67.9 % -0.02 [ -0.06, 0.02 ]
Total events: 40 (Laparoscopic (LC)), 48 (Small-incision (SIC)) Heterogeneity: Tau2= 0.00; Chi2= 20.50, df = 8 (P = 0.01); I2=61%
Test for overall effect: Z = 0.93 (P = 0.35)
Total (95% CI) 1164 1151 100.0 % -0.01 [ -0.04, 0.02 ]
Total events: 97 (Laparoscopic (LC)), 106 (Small-incision (SIC)) Heterogeneity: Tau2= 0.00; Chi2= 19.72, df = 11 (P = 0.05); I2=44%
Test for overall effect: Z = 0.71 (P = 0.48)
-0.5 -0.25 0 0.25 0.5
Favours LC Favours SIC
Analysis 3.4. Comparison 3 LC versus SIC - high-quality and low-quality trials regarding blinding, Outcome 4 Severe complications (without bile duct injuries).
Review: Laparoscopic versus small-incision cholecystectomy for patients with symptomatic cholecystolithiasis Comparison: 3 LC versus SIC - high-quality and low-quality trials regarding blinding
Outcome: 4 Severe complications (without bile duct injuries)
Study or subgroup Laparoscopic (LC) Small-incision (SIC) Risk
Difference Weight Risk
Difference
n/N n/N
M-H,Random,95%
CI
M-H,Random,95%
CI 1 High-quality trials
Keus 2006 6/120 1/137 11.3 % 0.04 [ 0.00, 0.08 ]
Majeed 1996 3/100 2/100 11.0 % 0.01 [ -0.03, 0.05 ]
Ros 2001 18/362 31/362 12.3 % -0.04 [ -0.07, 0.00 ]
Subtotal (95% CI) 582 599 34.6 % 0.00 [ -0.04, 0.05 ]
Total events: 27 (Laparoscopic (LC)), 34 (Small-incision (SIC)) Heterogeneity: Tau2= 0.00; Chi2= 9.14, df = 2 (P = 0.01); I2=78%
Test for overall effect: Z = 0.19 (P = 0.85) 2 Low-quality trials
Barkun 1992 1/37 0/25 5.6 % 0.03 [ -0.05, 0.11 ]
Bruce 1999 0/11 0/11 1.9 % 0.0 [ -0.16, 0.16 ]
Coelho 1993 0/15 0/15 3.1 % 0.0 [ -0.12, 0.12 ]
Grande 2002 0/18 0/22 4.6 % 0.0 [ -0.09, 0.09 ]
Kunz 1992 2/50 1/50 7.2 % 0.02 [ -0.05, 0.09 ]
McGinn 1995 8/155 0/155 12.3 % 0.05 [ 0.01, 0.09 ]
McMahon 1994 4/151 12/148 9.6 % -0.05 [ -0.11, 0.00 ]
Secco 2002 4/86 1/86 9.7 % 0.03 [ -0.02, 0.08 ]
Srivastava 2001 0/59 0/40 11.5 % 0.0 [ -0.04, 0.04 ]
Subtotal (95% CI) 582 552 65.4 % 0.01 [ -0.01, 0.04 ]
Total events: 19 (Laparoscopic (LC)), 14 (Small-incision (SIC)) Heterogeneity: Tau2= 0.00; Chi2= 12.85, df = 8 (P = 0.12); I2=38%
Test for overall effect: Z = 0.87 (P = 0.38)
Total (95% CI) 1164 1151 100.0 % 0.01 [ -0.01, 0.03 ]
Total events: 46 (Laparoscopic (LC)), 48 (Small-incision (SIC)) Heterogeneity: Tau2= 0.00; Chi2= 23.23, df = 11 (P = 0.02); I2=53%
Test for overall effect: Z = 0.76 (P = 0.45)
-0.5 -0.25 0 0.25 0.5
Favours LC Favours SIC
Analysis 3.5. Comparison 3 LC versus SIC - high-quality and low-quality trials regarding blinding, Outcome 5 Bile duct injuries.
Review: Laparoscopic versus small-incision cholecystectomy for patients with symptomatic cholecystolithiasis Comparison: 3 LC versus SIC - high-quality and low-quality trials regarding blinding
Outcome: 5 Bile duct injuries
Study or subgroup Laparoscopic (LC) Small-incision (SIC) Risk
Difference Weight Risk
Difference
n/N n/N M-H,Fixed,95% CI M-H,Fixed,95% CI
1 High-quality trials
Keus 2006 1/120 3/137 11.1 % -0.01 [ -0.04, 0.02 ]
Majeed 1996 1/100 0/100 8.7 % 0.01 [ -0.02, 0.04 ]
Ros 2001 6/362 7/362 31.4 % 0.00 [ -0.02, 0.02 ]
Subtotal (95% CI) 582 599 51.1 % 0.00 [ -0.02, 0.01 ]
Total events: 8 (Laparoscopic (LC)), 10 (Small-incision (SIC)) Heterogeneity: Chi2= 1.37, df = 2 (P = 0.51); I2=0.0%
Test for overall effect: Z = 0.40 (P = 0.69) 2 Low-quality trials
Barkun 1992 0/37 1/25 2.6 % -0.04 [ -0.14, 0.06 ]
Bruce 1999 0/11 0/11 1.0 % 0.0 [ -0.16, 0.16 ]
Coelho 1993 0/15 0/15 1.3 % 0.0 [ -0.12, 0.12 ]
Grande 2002 0/18 0/22 1.7 % 0.0 [ -0.09, 0.09 ]
Kunz 1992 0/50 1/50 4.3 % -0.02 [ -0.07, 0.03 ]
McGinn 1995 1/155 2/155 13.4 % -0.01 [ -0.03, 0.02 ]
McMahon 1994 4/151 3/148 13.0 % 0.01 [ -0.03, 0.04 ]
Secco 2002 0/86 0/86 7.5 % 0.0 [ -0.02, 0.02 ]
Srivastava 2001 1/59 5/40 4.1 % -0.11 [ -0.22, 0.00 ]
Subtotal (95% CI) 582 552 48.9 % -0.01 [ -0.03, 0.00 ]
Total events: 6 (Laparoscopic (LC)), 12 (Small-incision (SIC)) Heterogeneity: Chi2= 6.40, df = 8 (P = 0.60); I2=0.0%
Test for overall effect: Z = 1.49 (P = 0.14)
Total (95% CI) 1164 1151 100.0 % -0.01 [ -0.02, 0.00 ]
Total events: 14 (Laparoscopic (LC)), 22 (Small-incision (SIC)) Heterogeneity: Chi2= 7.22, df = 11 (P = 0.78); I2=0.0%
Test for overall effect: Z = 1.39 (P = 0.16)
-0.5 -0.25 0 0.25 0.5
Favours LC Favours SIC
Analysis 3.6. Comparison 3 LC versus SIC - high-quality and low-quality trials regarding blinding, Outcome 6 Total complications.
