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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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Funnel plot from perioperative complications. Test for assymetry, P = 0.75.
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Figure 3: Funnel plot from perioperative complications. Test for assymetry, P = 0.75.

Mentions: Thirty studies [10-21,24-35,37,38,40-43] addressed the perioperative complication risk in the two groups. This included 1079 laparoscopic patients and 1221 open surgery patients. The perioperative complication risk in the laparoscopic group was 12% compared with 18% in the open group. There is very strong evidence of a reduced risk of perioperative complications in the laparoscopic group (Risk Ratio 0.71, 95% CI 0.58 – 0.86, P = 0.001). There was statistical homogeneity in this outcome, with an I2 of 0% (P = 0.87) (Figure 2). Publication bias was assessed by funnel plot (Figure 3) There was no evidence of assymetry seen in the funnel plot (P = 0.75).


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)

Funnel plot from perioperative complications. Test for assymetry, P = 0.75.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Funnel plot from perioperative complications. Test for assymetry, P = 0.75.
Mentions: Thirty studies [10-21,24-35,37,38,40-43] addressed the perioperative complication risk in the two groups. This included 1079 laparoscopic patients and 1221 open surgery patients. The perioperative complication risk in the laparoscopic group was 12% compared with 18% in the open group. There is very strong evidence of a reduced risk of perioperative complications in the laparoscopic group (Risk Ratio 0.71, 95% CI 0.58 – 0.86, P = 0.001). There was statistical homogeneity in this outcome, with an I2 of 0% (P = 0.87) (Figure 2). Publication bias was assessed by funnel plot (Figure 3) There was no evidence of assymetry seen in the funnel plot (P = 0.75).

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