Source: Surgical Endoscopy and Other Interventional Techniques; 2017; vol. 31
Publication Date: 2017
Publication Type(s): Conference Abstract
Abstract:Introduction: The evidence from observational studies suggests improved postoperative outcomes associated with laparoscopic sigmoidectomy for diverticular disease. Our objective was to conduct the first meta-analysis of randomized controlled trials (RCT's) to compare the outcomes of laparoscopic and open sigmoidectomy in patients with diverticular disease. Methods: In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement standards, we conducted a systematic search of electronic information sources, includingMEDLINE;EMBASE; CINAHL; CENTRAL; TheWorld Health Organization International Clinical Trials Registry; ClinicalTrials.gov; ISRCTN Register, and bibliographic reference lists. We applied a combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators and limits in each of the above databases. The overall morbidity, mortality, and postoperative complications were defined as the primary outcome parameters. Long-term complications and length of hospital stay were secondary outcomes. The combined overall effect sizes were calculated using fixed-effect or random-effects models. Results: We identified 3 RCT's comparing outcomes of elective laparoscopic and open sigmoidectomy for diverticular disease. Our pooled analysis of 360 patients demonstrated that laparoscopic sigmoidectomy does not significantly reduce risk of overall morbidity (Odd ratio (OR):0.91, 95% CI 0.69-1.21, p=0.53), anastomotic leak (OR: 0.74, 95% CI 0.28-1.93, p=0.54), intra-abdominal abscess (OR: 0.71, 95% CI 0.16-3.15, p=0.65), wound infection (OR:0.86, 95% CI 0.52-1.43, p=0.57), and mortality (OR:0.24, 95% CI 0.03-2.07, p=0.19) when compared to open approach. Moreover, no significant differences existed in the long-term complications such as incisional hernia (OR:1.06, 95% CI 0.40-2.82, p=0.90) and bowel obstruction (OR:0.51, 95% CI 0.14-1.87, p=0.31) between both groups. Low between-study heterogeneity existed in all analysis. The available data did not allow appropriate analysis of length of hospital stay. Conclusions: Unlike previous meta-analysis on observational studies, our analysis of RCTs did not find any improved short-term and long-term outcomes associated with laparoscopic sigmoidectomy compared to open approach in patients with diverticular disease. Undoubtedly, future high quality RCT's are required to provide stronger evidence as there is a limited number of high level studies with sufficient sample size.