Review: Laparoscopic versus small-incision cholecystectomy for patients with symptomatic cholecystolithiasis Comparison: 3 LC versus SIC - high-quality and low-quality trials regarding blinding
Outcome: 6 Total complications
Study or subgroup Laparoscopic (LC) Small-incision (SIC) Risk
Difference Weight Risk
Difference
n/N n/N
M-H,Random,95%
CI
M-H,Random,95%
CI 1 High-quality trials
Keus 2006 21/120 16/137 9.2 % 0.06 [ -0.03, 0.14 ]
Majeed 1996 13/100 14/100 8.8 % -0.01 [ -0.10, 0.08 ]
Ros 2001 211/362 159/362 9.8 % 0.14 [ 0.07, 0.22 ]
Subtotal (95% CI) 582 599 27.8 % 0.07 [ -0.03, 0.16 ]
Total events: 245 (Laparoscopic (LC)), 189 (Small-incision (SIC)) Heterogeneity: Tau2= 0.00; Chi2= 7.42, df = 2 (P = 0.02); I2=73%
Test for overall effect: Z = 1.42 (P = 0.16) 2 Low-quality trials
Barkun 1992 1/37 2/25 7.8 % -0.05 [ -0.17, 0.07 ]
Bruce 1999 0/11 0/11 6.3 % 0.0 [ -0.16, 0.16 ]
Coelho 1993 0/15 1/15 6.0 % -0.07 [ -0.23, 0.10 ]
Grande 2002 0/18 0/22 8.9 % 0.0 [ -0.09, 0.09 ]
Kunz 1992 2/50 2/50 9.6 % 0.0 [ -0.08, 0.08 ]
McGinn 1995 14/155 4/155 10.5 % 0.06 [ 0.01, 0.12 ]
McMahon 1994 27/151 34/148 9.0 % -0.05 [ -0.14, 0.04 ]
Secco 2002 20/86 15/86 7.8 % 0.06 [ -0.06, 0.18 ]
Srivastava 2001 1/59 17/40 6.4 % -0.41 [ -0.56, -0.25 ]
Subtotal (95% CI) 582 552 72.2 % -0.04 [ -0.11, 0.03 ]
Total events: 65 (Laparoscopic (LC)), 75 (Small-incision (SIC)) Heterogeneity: Tau2= 0.01; Chi2= 38.11, df = 8 (P<0.00001); I2=79%
Test for overall effect: Z = 1.04 (P = 0.30)
Total (95% CI) 1164 1151 100.0 % -0.01 [ -0.07, 0.05 ]
Total events: 310 (Laparoscopic (LC)), 264 (Small-incision (SIC)) Heterogeneity: Tau2= 0.01; Chi2= 50.92, df = 11 (P<0.00001); I2=78%
Test for overall effect: Z = 0.29 (P = 0.77)
-0.5 -0.25 0 0.25 0.5
Favours LC Favours SIC
Analysis 3.8. Comparison 3 LC versus SIC - high-quality and low-quality trials regarding blinding, Outcome 8 Operative time (minutes).
Review: Laparoscopic versus small-incision cholecystectomy for patients with symptomatic cholecystolithiasis Comparison: 3 LC versus SIC - high-quality and low-quality trials regarding blinding
Outcome: 8 Operative time (minutes)
Study or subgroup Laparoscopic (LC) Small-incision (SIC) Mean
Difference Weight Mean
Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
1 High-quality trials
Keus 2006 120 71.85 (25.83) 137 60.41 (18.29) 12.2 % 11.44 [ 5.90, 16.98 ]
Majeed 1996 100 69.2 (24.6) 100 45.4 (19.8) 11.9 % 23.80 [ 17.61, 29.99 ]
Ros 2001 362 108 (45) 362 94 (45) 11.8 % 14.00 [ 7.44, 20.56 ]
Subtotal (95% CI) 582 599 35.9 % 16.36 [ 8.88, 23.83 ]
Heterogeneity: Tau2= 33.97; Chi2= 9.05, df = 2 (P = 0.01); I2=78%
Test for overall effect: Z = 4.29 (P = 0.000018) 2 Low-quality trials
Barkun 1992 37 85.9 (32) 25 73.1 (24.5) 8.7 % 12.80 [ -1.29, 26.89 ]
Grande 2002 18 42.95 (24) 22 32 (8) 9.8 % 10.95 [ -0.63, 22.53 ]
Kunz 1992 50 102 (35) 50 102 (32) 9.1 % 0.0 [ -13.14, 13.14 ]
McMahon 1994 151 71 (20) 148 57 (24) 12.3 % 14.00 [ 8.99, 19.01 ]
Secco 2002 86 35.7 (11.2) 86 37.6 (5.7) 12.9 % -1.90 [ -4.56, 0.76 ]
Srivastava 2001 59 54.2 (20.93) 40 57.2 (17.85) 11.4 % -3.00 [ -10.69, 4.69 ]
Subtotal (95% CI) 401 371 64.1 % 5.09 [ -2.66, 12.83 ]
Heterogeneity: Tau2= 71.42; Chi2= 36.52, df = 5 (P<0.00001); I2=86%
Test for overall effect: Z = 1.29 (P = 0.20)
Total (95% CI) 983 970 100.0 % 9.20 [ 2.06, 16.35 ]
Heterogeneity: Tau2= 101.35; Chi2= 92.52, df = 8 (P<0.00001); I2=91%
Test for overall effect: Z = 2.52 (P = 0.012)
-100 -50 0 50 100
Favours LC Favours SIC
Analysis 3.9. Comparison 3 LC versus SIC - high-quality and low-quality trials regarding blinding, Outcome 9 Hospital stay (days).
