Authors: Nicolò Pecorelli Massimiliano Greco Salvatore Amodeo Marco Braga
Publish Date: 2016/06/10
Volume: 31, Issue: 1, Pages: 85-99
Abstract
Recent studies show contrasting data on the impact of laparoscopy on longterm complications such as the occurrence of small bowel obstruction SBO and incisional hernia IH The objective of the study was to assess the impact of the laparoscopic approach on the occurrence of SBO and IH after colorectal resectionTwo trained investigators independently searched MEDLINE Embase PubMed and the Cochrane Central Register of clinical trials for studies comparing laparoscopy to open surgery for mid to longterm outcomes after colorectal surgery No language restriction was set Sensitivity analyses for study design and quality conversion rate type of procedure colon or rectal surgery and length of followup were performedEleven RCTs and 14 nonRCT comparative studies for a total of 6540 patients were included in the analysis Laparoscopy was associated with a significant reduction in the occurrence of SBO RR 057 95 CI 042–076 16 trials and IH RR 060 95 CI 050–072 19 trials Sensitivity analysis including only RCTs confirmed the reduction in SBO RR 058 95 CI 039–087 8 trials while the difference was close to significance for IH RR 076 95 CI 056–103 7 trials Sensitivity analysis including only studies with conversion rate lower than 15 showed a significant protective effect of laparoscopy for both SBO RR 053 95 CI 037–077 11 trials and IH RR 058 95 CI 047–072 12 trials No significant difference between laparoscopy and open surgery was found when the analysis was limited to studies with conversion rate 15 SBO RR 060 032–112 IH RR 070 046–106 Length of followup did not substantially impact on results
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