Systematic review and meta-analysis of laparoscopic versus open colectomy with end ileostomy for non-toxic colitis

Abstract

This review compared short-term outcomes after laparoscopic versus open subtotal colectomy for acute, colitis medically refractory. A systematic review of the literature was carried out using MEDLINE, Embase and the Cochrane databases. Overall study quality was assessed by the modified Methodological Index for Non-Randomized Studies (MINORS). Meta-analysis was performed for conversion, reoperation, wound infection, ileus, gastrointestinal bleeding, intra-abdominal abscess, postoperative length of stay and mortality. The search identified nine non-randomized studies: six cohort studies and three case-matched series, comprising 966 patients in total. The pooled conversion rate was 5·5 (95 per cent confidence interval (c.i.) 3·6 to 8·4) per cent in the laparoscopic group. The pooled risk ratio of wound infection was 0·60 (95 per cent c.i. 0·38 to 0·95; P = 0·03) and that of intra-abdominal abscess was 0·27 (0·08 to 0·91; P = 0·04), both in favour of laparoscopic surgery. Pooled risk ratios for other complications showed no significant differences. Length of stay was significantly shorter after laparoscopic subtotal colectomy, with a pooled mean difference of 3·17 (95 per cent c.i. 2·37 to 3·98) days (P < 0·001). Where the procedure can be completed laparoscopically, there may be short-term benefits over open colectomy for colitis. These results cannot be generalized to critically ill patients in need of an emergency subtotal colectomy.