Review: Laparoscopic versus small-incision cholecystectomy for patients with symptomatic cholecystolithiasis Comparison: 3 LC versus SIC - high-quality and low-quality trials regarding blinding
Outcome: 9 Hospital stay (days)
Study or subgroup Laparoscopic (LC) Small-incision (SIC) Mean
Difference Weight Mean
Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
1 High-quality trials
Keus 2006 120 2.38 (4.58) 137 3.08 (12.37) 4.1 % -0.70 [ -2.93, 1.53 ]
Majeed 1996 100 3.6 (2.3) 100 3.5 (2.1) 14.4 % 0.10 [ -0.51, 0.71 ]
Ros 2001 362 2.6 (3.3) 362 3.2 (5.1) 14.3 % -0.60 [ -1.23, 0.03 ]
Tate 1993 11 1.45 (0.69) 11 2.82 (1.4) 11.4 % -1.37 [ -2.29, -0.45 ]
Subtotal (95% CI) 593 610 44.1 % -0.56 [ -1.24, 0.11 ]
Heterogeneity: Tau2= 0.25; Chi2= 7.21, df = 3 (P = 0.07); I2=58%
Test for overall effect: Z = 1.63 (P = 0.10) 2 Low-quality trials
Grande 2002 18 3.18 (1.07) 22 5.2 (1.1) 13.8 % -2.02 [ -2.69, -1.35 ]
Kunz 1992 50 3.8 (2.3) 50 5.6 (3.1) 10.1 % -1.80 [ -2.87, -0.73 ]
Secco 2002 86 3.6 (1.3) 86 4 (1) 16.8 % -0.40 [ -0.75, -0.05 ]
Srivastava 2001 59 1.2 (1.33) 40 1.62 (1.25) 15.3 % -0.42 [ -0.94, 0.10 ]
Subtotal (95% CI) 213 198 55.9 % -1.08 [ -1.88, -0.28 ]
Heterogeneity: Tau2= 0.55; Chi2= 22.74, df = 3 (P = 0.00005); I2=87%
Test for overall effect: Z = 2.65 (P = 0.0081)
Total (95% CI) 806 808 100.0 % -0.85 [ -1.35, -0.34 ]
Heterogeneity: Tau2= 0.37; Chi2= 31.18, df = 7 (P = 0.00006); I2=78%
Test for overall effect: Z = 3.26 (P = 0.0011)
-4 -2 0 2 4
Favours LC Favours SIC
Analysis 3.10. Comparison 3 LC versus SIC - high-quality and low-quality trials regarding blinding, Outcome 10 Convalescence: work leave (days).
Review: Laparoscopic versus small-incision cholecystectomy for patients with symptomatic cholecystolithiasis Comparison: 3 LC versus SIC - high-quality and low-quality trials regarding blinding
Outcome: 10 Convalescence: work leave (days)
Study or subgroup Laparoscopic (LC) Small-incision (SIC) Mean
Difference Weight Mean
Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
1 High-quality trials
Keus 2006 120 25.48 (18.41) 137 24.71 (13.44) 30.9 % 0.77 [ -3.22, 4.76 ]
Majeed 1996 100 35 (18.2) 100 32.2 (17.5) 26.4 % 2.80 [ -2.15, 7.75 ]
Ros 2001 362 12.7 (10.3) 362 16 (9.9) 42.6 % -3.30 [ -4.77, -1.83 ]
Subtotal (95% CI) 582 599 100.0 % -0.43 [ -4.37, 3.51 ]
Heterogeneity: Tau2= 8.91; Chi2= 8.10, df = 2 (P = 0.02); I2=75%
Test for overall effect: Z = 0.21 (P = 0.83) 2 Low-quality trials
Subtotal (95% CI) 0 0 Not estimable
Heterogeneity: not applicable Test for overall effect: not applicable
Total (95% CI) 582 599 100.0 % -0.43 [ -4.37, 3.51 ]
Heterogeneity: Tau2= 8.91; Chi2= 8.10, df = 2 (P = 0.02); I2=75%
Test for overall effect: Z = 0.21 (P = 0.83)
-10 -5 0 5 10
Favours LC Favours SIC
Analysis 3.11. Comparison 3 LC versus SIC - high-quality and low-quality trials regarding blinding, Outcome 11 Convalescence: normal activity (at home) (days).
Review: Laparoscopic versus small-incision cholecystectomy for patients with symptomatic cholecystolithiasis Comparison: 3 LC versus SIC - high-quality and low-quality trials regarding blinding
Outcome: 11 Convalescence: normal activity (at home) (days)
Study or subgroup Laparoscopic (LC) Small-incision (SIC) Mean
Difference Weight Mean
Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
1 High-quality trials
Majeed 1996 100 30.1 (26.6) 100 25.2 (13.3) 16.3 % 4.90 [ -0.93, 10.73 ]
Ros 2001 362 8.6 (7.7) 362 10.7 (7.2) 38.4 % -2.10 [ -3.19, -1.01 ]
Subtotal (95% CI) 462 462 54.7 % 0.79 [ -5.96, 7.55 ]
Heterogeneity: Tau2= 19.92; Chi2= 5.35, df = 1 (P = 0.02); I2=81%
Test for overall effect: Z = 0.23 (P = 0.82) 2 Low-quality trials
Barkun 1992 37 11.9 (9.1) 25 20.2 (16.5) 12.6 % -8.30 [ -15.40, -1.20 ]
Secco 2002 86 12.2 (7) 86 16.6 (8.5) 32.7 % -4.40 [ -6.73, -2.07 ]
Subtotal (95% CI) 123 111 45.3 % -4.85 [ -7.28, -2.41 ]
Heterogeneity: Tau2= 0.34; Chi2= 1.05, df = 1 (P = 0.31); I2=4%
Test for overall effect: Z = 3.90 (P = 0.000096)
Total (95% CI) 585 573 100.0 % -2.50 [ -5.54, 0.55 ]
Heterogeneity: Tau2= 5.96; Chi2= 11.81, df = 3 (P = 0.01); I2=75%
Test for overall effect: Z = 1.61 (P = 0.11)
-10 -5 0 5 10
Favours LC Favours SIC
Analysis 4.1. Comparison 4 LC versus SIC - high-quality and low-quality trials regarding follow-up, Outcome 1 Mortality.
