Background: Surgical site infections complicate elective laparoscopic cholecystectomies in 2,4-3,2% of cases.\nDuring the operation the gallbladder is commonly extracted with a retrieval bag. We conducted a meta-analysis to\nclarify whether its use plays a role in preventing infections.\nMethods: Inclusion criteria: elective cholecystectomy, details about the gallbladder extraction and data about local\nor systemic infection rate. Exclusion criteria: cholecystitis, jaundice, concurrent antibiotic therapy,\nimmunosuppression, cancer. A comprehensive literature search of PubMed, Cochrane Library and MEDLINE\ndatabases was carried out independently by two researchers, according to the PRISMA guidelines and applying the\nGRADE approach. Terms used were (â??gallbladderâ?AND(â??specimentâ?ORâ??extractionâ?ORâ??extractâ?))\nOR(â??gallbladderâ?ORâ??cholecystectomyâ?)AND(â??bagâ?ORâ??retrieval|â?OR|â??endobagâ?ORâ??endocatchâ?).\nResults: The comprehensive literature revealed 279 articles. The eligible studies were 2 randomized trials and a\nmulticentre prospective study. Wound infections were documented in 14 on 334 (4,2%) patients operated using a\nretrieval bag versus 16 on 271 (5,9%) patients operated without the use of a retrieval bag. The statistical analysis\nrevealed a risk ratio (RR) of 0.82 (0.41â??1.63 95% CI). Concerning sensitivity analysis the estimated pooled RR ranged\nfrom 0.72 to 0.96, both not statistically significant. Harbord test did not reveal the occurrence of small-study effect\n(p = 0.892) and the funnel-plot showed no noteworthy pattern.\nConclusions: The results of this review highlight the paucity of well-designed large studies and despite limitations\nrelated to the low level of evidence, our meta-analysis showed no significant benefit of retrieval bags in reducing\nthe infection rate after elective laparoscopic cholecystectomy. In absence of acute cholecystitis, accidental\nintraoperative gallbladder perforation or suspected carcinoma their use, to date, may not be mandatory, so that,\nfurther studies focusing on complex cases are needed.
Loading....