Comparison of outcomes of laparoscopic and open pancreaticoduodenectomy: An updated meta-analysis

Objective

Laparoscopic pancreaticoduodenectomy (LPD) is an alternative to the open surgical approach. Several authors have investigated the advantages of LPD over open PD (OPD); this study aims to evaluate the effectiveness of LPD compared with OPD.

Methodology

This study conducted a meta-analysis following the Cochrane Handbook for Systematic Reviews and adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Multiple databases—including PubMed, the Cochrane Trial Register, and Google Scholar—were searched for relevant literature up to April 20, 2024. Studies comparing OPD with LPD were included.

Results

A total of 4 randomized controlled trials and 41 non-randomized comparative trials were analysed. No significant difference in post-operative mortality was found (P = .42). However, there was a significant reduction in overall post-operative complications in the LPD group (P < .002). The length of hospital stay was also significantly shorter in the LPD group (P < .00001). No significant differences were observed between LPD and OPD regarding post-operative pancreatic fistula (P = .93) and post-pancreatectomy haemorrhage (post-pancreatectomy haemorrhage; P = .19). However, the rate of post-operative bile leaks was higher in the LPD group compared with the OPD group (P = .02).

Conclusion

This study concluded that LPD is a safer approach with less post-operative complications, longer operative time, less estimated blood loss, and shorter hospital stays when compared with OPD.