Review: Laparoscopic versus small-incision cholecystectomy for patients with symptomatic cholecystolithiasis Comparison: 4 LC versus SIC - high-quality and low-quality trials regarding follow-up
Outcome: 1 Mortality
Study or subgroup Laparoscopic (LC) Small-incision (SIC) Risk
Difference Weight Risk
Difference
n/N n/N M-H,Fixed,95% CI M-H,Fixed,95% CI
1 High-quality trials
Barkun 1992 0/37 0/25 3.1 % 0.0 [ -0.06, 0.06 ]
Keus 2006 0/120 0/137 13.1 % 0.0 [ -0.02, 0.02 ]
Majeed 1996 0/100 0/100 10.3 % 0.0 [ -0.02, 0.02 ]
McGinn 1995 1/155 0/155 15.9 % 0.01 [ -0.01, 0.02 ]
McMahon 1994 0/151 1/148 15.3 % -0.01 [ -0.03, 0.01 ]
Ros 2001 0/362 0/362 37.2 % 0.0 [ -0.01, 0.01 ]
Subtotal (95% CI) 925 927 94.9 % 0.00 [ -0.01, 0.01 ]
Total events: 1 (Laparoscopic (LC)), 1 (Small-incision (SIC)) Heterogeneity: Chi2= 1.03, df = 5 (P = 0.96); I2=0.0%
Test for overall effect: Z = 0.00 (P = 1.0) 2 Low-quality trials
Kunz 1992 0/50 0/50 5.1 % 0.0 [ -0.04, 0.04 ]
Subtotal (95% CI) 50 50 5.1 % 0.0 [ -0.04, 0.04 ]
Total events: 0 (Laparoscopic (LC)), 0 (Small-incision (SIC)) Heterogeneity: not applicable
Test for overall effect: Z = 0.0 (P = 1.0)
Total (95% CI) 975 977 100.0 % 0.00 [ -0.01, 0.01 ]
Total events: 1 (Laparoscopic (LC)), 1 (Small-incision (SIC)) Heterogeneity: Chi2= 1.03, df = 6 (P = 0.98); I2=0.0%
Test for overall effect: Z = 0.00 (P = 1.0)
-0.5 -0.25 0 0.25 0.5
Favours LC Favours SIC
Analysis 4.2. Comparison 4 LC versus SIC - high-quality and low-quality trials regarding follow-up, Outcome 2 Intra-operative complications.
Review: Laparoscopic versus small-incision cholecystectomy for patients with symptomatic cholecystolithiasis Comparison: 4 LC versus SIC - high-quality and low-quality trials regarding follow-up
Outcome: 2 Intra-operative complications
Study or subgroup Laparoscopic (LC) Small-incision (SIC) Risk
Difference Weight Risk
Difference
n/N n/N
M-H,Random,95%
CI
M-H,Random,95%
CI 1 High-quality trials
Barkun 1992 0/37 0/25 8.2 % 0.0 [ -0.06, 0.06 ]
Keus 2006 4/120 2/137 9.5 % 0.02 [ -0.02, 0.06 ]
Majeed 1996 1/100 0/100 9.9 % 0.01 [ -0.02, 0.04 ]
McGinn 1995 0/155 0/155 10.2 % 0.0 [ -0.01, 0.01 ]
McMahon 1994 0/151 0/148 10.2 % 0.0 [ -0.01, 0.01 ]
Ros 2001 148/362 85/362 8.1 % 0.17 [ 0.11, 0.24 ]
Secco 2002 0/86 0/86 10.0 % 0.0 [ -0.02, 0.02 ]
Srivastava 2001 0/59 1/40 8.3 % -0.03 [ -0.09, 0.04 ]
Subtotal (95% CI) 1070 1053 74.5 % 0.02 [ -0.03, 0.07 ]
Total events: 153 (Laparoscopic (LC)), 88 (Small-incision (SIC)) Heterogeneity: Tau2= 0.01; Chi2= 248.60, df = 7 (P<0.00001); I2=97%
Test for overall effect: Z = 0.76 (P = 0.45) 2 Low-quality trials
Bruce 1999 0/11 0/11 4.0 % 0.0 [ -0.16, 0.16 ]
Coelho 1993 0/15 0/15 5.4 % 0.0 [ -0.12, 0.12 ]
Grande 2002 0/18 0/22 6.7 % 0.0 [ -0.09, 0.09 ]
Kunz 1992 0/50 0/50 9.5 % 0.0 [ -0.04, 0.04 ]
Subtotal (95% CI) 94 98 25.5 % 0.0 [ -0.03, 0.03 ]
Total events: 0 (Laparoscopic (LC)), 0 (Small-incision (SIC)) Heterogeneity: Tau2= 0.0; Chi2= 0.0, df = 3 (P = 1.00); I2=0.0%
Test for overall effect: Z = 0.0 (P = 1.0)
Total (95% CI) 1164 1151 100.0 % 0.01 [ -0.03, 0.06 ]
Total events: 153 (Laparoscopic (LC)), 88 (Small-incision (SIC)) Heterogeneity: Tau2= 0.00; Chi2= 222.50, df = 11 (P<0.00001); I2=95%
Test for overall effect: Z = 0.71 (P = 0.48)
-0.5 -0.25 0 0.25 0.5
Favours LC Favours SIC
Analysis 4.3. Comparison 4 LC versus SIC - high-quality and low-quality trials regarding follow-up, Outcome 3 Minor complications.
Review: Laparoscopic versus small-incision cholecystectomy for patients with symptomatic cholecystolithiasis Comparison: 4 LC versus SIC - high-quality and low-quality trials regarding follow-up
Outcome: 3 Minor complications
Study or subgroup Laparoscopic (LC) Small-incision (SIC) Risk
Difference Weight Risk
Difference
n/N n/N
M-H,Random,95%
CI
M-H,Random,95%
CI 1 High-quality trials
Barkun 1992 0/37 1/25 6.1 % -0.04 [ -0.14, 0.06 ]
Keus 2006 10/120 10/137 10.1 % 0.01 [ -0.06, 0.08 ]
Majeed 1996 8/100 12/100 7.6 % -0.04 [ -0.12, 0.04 ]
McGinn 1995 5/155 2/155 17.3 % 0.02 [ -0.01, 0.05 ]
McMahon 1994 19/151 19/148 8.6 % 0.00 [ -0.08, 0.07 ]
Ros 2001 39/362 36/362 14.5 % 0.01 [ -0.04, 0.05 ]
Secco 2002 16/86 14/86 4.8 % 0.02 [ -0.09, 0.14 ]
Srivastava 2001 0/59 11/40 3.4 % -0.28 [ -0.41, -0.14 ]
Subtotal (95% CI) 1070 1053 72.4 % -0.02 [ -0.06, 0.02 ]
Total events: 97 (Laparoscopic (LC)), 105 (Small-incision (SIC)) Heterogeneity: Tau2= 0.00; Chi2= 18.98, df = 7 (P = 0.01); I2=63%
Test for overall effect: Z = 0.83 (P = 0.41) 2 Low-quality trials
Bruce 1999 0/11 0/11 2.7 % 0.0 [ -0.16, 0.16 ]
Coelho 1993 0/15 1/15 2.5 % -0.07 [ -0.23, 0.10 ]
Grande 2002 0/18 0/22 6.4 % 0.0 [ -0.09, 0.09 ]
Kunz 1992 0/50 0/50 16.0 % 0.0 [ -0.04, 0.04 ]
Subtotal (95% CI) 94 98 27.6 % 0.00 [ -0.04, 0.03 ]
Total events: 0 (Laparoscopic (LC)), 1 (Small-incision (SIC)) Heterogeneity: Tau2= 0.0; Chi2= 0.79, df = 3 (P = 0.85); I2=0.0%
Test for overall effect: Z = 0.16 (P = 0.87)
Total (95% CI) 1164 1151 100.0 % -0.01 [ -0.04, 0.02 ]
Total events: 97 (Laparoscopic (LC)), 106 (Small-incision (SIC)) Heterogeneity: Tau2= 0.00; Chi2= 19.72, df = 11 (P = 0.05); I2=44%
Test for overall effect: Z = 0.71 (P = 0.48)
-0.5 -0.25 0 0.25 0.5
Favours LC Favours SIC
Analysis 4.4. Comparison 4 LC versus SIC - high-quality and low-quality trials regarding follow-up, Outcome 4 Severe complications (without bile duct injuries).
