Roberto Cirocchi1, Nicola Fearnhead2, Nereo Vettoretto3, Diletta Cassini4, Georgi Popivanov5, Brandon Michael Henry6, Krzysztof Tomaszewski7, Vito D'Andrea8, Justin Davies9, Salomone Di Saverio10. 1. Department of Surgical and Biomedical Sciences, University of Perugia, Italy. Electronic address: roberto.cirocchi@unipg.it. 2. Cambridge Colorectal Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK. Electronic address: nicola.fearnhead@cambridgecolorectal.org. 3. Montichiari Surgery, ASST Spedali Civili, Brescia, Italy. Electronic address: nereovet@gmail.com. 4. Policlinic of Abano Terme, Padua, Italy. Electronic address: diletta_cassini@yahoo.it. 5. Military Medical Academy, Clinic of Endoscopic, Endocrine Surgery and Coloproctology, Sofia, Bulgaria. Electronic address: gerasimpopivanov@rocketmail.com. 6. Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland. Electronic address: bmhenry55@gmail.com. 7. Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland. Electronic address: krtomaszewski@gmail.com. 8. Department of Surgical Sciences, The University of Rome "La Sapienza", Rome, Italy. Electronic address: vito.dandrea@uniroma1.it. 9. Cambridge Colorectal Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK. Electronic address: justin.davies@addenbrookes.nhs.uk. 10. Cambridge Colorectal Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK. Electronic address: salomone.disaverio@addenbrookes.nhs.uk.
Abstract
BACKGROUND: Nowadays sigmoidectomy is recommended as "gold standard" treatment for generalized purulent or faecal peritonitis from sigmoid perforated diverticulitis. This systematic review and meta-analysis aimed to assess effectiveness and safety of laparoscopic access versus open sigmoidectomy in acute setting. METHODS: A systematic literature search was performed for randomized controlled trials (RCTs) and non-RCTs published in PubMed, SCOPUS and Web of Science. RESULTS: The search yielded four non-RCTs encompassing 436 patients undergoing either laparoscopic (181 patients, 41.51%) versus open sigmoid resection (255 patients, 58.49%). All studies reported ASA scores, but only four studies reported other severity scoring systems (Mannheim Peritonitis Index, P-POSSUM). Level of surgical expertise was reported in only one study. Laparoscopy improves slightly the rates of overall post-operative complications and post-operative hospital stay, respectively (RR 0.62, 95% CI 0.49 to 0.80 and MD -6.53, 95% CI -16.05 to 2.99). Laparoscopy did not seem to improve the other clinical outcomes: rate of Hartmann's vs anastomosis, operating time, reoperation rate and postoperative 30-day mortality. CONCLUSION: In this review four prospective studies were included, over 20 + year period, including overall 400 + patients. This meta-analysis revealed significant advantages associated with a laparoscopic over open approach to emergency sigmoidectomy in acute diverticulitis in terms of postoperative complication rates, although no differences were found in other outcomes. The lack of hemodynamic data and reasons for operative approach hamper interpretation of the data suggesting that patients undergoing open surgery were sicker and these results must be considered with extreme caution and this hypothesis requires confirmation by future prospective randomised controlled trials.
BACKGROUND: Nowadays sigmoidectomy is recommended as "gold standard" treatment for generalized purulent or faecal peritonitis from sigmoid perforated diverticulitis. This systematic review and meta-analysis aimed to assess effectiveness and safety of laparoscopic access versus open sigmoidectomy in acute setting. METHODS: A systematic literature search was performed for randomized controlled trials (RCTs) and non-RCTs published in PubMed, SCOPUS and Web of Science. RESULTS: The search yielded four non-RCTs encompassing 436 patients undergoing either laparoscopic (181 patients, 41.51%) versus open sigmoid resection (255 patients, 58.49%). All studies reported ASA scores, but only four studies reported other severity scoring systems (Mannheim Peritonitis Index, P-POSSUM). Level of surgical expertise was reported in only one study. Laparoscopy improves slightly the rates of overall post-operative complications and post-operative hospital stay, respectively (RR 0.62, 95% CI 0.49 to 0.80 and MD -6.53, 95% CI -16.05 to 2.99). Laparoscopy did not seem to improve the other clinical outcomes: rate of Hartmann's vs anastomosis, operating time, reoperation rate and postoperative 30-day mortality. CONCLUSION: In this review four prospective studies were included, over 20 + year period, including overall 400 + patients. This meta-analysis revealed significant advantages associated with a laparoscopic over open approach to emergency sigmoidectomy in acute diverticulitis in terms of postoperative complication rates, although no differences were found in other outcomes. The lack of hemodynamic data and reasons for operative approach hamper interpretation of the data suggesting that patients undergoing open surgery were sicker and these results must be considered with extreme caution and this hypothesis requires confirmation by future prospective randomised controlled trials.
Authors: Nicolás H Dreifuss; Francisco Schlottmann; Jose M Piatti; Maximiliano E Bun; Nicolás A Rotholtz Journal: Surg Endosc Date: 2019-06-17 Impact factor: 4.584
Authors: R Nascimbeni; A Amato; R Cirocchi; A Serventi; A Laghi; M Bellini; G Tellan; M Zago; C Scarpignato; G A Binda Journal: Tech Coloproctol Date: 2020-11-05 Impact factor: 3.781