Meta-analysis of the laparoscopic versus open colorectal surgery within fast track surgery

• Published in: International journal of colorectal disease Vol. 31; no. 3; pp. 613 - 622
• Main Authors: Zhao, Jun-hua, Sun, Jing-xu, Huang, Xuan-zhang, Gao, Peng, Chen, Xiao-wan, Song, Yong-xi, Liu, Jing, Cai, Cheng-zhe, Xu, Hui-mian, Wang, Zhen-ning
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.03.2016; Springer; Springer Nature B.V
• Subjects: Aged; Aged, 80 and over; Analysis; Colorectal Surgery - adverse effects; Colorectal Surgery - mortality; Defecation; Gastroenterology; Health aspects; Hepatology; Humans; Internal Medicine; Laparoscopic surgery; Laparoscopy; Laparoscopy - adverse effects; Laparoscopy - mortality; Length of Stay; Medicine; Medicine & Public Health; Middle Aged; Mortality; Original Article; Patient Readmission; Postoperative Complications - etiology; Proctology; Risk Factors; Surgery; Time Factors; Fast track surgery; Laparoscopic surgery; Colorectal surgery
• ISSN: 0179-1958; 1432-1262
• DOI: 10.1007/s00384-015-2493-2

Background Laparoscopic methods and fast-track surgery (FTS) can enhance recovery and reduce postoperative hospital stay. However, whether laparoscopic surgery can provide short-term benefits within FTS is controversial. Thus, we conducted a meta-analysis of published studies to evaluate the effect of laparoscopic colorectal surgery within FTS. Methods We searched PubMed, EMBASE, Cochrane Library, and Ovid databases for eligible studies. Endpoints were duration of postoperative hospital stay, time to first bowel movement, total postoperative complication rate, readmission rate, mortality within 30 days after surgery, and conversation rate of laparoscopic surgery. Results Four randomized controlled trials and six clinical controlled trials (1510 patients) were eligible for analyses. Duration of postoperative hospital stay (weighted mean difference, –1.65 days; p  < 0.001), time to first bowel movement (–1.13 days; p  < 0.001), total postoperative complication rate (risk ratio [RR], 0.65; p  < 0.001), readmission rate (0.46; p  < 0.001), and mortality (0.45; p  < 0.001) were significantly reduced in the laparoscopic surgery group. Overall conversion rate of laparoscopic surgery was 11.1 %. Subgroup analyses based on each FT element demonstrated that studies without the element “prevention of hypothermia,” “no bowel preparation,” or “no routine use of drains” did not show significant differences between two groups with regard to duration of postoperative hospital stay or total prevalence of postoperative complications. Conclusion Within FTS, laparoscopic methods can significantly shorten postoperative hospital stay, accelerate postoperative recovery, and enhance safety in colorectal surgery. The FT elements “prevention of hypothermia,” “no bowel preparation,” and “no routine use of drains” may play important parts in the combined effect of these two methods.