Review: Laparoscopic versus small-incision cholecystectomy for patients with symptomatic cholecystolithiasis Comparison: 4 LC versus SIC - high-quality and low-quality trials regarding follow-up
Outcome: 4 Severe complications (without bile duct injuries)
Study or subgroup Laparoscopic (LC) Small-incision (SIC) Risk
Difference Weight Risk
Difference
n/N n/N
M-H,Random,95%
CI
M-H,Random,95%
CI 1 High-quality trials
Barkun 1992 1/37 0/25 5.6 % 0.03 [ -0.05, 0.11 ]
Keus 2006 6/120 1/137 11.3 % 0.04 [ 0.00, 0.08 ]
Majeed 1996 3/100 2/100 11.0 % 0.01 [ -0.03, 0.05 ]
McGinn 1995 8/155 0/155 12.3 % 0.05 [ 0.01, 0.09 ]
McMahon 1994 4/151 12/148 9.6 % -0.05 [ -0.11, 0.00 ]
Ros 2001 18/362 31/362 12.3 % -0.04 [ -0.07, 0.00 ]
Secco 2002 4/86 1/86 9.7 % 0.03 [ -0.02, 0.08 ]
Srivastava 2001 0/59 0/40 11.5 % 0.0 [ -0.04, 0.04 ]
Subtotal (95% CI) 1070 1053 83.3 % 0.01 [ -0.02, 0.04 ]
Total events: 44 (Laparoscopic (LC)), 47 (Small-incision (SIC)) Heterogeneity: Tau2= 0.00; Chi2= 23.23, df = 7 (P = 0.002); I2=70%
Test for overall effect: Z = 0.61 (P = 0.54) 2 Low-quality trials
Bruce 1999 0/11 0/11 1.9 % 0.0 [ -0.16, 0.16 ]
Coelho 1993 0/15 0/15 3.1 % 0.0 [ -0.12, 0.12 ]
Grande 2002 0/18 0/22 4.6 % 0.0 [ -0.09, 0.09 ]
Kunz 1992 2/50 1/50 7.2 % 0.02 [ -0.05, 0.09 ]
Subtotal (95% CI) 94 98 16.7 % 0.01 [ -0.04, 0.06 ]
Total events: 2 (Laparoscopic (LC)), 1 (Small-incision (SIC)) Heterogeneity: Tau2= 0.0; Chi2= 0.17, df = 3 (P = 0.98); I2=0.0%
Test for overall effect: Z = 0.42 (P = 0.68)
Total (95% CI) 1164 1151 100.0 % 0.01 [ -0.01, 0.03 ]
Total events: 46 (Laparoscopic (LC)), 48 (Small-incision (SIC)) Heterogeneity: Tau2= 0.00; Chi2= 23.23, df = 11 (P = 0.02); I2=53%
Test for overall effect: Z = 0.76 (P = 0.45)
-0.5 -0.25 0 0.25 0.5
Favours LC Favours SIC
Analysis 4.5. Comparison 4 LC versus SIC - high-quality and low-quality trials regarding follow-up, Outcome 5 Bile duct injuries.
Review: Laparoscopic versus small-incision cholecystectomy for patients with symptomatic cholecystolithiasis Comparison: 4 LC versus SIC - high-quality and low-quality trials regarding follow-up
Outcome: 5 Bile duct injuries
Study or subgroup Laparoscopic (LC) Small-incision (SIC) Risk
Difference Weight Risk
Difference
n/N n/N M-H,Fixed,95% CI M-H,Fixed,95% CI
1 High-quality trials
Barkun 1992 0/37 1/25 2.6 % -0.04 [ -0.14, 0.06 ]
Keus 2006 1/120 3/137 11.1 % -0.01 [ -0.04, 0.02 ]
Majeed 1996 1/100 0/100 8.7 % 0.01 [ -0.02, 0.04 ]
McGinn 1995 1/155 2/155 13.4 % -0.01 [ -0.03, 0.02 ]
McMahon 1994 4/151 3/148 13.0 % 0.01 [ -0.03, 0.04 ]
Ros 2001 6/362 7/362 31.4 % 0.00 [ -0.02, 0.02 ]
Secco 2002 0/86 0/86 7.5 % 0.0 [ -0.02, 0.02 ]
Srivastava 2001 1/59 5/40 4.1 % -0.11 [ -0.22, 0.00 ]
Subtotal (95% CI) 1070 1053 91.7 % -0.01 [ -0.02, 0.00 ]
Total events: 14 (Laparoscopic (LC)), 21 (Small-incision (SIC)) Heterogeneity: Chi2= 6.89, df = 7 (P = 0.44); I2=0.0%
Test for overall effect: Z = 1.32 (P = 0.19) 2 Low-quality trials
Bruce 1999 0/11 0/11 1.0 % 0.0 [ -0.16, 0.16 ]
Coelho 1993 0/15 0/15 1.3 % 0.0 [ -0.12, 0.12 ]
Grande 2002 0/18 0/22 1.7 % 0.0 [ -0.09, 0.09 ]
Kunz 1992 0/50 1/50 4.3 % -0.02 [ -0.07, 0.03 ]
Subtotal (95% CI) 94 98 8.3 % -0.01 [ -0.06, 0.03 ]
Total events: 0 (Laparoscopic (LC)), 1 (Small-incision (SIC)) Heterogeneity: Chi2= 0.21, df = 3 (P = 0.98); I2=0.0%
Test for overall effect: Z = 0.45 (P = 0.65)
Total (95% CI) 1164 1151 100.0 % -0.01 [ -0.02, 0.00 ]
Total events: 14 (Laparoscopic (LC)), 22 (Small-incision (SIC)) Heterogeneity: Chi2= 7.22, df = 11 (P = 0.78); I2=0.0%
Test for overall effect: Z = 1.39 (P = 0.16)
-0.5 -0.25 0 0.25 0.5
Favours LC Favours SIC
Analysis 4.6. Comparison 4 LC versus SIC - high-quality and low-quality trials regarding follow-up, Outcome 6 Total complications.
