Elective laparoscopic sigmoid resection for diverticular disease has fewer complications than conventional surgery: a meta-analysis
Abstract Background We performed a meta-analysis of published literature comparing the complications after open and laparoscopic elective sigmoidectomy for diverticular disease. Methods Electronic databases were searched from January 1991 to March 2009. A systematic review was performed to obtain a...
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| Veröffentlicht in: | The American journal of surgery 2010-07, Vol.200 (1), p.144-161 |
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| creator | Siddiqui, Muhammad Rafay Sameem Sajid, M.S Qureshi, S Cheek, E Baig, M.K |
| description | Abstract Background We performed a meta-analysis of published literature comparing the complications after open and laparoscopic elective sigmoidectomy for diverticular disease. Methods Electronic databases were searched from January 1991 to March 2009. A systematic review was performed to obtain a summative outcome. Results Nineteen comparative studies involving 2,383 patients were analyzed. There were 1,014 patients in the laparoscopic group and 1,369 patients in the open group. There was no significant heterogeneity among any of the complications analyzed. Patients in the laparoscopic sigmoid resection group had fewer wound infections (fixed effects model: risk ratio [RR], .54; 95% confidence interval [CI], .36–.80; z , −3.05; P < .01; random effects model: RR, .59; 95% CI, .39–.89; z , −2.54; P < .05), blood transfusions (fixed effects model: RR, .25; 95% CI, .10–.60; z , −3.10; P < .01; random effects model: RR, .28; 95% CI, .11–.68; z , −2.81; P < .01), and ileus rates (fixed effects model: RR, .37; 95% CI, .20–.66; z , −3.34; P = .001; random effects model: RR, .37; 95% CI, .20–.68; z , −3.21; P = .001) compared with open sigmoid resections. No difference was seen for medical complications, need for rehospitalization, and reoperation. Conclusions Laparoscopic sigmoid resection is safe and has fewer postoperative surgical complications. This approach should be considered for elective cases, however, more randomized controlled trials are required to strengthen the evidence. |
| doi_str_mv | 10.1016/j.amjsurg.2009.08.021 |
| format | Article |
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Methods Electronic databases were searched from January 1991 to March 2009. A systematic review was performed to obtain a summative outcome. Results Nineteen comparative studies involving 2,383 patients were analyzed. There were 1,014 patients in the laparoscopic group and 1,369 patients in the open group. There was no significant heterogeneity among any of the complications analyzed. Patients in the laparoscopic sigmoid resection group had fewer wound infections (fixed effects model: risk ratio [RR], .54; 95% confidence interval [CI], .36–.80; z , −3.05; P < .01; random effects model: RR, .59; 95% CI, .39–.89; z , −2.54; P < .05), blood transfusions (fixed effects model: RR, .25; 95% CI, .10–.60; z , −3.10; P < .01; random effects model: RR, .28; 95% CI, .11–.68; z , −2.81; P < .01), and ileus rates (fixed effects model: RR, .37; 95% CI, .20–.66; z , −3.34; P = .001; random effects model: RR, .37; 95% CI, .20–.68; z , −3.21; P = .001) compared with open sigmoid resections. No difference was seen for medical complications, need for rehospitalization, and reoperation. Conclusions Laparoscopic sigmoid resection is safe and has fewer postoperative surgical complications. This approach should be considered for elective cases, however, more randomized controlled trials are required to strengthen the evidence.