Jane J Y Tan1, Joe J Tjandra. 1. Department of Colorectal Surgery, Royal Melbourne Hospital and Epworth Colorectal Centre, Melbourne, Australia.
Abstract
PURPOSE: This study was designed to determine the safety and feasibility of laparoscopic surgery in Crohn's disease. METHODS: A search of published studies in English between January 1990 and February 2006 was performed by using the MEDLINE and PubMed databases and the Cochrane Central Register of Controlled Trials. The studies were reviewed by two independent assessors. Meta-analysis with the Forest plot was performed when raw data, means, and standard deviations were available. RESULTS: The rate of conversion from laparoscopic to open surgery was 11.2 percent. Laparoscopic procedures took longer to perform compared with open procedures, with a weighted mean difference of 25.54 minutes (P = 0.03). Patients who underwent laparoscopic surgery had a more rapid recovery of bowel function, with a weighted mean difference of 0.75 days (P = 0.02) and were able to tolerate oral intake earlier, with a weighted mean difference of 1.43 days (P = 0.0008). The duration of hospitalization was shorter, with a weighted mean difference of 1.82 days (P = 0.02). Morbidity was lower for laparoscopic procedures compared with open procedures (odds ratio, 0.57; 95 percent confidence interval, 0.37-0.87; P = 0.01). The rate of disease recurrence was similar for both laparoscopic and open surgery. CONCLUSIONS: Laparoscopic surgery for Crohn's disease takes longer to perform, but there are significant short-term benefits to the patient. The morbidity also is lower, and the rate of disease recurrence is similar. Therefore, laparoscopic surgery for Crohn's disease is both safe and feasible.
PURPOSE: This study was designed to determine the safety and feasibility of laparoscopic surgery in Crohn's disease. METHODS: A search of published studies in English between January 1990 and February 2006 was performed by using the MEDLINE and PubMed databases and the Cochrane Central Register of Controlled Trials. The studies were reviewed by two independent assessors. Meta-analysis with the Forest plot was performed when raw data, means, and standard deviations were available. RESULTS: The rate of conversion from laparoscopic to open surgery was 11.2 percent. Laparoscopic procedures took longer to perform compared with open procedures, with a weighted mean difference of 25.54 minutes (P = 0.03). Patients who underwent laparoscopic surgery had a more rapid recovery of bowel function, with a weighted mean difference of 0.75 days (P = 0.02) and were able to tolerate oral intake earlier, with a weighted mean difference of 1.43 days (P = 0.0008). The duration of hospitalization was shorter, with a weighted mean difference of 1.82 days (P = 0.02). Morbidity was lower for laparoscopic procedures compared with open procedures (odds ratio, 0.57; 95 percent confidence interval, 0.37-0.87; P = 0.01). The rate of disease recurrence was similar for both laparoscopic and open surgery. CONCLUSIONS: Laparoscopic surgery for Crohn's disease takes longer to perform, but there are significant short-term benefits to the patient. The morbidity also is lower, and the rate of disease recurrence is similar. Therefore, laparoscopic surgery for Crohn's disease is both safe and feasible.
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