Review: Laparoscopic versus small-incision cholecystectomy for patients with symptomatic cholecystolithiasis Comparison: 4 LC versus SIC - high-quality and low-quality trials regarding follow-up
Outcome: 6 Total complications
Study or subgroup Laparoscopic (LC) Small-incision (SIC) Risk
Difference Weight Risk
Difference
n/N n/N
M-H,Random,95%
CI
M-H,Random,95%
CI 1 High-quality trials
Barkun 1992 1/37 2/25 7.8 % -0.05 [ -0.17, 0.07 ]
Keus 2006 21/120 16/137 9.2 % 0.06 [ -0.03, 0.14 ]
Majeed 1996 13/100 14/100 8.8 % -0.01 [ -0.10, 0.08 ]
McGinn 1995 14/155 4/155 10.5 % 0.06 [ 0.01, 0.12 ]
McMahon 1994 27/151 34/148 9.0 % -0.05 [ -0.14, 0.04 ]
Ros 2001 211/362 159/362 9.8 % 0.14 [ 0.07, 0.22 ]
Secco 2002 20/86 15/86 7.8 % 0.06 [ -0.06, 0.18 ]
Srivastava 2001 1/59 17/40 6.4 % -0.41 [ -0.56, -0.25 ]
Subtotal (95% CI) 1070 1053 69.3 % -0.01 [ -0.09, 0.07 ]
Total events: 308 (Laparoscopic (LC)), 261 (Small-incision (SIC)) Heterogeneity: Tau2= 0.01; Chi2= 47.90, df = 7 (P<0.00001); I2=85%
Test for overall effect: Z = 0.26 (P = 0.79) 2 Low-quality trials
Bruce 1999 0/11 0/11 6.3 % 0.0 [ -0.16, 0.16 ]
Coelho 1993 0/15 1/15 6.0 % -0.07 [ -0.23, 0.10 ]
Grande 2002 0/18 0/22 8.9 % 0.0 [ -0.09, 0.09 ]
Kunz 1992 2/50 2/50 9.6 % 0.0 [ -0.08, 0.08 ]
Subtotal (95% CI) 94 98 30.7 % -0.01 [ -0.06, 0.05 ]
Total events: 2 (Laparoscopic (LC)), 3 (Small-incision (SIC)) Heterogeneity: Tau2= 0.0; Chi2= 0.57, df = 3 (P = 0.90); I2=0.0%
Test for overall effect: Z = 0.25 (P = 0.80)
Total (95% CI) 1164 1151 100.0 % -0.01 [ -0.07, 0.05 ]
Total events: 310 (Laparoscopic (LC)), 264 (Small-incision (SIC)) Heterogeneity: Tau2= 0.01; Chi2= 50.92, df = 11 (P<0.00001); I2=78%
Test for overall effect: Z = 0.29 (P = 0.77)
-0.5 -0.25 0 0.25 0.5
Favours LC Favours SIC
Analysis 4.7. Comparison 4 LC versus SIC - high-quality and low-quality trials regarding follow-up, Outcome 7 Conversions.
Review: Laparoscopic versus small-incision cholecystectomy for patients with symptomatic cholecystolithiasis Comparison: 4 LC versus SIC - high-quality and low-quality trials regarding follow-up
Outcome: 7 Conversions
Study or subgroup Laparoscopic (LC) Small-Incision (SIC)
Risk
Difference Weight
Risk Difference
n/N n/N
M-H,Random,95%
CI
M-H,Random,95%
CI 1 High-quality trials
Barkun 1992 1/37 0/25 11.5 % 0.03 [ -0.05, 0.11 ]
Keus 2006 14/120 22/137 11.2 % -0.04 [ -0.13, 0.04 ]
Majeed 1996 20/100 22/100 8.4 % -0.02 [ -0.13, 0.09 ]
McGinn 1995 20/155 6/155 14.0 % 0.09 [ 0.03, 0.15 ]
McMahon 1994 15/151 14/148 13.2 % 0.00 [ -0.06, 0.07 ]
Ros 2001 69/362 101/362 13.9 % -0.09 [ -0.15, -0.03 ]
Secco 2002 5/91 4/90 13.7 % 0.01 [ -0.05, 0.07 ]
Srivastava 2001 0/59 1/40 13.9 % -0.03 [ -0.09, 0.04 ]
Subtotal (95% CI) 1075 1057 100.0 % 0.00 [ -0.05, 0.04 ]
Total events: 144 (Laparoscopic (LC)), 170 (Small-Incision (SIC)) Heterogeneity: Tau2= 0.00; Chi2= 21.07, df = 7 (P = 0.004); I2=67%
Test for overall effect: Z = 0.20 (P = 0.84) 2 Low-quality trials
Subtotal (95% CI) 0 0 Not estimable
Total events: 0 (Laparoscopic (LC)), 0 (Small-Incision (SIC)) Heterogeneity: not applicable
Test for overall effect: not applicable
Total (95% CI) 1075 1057 100.0 % 0.00 [ -0.05, 0.04 ]
Total events: 144 (Laparoscopic (LC)), 170 (Small-Incision (SIC)) Heterogeneity: Tau2= 0.00; Chi2= 21.07, df = 7 (P = 0.004); I2=67%
Test for overall effect: Z = 0.20 (P = 0.84)
-0.5 -0.25 0 0.25 0.5
Favours LC Favours SIC
Analysis 4.8. Comparison 4 LC versus SIC - high-quality and low-quality trials regarding follow-up, Outcome 8 Operative time (minutes).
