Laparoscopic vs. open surgery for the treatment of iatrogenic colonoscopic perforations: a systematic review and meta-analysis

被引:29
作者
Martinez-Perez, Aleix [1 ,2 ]
de'Angelis, Nicola [1 ]
Brunetti, Francesco [1 ]
Le Baleur, Yann [3 ]
Paya-Llorente, Carmen [2 ]
Memeo, Riccardo [4 ]
Gaiani, Federica [5 ]
Manfredi, Marco [5 ]
Gavriilidis, Paschalis [6 ]
Nervi, Giorgio [5 ]
Coccolini, Federico [7 ]
Amiot, Aurelien [3 ]
Sobhani, Iradj [3 ]
Catena, Fausto [8 ]
de'Angelis, Gian Luigi [5 ]
机构
[1] Univ Paris Est UPEC, Henri Mondor Univ Hosp, AP HP, Dept Digest Hepatobiliary Surg & Liver Transplant, 51 Ave Marechal Lattre Tassigny, F-94010 Creteil, France
[2] Hosp Univ Doctor Peset, Dept Gen & Digest Surg, Ave Gaspar Aguilar 90, Valencia 46017, Spain
[3] Univ Paris Est Val Marne UPEC, Henri Mondor Hosp, AP HP, Dept Gastroenterol & Digest Endoscopy, F-94010 Creteil, France
[4] Osped Gen Reg Francesco Miulli, Unit Hepatobiliopancreat Surg, Acquaviva Delle Fonti, Italy
[5] Univ Hosp Parma, Gastroenterol & Endoscopy Unit, Via Gramsci 14, I-43126 Parma, Italy
[6] St James Univ Hosp, Dept HPB & Transplant Surg, Beckett Str, Leeds LS9 7TF, W Yorkshire, England
[7] Papa Giovanni XXIII Hosp, Dept Gen Surg, Bergamo, Italy
[8] Univ Hosp Osped Maggiore Parma, Dept Emergency Surg, Parma, Italy
来源
WORLD JOURNAL OF EMERGENCY SURGERY | 2017年 / 12卷
关键词
Colonoscopic perforation; Emergency surgery; Laparoscopy; Open surgery; Meta-analysis; ENDOSCOPIC CLIP CLOSURE; SMALL-BOWEL OBSTRUCTION; COLON PERFORATION; SURGICAL-MANAGEMENT; RISK-FACTORS; CANCER; OUTCOMES; QUALITY; REPAIR; MULTICENTER;
D O I
10.1186/s13017-017-0121-x
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Aims: Iatrogenic colonoscopy perforations (ICP) are a rare but severe complication of diagnostic and therapeutic colonoscopies. The present systematic review and meta-analysis aims to investigate the operative and post-operative outcomes of laparoscopy vs. open surgery performed for the management of ICP. Methods: A literature search was carried out on Medline, EMBASE, and Scopus databases from January 1990 to June 2016. Clinical studies comparing the outcomes of laparoscopic and open surgical procedures for the treatment for ICP were retrieved and analyzed. Results: A total of 6 retrospective studies were selected, including 161 patients with ICP who underwent surgery. Laparoscopy was used in 55% of the patients, with a conversion rate of 10%. The meta-analysis shows that the laparoscopic approach was associated with significantly fewer post-operative complications compared to open surgery (18.2% vs. 53.5% respectively; Relative risk, RR: 0.32 [95% CI: 0.19-0.54; p < 0.0001; I-2 = 0%]) and shorter hospital stay (mean difference -5.35 days [95% CI: -6.94 to -3.76; p < 0.00001; I-2 = 0%]). No differences between the two surgical approaches were observed for postoperative mortality, need of re-intervention, and operative time. Conclusion: The present study highlights the outcomes of the surgical management of an endoscopic complication that is not yet considered in clinical guidelines. Based on the current available literature, the laparoscopic approach appears to provide better outcomes in terms of postoperative complications and length of hospital stay than open surgery in the case of ICP surgical repair. However, the creation of large prospective registries of patients with ICP would be a step forward in addressing the lack of evidence concerning the surgical treatment of this endoscopic complication.
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页数:10
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