Laparoscopic vs. Open Surgery for Diverticular Disease: A Meta-Analysis of Nonrandomized Studies

Abstract

This study was designed to compare outcomes between laparoscopic and open surgery for patients with diverticular disease by using meta-analytic techniques. Comparative studies published between 1996 and 2004 of open vs. laparoscopic surgery for diverticular disease were included. The end points that were evaluated are operative and functional outcomes and adverse events. A random effects model was used during analysis of these outcomes; heterogeneity was assessed and sensitivity analysis was performed to account for bias in patient selection. Twelve nonrandomized studies, incorporating 19,608 patients, were included in the analysis. One study with 18,444 patients accounted for 94.5 percent of the total sample. Laparoscopic surgery resulted in reduced infective (odds ratio, 0.61; P = 0.01), pulmonary (odds ratio, 0.4; P < 0.001), gastrointestinal tract (odds ratio, 0.75; P = 0.03), and cardiovascular complications (odds ratio, 0.28; P = 0.0008) with no significant heterogeneity. Operative time was longer with laparoscopic surgery (weighted mean difference, 67.59; P = 0.04), and length of stay was significantly shorter (weighted mean difference, -3.81; P < 0.0001); however, these outcomes demonstrated significant heterogeneity. These results remained significant throughout all the sensitivity analyses except when evaluating high-quality studies (when the study with 18,444 patients was excluded), in which only blood loss and length of stay were significantly in favor of the laparoscopic group. The results for patients selected for laparoscopic surgery compared with open surgery for diverticular disease are equivalent with a potential reduction in complications and hospital stay. Laparoscopic surgery for diverticular disease performed by appropriately experienced surgeons in the elective setting may be safe and feasible; because of the potential of significant bias arising from the included studies, a randomized, controlled trial is recommended.