Review: Laparoscopic versus small-incision cholecystectomy for patients with symptomatic cholecystolithiasis Comparison: 4 LC versus SIC - high-quality and low-quality trials regarding follow-up
Outcome: 8 Operative time (minutes)
Study or subgroup Laparoscopic (LC) Small-incision (SIC) Mean
Difference Weight Mean
Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
1 High-quality trials
Barkun 1992 37 85.9 (32) 25 73.1 (24.5) 8.7 % 12.80 [ -1.29, 26.89 ]
Keus 2006 120 71.85 (25.83) 137 60.41 (18.29) 12.2 % 11.44 [ 5.90, 16.98 ]
Majeed 1996 100 69.2 (24.6) 100 45.4 (19.8) 11.9 % 23.80 [ 17.61, 29.99 ]
McMahon 1994 151 71 (20) 148 57 (24) 12.3 % 14.00 [ 8.99, 19.01 ]
Ros 2001 362 108 (45) 362 94 (45) 11.8 % 14.00 [ 7.44, 20.56 ]
Secco 2002 86 35.7 (11.2) 86 37.6 (5.7) 12.9 % -1.90 [ -4.56, 0.76 ]
Srivastava 2001 59 54.2 (20.93) 40 57.2 (17.85) 11.4 % -3.00 [ -10.69, 4.69 ]
Subtotal (95% CI) 915 898 81.2 % 10.03 [ 1.79, 18.27 ]
Heterogeneity: Tau2= 110.44; Chi2= 91.01, df = 6 (P<0.00001); I2=93%
Test for overall effect: Z = 2.39 (P = 0.017) 2 Low-quality trials
Grande 2002 18 42.95 (24) 22 32 (8) 9.8 % 10.95 [ -0.63, 22.53 ]
Kunz 1992 50 102 (35) 50 102 (32) 9.1 % 0.0 [ -13.14, 13.14 ]
Subtotal (95% CI) 68 72 18.8 % 5.93 [ -4.76, 16.63 ]
Heterogeneity: Tau2= 20.01; Chi2= 1.50, df = 1 (P = 0.22); I2=33%
Test for overall effect: Z = 1.09 (P = 0.28)
Total (95% CI) 983 970 100.0 % 9.20 [ 2.06, 16.35 ]
Heterogeneity: Tau2= 101.35; Chi2= 92.52, df = 8 (P<0.00001); I2=91%
Test for overall effect: Z = 2.52 (P = 0.012)
-100 -50 0 50 100
Favours LC Favours SIC
Analysis 4.9. Comparison 4 LC versus SIC - high-quality and low-quality trials regarding follow-up, Outcome 9 Hospital stay (days).
Review: Laparoscopic versus small-incision cholecystectomy for patients with symptomatic cholecystolithiasis Comparison: 4 LC versus SIC - high-quality and low-quality trials regarding follow-up
Outcome: 9 Hospital stay (days)
Study or subgroup Laparoscopic (LC) Small-incision (SIC) Mean
Difference Weight Mean
Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
1 High-quality trials
Keus 2006 120 2.38 (4.58) 137 3.08 (12.37) 4.1 % -0.70 [ -2.93, 1.53 ]
Majeed 1996 100 3.6 (2.3) 100 3.5 (2.1) 14.4 % 0.10 [ -0.51, 0.71 ]
Ros 2001 362 2.6 (3.3) 362 3.2 (5.1) 14.3 % -0.60 [ -1.23, 0.03 ]
Secco 2002 86 3.6 (1.3) 86 4 (1) 16.8 % -0.40 [ -0.75, -0.05 ]
Srivastava 2001 59 1.2 (1.33) 40 1.62 (1.25) 15.3 % -0.42 [ -0.94, 0.10 ]
Subtotal (95% CI) 727 725 64.8 % -0.36 [ -0.60, -0.12 ]
Heterogeneity: Tau2= 0.0; Chi2= 2.94, df = 4 (P = 0.57); I2=0.0%
Test for overall effect: Z = 2.96 (P = 0.0031) 2 Low-quality trials
Grande 2002 18 3.18 (1.07) 22 5.2 (1.1) 13.8 % -2.02 [ -2.69, -1.35 ]
Kunz 1992 50 3.8 (2.3) 50 5.6 (3.1) 10.1 % -1.80 [ -2.87, -0.73 ]
Tate 1993 11 1.45 (0.69) 11 2.82 (1.4) 11.4 % -1.37 [ -2.29, -0.45 ]
Subtotal (95% CI) 79 83 35.2 % -1.79 [ -2.28, -1.31 ]
Heterogeneity: Tau2= 0.0; Chi2= 1.24, df = 2 (P = 0.54); I2=0.0%
Test for overall effect: Z = 7.25 (P < 0.00001)
Total (95% CI) 806 808 100.0 % -0.85 [ -1.35, -0.34 ]
Heterogeneity: Tau2= 0.37; Chi2= 31.18, df = 7 (P = 0.00006); I2=78%
Test for overall effect: Z = 3.26 (P = 0.0011)
-4 -2 0 2 4
Favours LC Favours SIC
Analysis 4.10. Comparison 4 LC versus SIC - high-quality and low-quality trials regarding follow-up, Outcome 10 Convalescence: work leave (days).
Review: Laparoscopic versus small-incision cholecystectomy for patients with symptomatic cholecystolithiasis Comparison: 4 LC versus SIC - high-quality and low-quality trials regarding follow-up
Outcome: 10 Convalescence: work leave (days)
Study or subgroup Laparoscopic (LC) Small-incision (SIC) Mean
Difference Weight Mean
Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
1 High-quality trials
Keus 2006 120 25.48 (18.41) 137 24.71 (13.44) 30.9 % 0.77 [ -3.22, 4.76 ]
Majeed 1996 100 35 (18.2) 100 32.2 (17.5) 26.4 % 2.80 [ -2.15, 7.75 ]
Ros 2001 362 12.7 (10.3) 362 16 (9.9) 42.6 % -3.30 [ -4.77, -1.83 ]
Subtotal (95% CI) 582 599 100.0 % -0.43 [ -4.37, 3.51 ]
Heterogeneity: Tau2= 8.91; Chi2= 8.10, df = 2 (P = 0.02); I2=75%
Test for overall effect: Z = 0.21 (P = 0.83) 2 Low-quality trials
Subtotal (95% CI) 0 0 Not estimable
Heterogeneity: not applicable Test for overall effect: not applicable
Total (95% CI) 582 599 100.0 % -0.43 [ -4.37, 3.51 ]
Heterogeneity: Tau2= 8.91; Chi2= 8.10, df = 2 (P = 0.02); I2=75%
Test for overall effect: Z = 0.21 (P = 0.83)
-10 -5 0 5 10
Favours LC Favours SIC
Analysis 4.11. Comparison 4 LC versus SIC - high-quality and low-quality trials regarding follow-up, Outcome 11 Convalescence: normal activity (at home) (days).
