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Laparoscopic surgery for Crohn's disease: a meta-analysis of perioperative complications and long term outcomes compared with open surgery.

Patel SV, Patel SV, Ramagopalan SV, Ott MC - BMC Surg (2013)

Bottom Line: There was no evidence of a difference in the rate of surgical recurrence (Rate Ratio 0.78, 95% CI 0.54 - 1.11, P = 0.17) or small bowel obstruction (Rate Ratio 0.63, 95% CI 0.28 - 1.45, P = 0.28) between techniques.There was evidence of a decrease in incisional hernia following laparoscopic surgery (Rate Ratio 0.24, 95% CI 0.07 - 0.82, P = 0.02).The results of this analysis are based primarily on non-randomized studies and thus have significant limitations in regards to selection bias, confounding, lack of blinding and potential publication bias.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of General Surgery, The University of Western Ontario London, Ontario, ON, Canada. spatel2009@meds.uwo.ca

ABSTRACT

Background: Previous meta-analyses have had conflicting conclusions regarding the differences between laparoscopic and open techniques in patients with Crohn's Disease. The objective of this meta-analysis was to compare outcomes in patients with Crohn's disease undergoing laparoscopic or open surgical resection.

Methods: A literature search of EMBASE, MEDLINE, The Cochrane Central Register of Controlled Trials and the US National Institute of Health's Clinical Trials Registry was completed. Randomized clinical trials and non-randomized comparative studies were included if laparoscopic and open surgical resections were compared. Primary outcomes assessed included perioperative complications, recurrence requiring surgery, small bowel obstruction and incisional hernia.

Results: 34 studies were included in the analysis, and represented 2,519 patients. Pooled analysis showed reduced perioperative complications in patients undergoing laparoscopic resection vs. open resection (Risk Ratio 0.71, 95% CI 0.58 - 0.86, P = 0.001). There was no evidence of a difference in the rate of surgical recurrence (Rate Ratio 0.78, 95% CI 0.54 - 1.11, P = 0.17) or small bowel obstruction (Rate Ratio 0.63, 95% CI 0.28 - 1.45, P = 0.28) between techniques. There was evidence of a decrease in incisional hernia following laparoscopic surgery (Rate Ratio 0.24, 95% CI 0.07 - 0.82, P = 0.02).

Conclusions: This is the largest review in this topic. The results of this analysis are based primarily on non-randomized studies and thus have significant limitations in regards to selection bias, confounding, lack of blinding and potential publication bias. Although we found evidence of decreased perioperative complications and incisional hernia in the laparoscopic group, further randomized controlled trials, with adequate follow up, are needed before strong recommendations can be made.

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Related in: MedlinePlus

Flow Diagram of search results, and trial inclusion.
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Figure 1: Flow Diagram of search results, and trial inclusion.

Mentions: A literature search found 861 articles. After eliminating duplicates and identifying relevant studies, 127 articles were selected for full text review. Of these, 34 articles were included in the study (FigureĀ 1). A total of 2,519 patients were included in our analysis. Two independent reviewers assessed articles for inclusion. The weighted kappa statistic was 0.92, which indicated very good agreement between the two reviewers. Disagreements were resolved through discussion and consensus.


Laparoscopic surgery for Crohn's disease: a meta-analysis of perioperative complications and long term outcomes compared with open surgery.

Patel SV, Patel SV, Ramagopalan SV, Ott MC - BMC Surg (2013)

Flow Diagram of search results, and trial inclusion.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3733939&req=5

Figure 1: Flow Diagram of search results, and trial inclusion.
Mentions: A literature search found 861 articles. After eliminating duplicates and identifying relevant studies, 127 articles were selected for full text review. Of these, 34 articles were included in the study (FigureĀ 1). A total of 2,519 patients were included in our analysis. Two independent reviewers assessed articles for inclusion. The weighted kappa statistic was 0.92, which indicated very good agreement between the two reviewers. Disagreements were resolved through discussion and consensus.

Bottom Line: There was no evidence of a difference in the rate of surgical recurrence (Rate Ratio 0.78, 95% CI 0.54 - 1.11, P = 0.17) or small bowel obstruction (Rate Ratio 0.63, 95% CI 0.28 - 1.45, P = 0.28) between techniques.There was evidence of a decrease in incisional hernia following laparoscopic surgery (Rate Ratio 0.24, 95% CI 0.07 - 0.82, P = 0.02).The results of this analysis are based primarily on non-randomized studies and thus have significant limitations in regards to selection bias, confounding, lack of blinding and potential publication bias.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of General Surgery, The University of Western Ontario London, Ontario, ON, Canada. spatel2009@meds.uwo.ca

ABSTRACT

Background: Previous meta-analyses have had conflicting conclusions regarding the differences between laparoscopic and open techniques in patients with Crohn's Disease. The objective of this meta-analysis was to compare outcomes in patients with Crohn's disease undergoing laparoscopic or open surgical resection.

Methods: A literature search of EMBASE, MEDLINE, The Cochrane Central Register of Controlled Trials and the US National Institute of Health's Clinical Trials Registry was completed. Randomized clinical trials and non-randomized comparative studies were included if laparoscopic and open surgical resections were compared. Primary outcomes assessed included perioperative complications, recurrence requiring surgery, small bowel obstruction and incisional hernia.

Results: 34 studies were included in the analysis, and represented 2,519 patients. Pooled analysis showed reduced perioperative complications in patients undergoing laparoscopic resection vs. open resection (Risk Ratio 0.71, 95% CI 0.58 - 0.86, P = 0.001). There was no evidence of a difference in the rate of surgical recurrence (Rate Ratio 0.78, 95% CI 0.54 - 1.11, P = 0.17) or small bowel obstruction (Rate Ratio 0.63, 95% CI 0.28 - 1.45, P = 0.28) between techniques. There was evidence of a decrease in incisional hernia following laparoscopic surgery (Rate Ratio 0.24, 95% CI 0.07 - 0.82, P = 0.02).

Conclusions: This is the largest review in this topic. The results of this analysis are based primarily on non-randomized studies and thus have significant limitations in regards to selection bias, confounding, lack of blinding and potential publication bias. Although we found evidence of decreased perioperative complications and incisional hernia in the laparoscopic group, further randomized controlled trials, with adequate follow up, are needed before strong recommendations can be made.

Show MeSH
Related in: MedlinePlus