</description><identifier>ISSN: 0002-9610</identifier><identifier>EISSN: 1879-1883</identifier><identifier>DOI: 10.1016/j.amjsurg.2009.08.021</identifier><identifier>PMID: 20637347</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Abdomen ; Blood transfusion ; Blood transfusions ; Cancer ; Clinical trials ; Colectomy - adverse effects ; Colectomy - methods ; Colon ; Comparative studies ; Complications ; Confidence intervals ; Diverticular disease ; Diverticulitis ; Diverticulosis ; Diverticulum, Colon - surgery ; Elective Surgical Procedures - adverse effects ; Heart attacks ; Hernias ; Heterogeneity ; Hospitals ; Humans ; Laparoscopy ; Laparoscopy - adverse effects ; Meta-analysis ; Patients ; Pneumonia ; Sigmoid Diseases - surgery ; Studies ; Surgery ; Surgical outcomes ; Wounds</subject><ispartof>The American journal of surgery, 2010-07, Vol.200 (1), p.144-161</ispartof><rights>Elsevier Inc.</rights><rights>2010 Elsevier Inc.</rights><rights>Copyright (c) 2010 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Jul 1, 2010</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c513t-973f90c6ac7116f6e437381f4512fca193bd7b58201b1df5802466af50408c203</citedby><cites>FETCH-LOGICAL-c513t-973f90c6ac7116f6e437381f4512fca193bd7b58201b1df5802466af50408c203</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1924850390?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,777,781,3537,27905,27906,45976,64364,64366,64368,72218</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20637347$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Siddiqui, Muhammad Rafay Sameem</creatorcontrib><creatorcontrib>Sajid, M.S</creatorcontrib><creatorcontrib>Qureshi, S</creatorcontrib><creatorcontrib>Cheek, E</creatorcontrib><creatorcontrib>Baig, M.K</creatorcontrib><title>Elective laparoscopic sigmoid resection for diverticular disease has fewer complications than conventional surgery: a meta-analysis</title><title>The American journal of surgery</title><addtitle>Am J Surg</addtitle><description>Abstract Background We performed a meta-analysis of published literature comparing the complications after open and laparoscopic elective sigmoidectomy for diverticular disease. Methods Electronic databases were searched from January 1991 to March 2009. A systematic review was performed to obtain a summative outcome. Results Nineteen comparative studies involving 2,383 patients were analyzed. There were 1,014 patients in the laparoscopic group and 1,369 patients in the open group. There was no significant heterogeneity among any of the complications analyzed. Patients in the laparoscopic sigmoid resection group had fewer wound infections (fixed effects model: risk ratio [RR], .54; 95% confidence interval [CI], .36–.80; z , −3.05; P < .01; random effects model: RR, .59; 95% CI, .39–.89; z , −2.54; P < .05), blood transfusions (fixed effects model: RR, .25; 95% CI, .10–.60; z , −3.10; P < .01; random effects model: RR, .28; 95% CI, .11–.68; z , −2.81; P < .01), and ileus rates (fixed effects model: RR, .37; 95% CI, .20–.66; z , −3.34; P = .001; random effects model: RR, .37; 95% CI, .20–.68; z , −3.21; P = .001) compared with open sigmoid resections. No difference was seen for medical complications, need for rehospitalization, and reoperation. Conclusions Laparoscopic sigmoid resection is safe and has fewer postoperative surgical complications. This approach should be considered for elective cases, however, more randomized controlled trials are required to strengthen the evidence.</description><subject>Abdomen</subject><subject>Blood transfusion</subject><subject>Blood transfusions</subject><subject>Cancer</subject><subject>Clinical trials</subject><subject>Colectomy - adverse effects</subject><subject>Colectomy - methods</subject><subject>Colon</subject><subject>Comparative studies</subject><subject>Complications</subject><subject>Confidence intervals</subject><subject>Diverticular disease</subject><subject>Diverticulitis</subject><subject>Diverticulosis</subject><subject>Diverticulum, Colon - surgery</subject><subject>Elective Surgical Procedures - adverse effects</subject><subject>Heart attacks</subject><subject>Hernias</subject><subject>Heterogeneity</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Laparoscopy</subject><subject>Laparoscopy - adverse effects</subject><subject>Meta-analysis</subject><subject>Patients</subject><subject>Pneumonia</subject><subject>Sigmoid Diseases - surgery</subject><subject>Studies</subject><subject>Surgery</subject><subject>Surgical outcomes</subject><subject>Wounds</subject><issn>0002-9610</issn><issn>1879-1883</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkktv1DAQxyMEotvCRwBZ4sApYWznYXOgQlV5SJU4AGfL60xahzwWT7Joz3zx2toFpF44WTP-zfM_WfaCQ8GB12_6wo49reG2EAC6AFWA4I-yDVeNzrlS8nG2AQCR65rDWXZO1EeT81I-zc4E1LKRZbPJfl8P6Ba_RzbYnQ0zuXnnHSN_O86-ZQEpfc8T6-bA2siFxbt1sMkgtITszhLr8BcG5uZxN3hnE09subNTdE17nJLDDix1i-Hwllk24mJzG50H8vQse9LZgfD56b3Ivn-4_nb1Kb_58vHz1fub3FVcLrluZKfB1dY1nNddjWWcQfGurLjonOVabttmWykBfMvbrlIgyrq2XQUlKCdAXmSvj3l3Yf65Ii1m9ORwGOyE80qmkVJrXdaJfPWA7Oc1xHbJcC1KVYHUiaqOlIt7o4Cd2QU_2nAwHEwSyfTmJJJJIhlQJooU416esq_bEdu_UX9UicDlEcC4jb3HYMh5nBy2PkQ5TDv7_5Z49yCDG_wUtRl-4AHp3zSGhAHzNV1KOhTQAHUlGnkPv4i8Rw</recordid><startdate>20100701</startdate><enddate>20100701</enddate><creator>Siddiqui, Muhammad Rafay Sameem</creator><creator>Sajid, M.S</creator><creator>Qureshi, S</creator><creator>Cheek, E</creator><creator>Baig, M.K</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20100701</creationdate><title>Elective laparoscopic sigmoid resection for diverticular disease has fewer complications than conventional surgery: a meta-analysis</title><author>Siddiqui, Muhammad Rafay Sameem ; 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Methods Electronic databases were searched from January 1991 to March 2009. A systematic review was performed to obtain a summative outcome. Results Nineteen comparative studies involving 2,383 patients were analyzed. There were 1,014 patients in the laparoscopic group and 1,369 patients in the open group. There was no significant heterogeneity among any of the complications analyzed. Patients in the laparoscopic sigmoid resection group had fewer wound infections (fixed effects model: risk ratio [RR], .54; 95% confidence interval [CI], .36–.80; z , −3.05; P < .01; random effects model: RR, .59; 95% CI, .39–.89; z , −2.54; P < .05), blood transfusions (fixed effects model: RR, .25; 95% CI, .10–.60; z , −3.10; P < .01; random effects model: RR, .28; 95% CI, .11–.68; z , −2.81; P < .01), and ileus rates (fixed effects model: RR, .37; 95% CI, .20–.66; z , −3.34; P = .001; random effects model: RR, .37; 95% CI, .20–.68; z , −3.21; P = .001) compared with open sigmoid resections. No difference was seen for medical complications, need for rehospitalization, and reoperation. Conclusions Laparoscopic sigmoid resection is safe and has fewer postoperative surgical complications. This approach should be considered for elective cases, however, more randomized controlled trials are required to strengthen the evidence.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>20637347</pmid><doi>10.1016/j.amjsurg.2009.08.021</doi><tpages>18</tpages></addata></record> |
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| subjects | Abdomen Blood transfusion Blood transfusions Cancer Clinical trials Colectomy - adverse effects Colectomy - methods Colon Comparative studies Complications Confidence intervals Diverticular disease Diverticulitis Diverticulosis Diverticulum, Colon - surgery Elective Surgical Procedures - adverse effects Heart attacks Hernias Heterogeneity Hospitals Humans Laparoscopy Laparoscopy - adverse effects Meta-analysis Patients Pneumonia Sigmoid Diseases - surgery Studies Surgery Surgical outcomes Wounds |
| title | Elective laparoscopic sigmoid resection for diverticular disease has fewer complications than conventional surgery: a meta-analysis |
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