Review: Laparoscopic versus small-incision cholecystectomy for patients with symptomatic cholecystolithiasis Comparison: 4 LC versus SIC - high-quality and low-quality trials regarding follow-up
Outcome: 11 Convalescence: normal activity (at home) (days)
Study or subgroup Laparoscopic (LC) Small-incision (SIC) Mean
Difference Weight Mean
Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
1 High-quality trials
Barkun 1992 37 11.9 (9.1) 25 20.2 (16.5) 12.6 % -8.30 [ -15.40, -1.20 ]
Majeed 1996 100 30.1 (26.6) 100 25.2 (13.3) 16.3 % 4.90 [ -0.93, 10.73 ]
Ros 2001 362 8.6 (7.7) 362 10.7 (7.2) 38.4 % -2.10 [ -3.19, -1.01 ]
Secco 2002 86 12.2 (7) 86 16.6 (8.5) 32.7 % -4.40 [ -6.73, -2.07 ]
Subtotal (95% CI) 585 573 100.0 % -2.50 [ -5.54, 0.55 ]
Heterogeneity: Tau2= 5.96; Chi2= 11.81, df = 3 (P = 0.01); I2=75%
Test for overall effect: Z = 1.61 (P = 0.11) 2 Low-quality trials
Subtotal (95% CI) 0 0 Not estimable
Heterogeneity: not applicable Test for overall effect: not applicable
Total (95% CI) 585 573 100.0 % -2.50 [ -5.54, 0.55 ]
Heterogeneity: Tau2= 5.96; Chi2= 11.81, df = 3 (P = 0.01); I2=75%
Test for overall effect: Z = 1.61 (P = 0.11)
-10 -5 0 5 10
Favours LC Favours SIC
Analysis 5.1. Comparison 5 LC versus SIC - sensitivity and subgroup analyses, Outcome 1 Sensitivity analysis 1: Assuming zero mortality in nonreporting trials.
Review: Laparoscopic versus small-incision cholecystectomy for patients with symptomatic cholecystolithiasis Comparison: 5 LC versus SIC - sensitivity and subgroup analyses
Outcome: 1 Sensitivity analysis 1: Assuming zero mortality in nonreporting trials
Study or subgroup Laparoscopic (LC) Small-incision (SIC) Risk
Difference Weight Risk
Difference
n/N n/N M-H,Fixed,95% CI M-H,Fixed,95% CI
Barkun 1992 0/37 0/25 2.6 % 0.0 [ -0.06, 0.06 ]
Bruce 1999 0/11 0/11 0.9 % 0.0 [ -0.16, 0.16 ]
Coelho 1993 0/15 0/15 1.3 % 0.0 [ -0.12, 0.12 ]
Grande 2002 0/18 0/22 1.7 % 0.0 [ -0.09, 0.09 ]
Keus 2006 0/120 0/137 11.0 % 0.0 [ -0.02, 0.02 ]
Kunz 1992 0/50 0/50 4.3 % 0.0 [ -0.04, 0.04 ]
Majeed 1996 0/100 0/100 8.6 % 0.0 [ -0.02, 0.02 ]
McGinn 1995 1/155 0/155 13.3 % 0.01 [ -0.01, 0.02 ]
McMahon 1994 0/151 1/148 12.8 % -0.01 [ -0.03, 0.01 ]
Ros 2001 0/362 0/362 31.1 % 0.0 [ -0.01, 0.01 ]
Secco 2002 0/86 0/86 7.4 % 0.0 [ -0.02, 0.02 ]
Srivastava 2001 0/59 0/40 4.1 % 0.0 [ -0.04, 0.04 ]
Tate 1993 0/11 0/11 0.9 % 0.0 [ -0.16, 0.16 ]
Total (95% CI) 1175 1162 100.0 % 0.00 [ -0.01, 0.01 ]
Total events: 1 (Laparoscopic (LC)), 1 (Small-incision (SIC)) Heterogeneity: Chi2= 1.03, df = 12 (P = 1.00); I2=0.0%
Test for overall effect: Z = 0.00 (P = 1.0)
-0.5 -0.25 0 0.25 0.5
Favours LC Favours SIC
Analysis 5.2. Comparison 5 LC versus SIC - sensitivity and subgroup analyses, Outcome 2 Sensitivity analysis 2: Assuming zero conversions in nonreporting trials.
Review: Laparoscopic versus small-incision cholecystectomy for patients with symptomatic cholecystolithiasis Comparison: 5 LC versus SIC - sensitivity and subgroup analyses
Outcome: 2 Sensitivity analysis 2: Assuming zero conversions in nonreporting trials
Study or subgroup Laparoscopic (LC) Small-Incision (SIC) Risk
Difference Weight Risk
Difference
n/N n/N M-H,Fixed,95% CI M-H,Fixed,95% CI
Barkun 1992 1/37 0/25 2.6 % 0.03 [ -0.05, 0.11 ]
Bruce 1999 0/11 0/11 0.9 % 0.0 [ -0.16, 0.16 ]
Coelho 1993 0/15 0/15 1.3 % 0.0 [ -0.12, 0.12 ]
Grande 2002 0/18 0/22 1.7 % 0.0 [ -0.09, 0.09 ]
Keus 2006 14/120 22/137 10.9 % -0.04 [ -0.13, 0.04 ]
Kunz 1992 0/50 0/50 4.3 % 0.0 [ -0.04, 0.04 ]
Majeed 1996 20/100 22/100 8.6 % -0.02 [ -0.13, 0.09 ]
McGinn 1995 20/155 6/155 13.3 % 0.09 [ 0.03, 0.15 ]
McMahon 1994 15/151 14/148 12.8 % 0.00 [ -0.06, 0.07 ]
Ros 2001 69/362 101/362 31.0 % -0.09 [ -0.15, -0.03 ]
Secco 2002 5/91 4/90 7.7 % 0.01 [ -0.05, 0.07 ]
Srivastava 2001 0/59 1/40 4.1 % -0.03 [ -0.09, 0.04 ]
Tate 1993 0/11 0/11 0.9 % 0.0 [ -0.16, 0.16 ]
Total (95% CI) 1180 1166 100.0 % -0.02 [ -0.05, 0.01 ]
Total events: 144 (Laparoscopic (LC)), 170 (Small-Incision (SIC)) Heterogeneity: Chi2= 22.16, df = 12 (P = 0.04); I2=46%
Test for overall effect: Z = 1.51 (P = 0.13)
-0.5 -0.25 0 0.25 0.5
Favours LC Favours SIC