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Laparoscopic Surgery for Complex Crohn's Disease: A Meta-Analysis
Zhao-Liang Yu1,2, De-Zheng Lin2,3, Jian-Cong Hu2,3
1Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Insights
Laparoscopic surgery for complex Crohn's disease (CD) is safe but involves more blood loss and longer operative times. Postoperative complications are comparable to open surgery, making it a feasible option.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Minimally Invasive Surgery
Background:
- Laparoscopic surgery for complex Crohn's disease (CD) lacks a consensus regarding its routine recommendation.
- Assessing the safety and feasibility of laparoscopic approaches in CD management is crucial.
Purpose of the Study:
- To compare outcomes of laparoscopic surgery for complex Crohn's disease (LC) versus simple Crohn's disease (LS).
- To evaluate safety and feasibility of LC by analyzing key surgical and postoperative metrics.
Main Methods:
- A systematic review and meta-analysis of comparative studies was conducted.
- Searched PubMed, Embase, and Cochrane Library databases up to February 2019.
- Included 13 retrospective studies with 1120 participants comparing LC and LS groups.
Main Results:
- Laparoscopic surgery for complex CD showed significantly higher blood loss, longer operative time, and increased conversion rates.
- Length of hospital stay was also significantly longer in the LC group.
- However, overall postoperative complication rates did not significantly differ between LC and LS groups.
Conclusions:
- Laparoscopic surgery is a safe and feasible option for complex Crohn's disease.
- While associated with increased blood loss, operative time, and hospital stay, it offers comparable postoperative complication rates.
Abstract:
There is still no consensus on whether laparoscopic surgery can be routinely recommended as a safe approach for complex Crohn's disease (CD). PubMed, Embase, and Cochrane library databases were searched (up to February 2019). Comparative studies reporting laparoscopic surgery for complex CD (LC group) comparing with simple CD (LS group) were included. The outcomes were blood loss, operative time, conversion rate, length of hospital stay, postoperative complications, and reoperation rate within 30 days after surgery. Thirteen retrospective studies with 1120 participants were included. The LC group has significantly more blood loss (weighted mean difference [WMD] 43.64 mL; 95% confidence interval (CI) 8.37-78.91; P = .020), longer operative time (WMD 17.59 minutes; 95% CI 6.38-28.81; P = .002), higher conversion rate (WMD 2.04%; 95% CI 1.43-2.91; P < .001), and longer length of hospital stay (WMD 0.86 day; 95% CI 0.53-1.19; P < .001). Overall postoperative complication rates (WMD 0.98; 95% CI 0.71-1.34; P = .90) did not differ significantly between the 2 groups. LC is safe and feasible with comparable postoperative complications, although there is a more blood loss, longer operative time, higher conversion rate, and longer length of hospital stay.
