Adhesive small bowel obstruction after laparoscopic and open colorectal surgery: a systematic review and meta-analysis

BACKGROUND: It is considered that laparoscopic surgery is associated with a much lower rate of postoperative formation of adhesions than open surgery. This meta-analysis assessed the incidence of adhesion-related readmissions and surgery for adhesive small bowel obstruction (SBO) in patients who underwent laparoscopic or open colorectal surgery. METHODS: Multiple comprehensive databases were searched systematically to identify relevant studies and meta-analysis was done. RESULTS: Meta-analysis showed that laparoscopic surgery was associated with a lower rate of adhesive SBO, both for randomized clinical trials (relative risk [RR] .26, 95% confidence interval [CI] .10 to .67, I-2 = 41%) and nonrandomized studies (RR .49, 95% CI .32 to.76, I-2 = 91%). Laparoscopic surgery was also associated with a lower rate of subsequent surgery for adhesive SBO, both for randomized clinical trials (RR .25, 95% CI .06 to .96, I-2 =0%) and nonrandomized studies (RR .56, 95% CI .33 to .94, I-2 =77%). CONCLUSIONS: Laparoscopic colorectal surgery significantly reduced the rates of adhesive SBO and subsequent surgery for adhesive SBO, compared with open surgery. (C) 2016 Published by Elsevier Inc.