Laparoscopic Versus Open Live Donor Hepatectomy In Liver Transplantation: A Systemic Review And Meta-Analysis

Objective: The aim of this study was to compare laparoscopic versus open live donor liver transplantation using meta-analysis. Background: Living donor liver transplantation (LDLT), as an alternative to deceased donor liver transplantation (DDLT), has increasingly performed all around the world. Laparoscopic live donor hepatectomy (LLDH) has been performed increasingly, and is gaining worldwide acceptance. As the studies assessing the safety and efficacy of laparoscopic compared with open techniques is growing, we combined the available data to conduct this meta-analysis to compare the two techniques. Methods: A literature search was performed to identify studies comparing laparoscopic with open live donor hepatectomy (OLDH) published before June 2015. Perioperative outcomes (blood loss, operative time, hospital stay, analgesia use) and postoperative complications (donors and recipients postoperative complications, recipients specific postoperative complications including biliary complications and vascular complications) were the main outcomes evaluated in the meta-analysis. Results: Fourteen studies with a total of 1136 patients were included in this meta-analysis, of which 357 were treated by laparoscopic technique and 779 were treated by the open procedures. Compared with the open group, laparoscopic group was associated with significant less estimated blood loss (P=0.01), shorter duration of operation (P=0.02), length of hospital stay (P=0.003) and duration of PCA use (P=0.04). The laboratory tests such as peak ALT and AST after operation were similar (P=0.72 and P=1.00). There was a significant higher rate of overall donor morbidity (P=0.002) and donor minor complications (Grade I-II) (P=0.02) in the open group. No significant difference was observed in donor major complications (Grade III-V), recipients overal morbidity and recipients complications such as bile complications and vascular complications. Conclusions: LLDH is a excellent alternative to OLDH because it is associated with better perioperative outcomes and similar prognosis.