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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews.

Safety of laparoscopic vs open bariatric surgery: a systematic review and meta-analysis

Review published: 2011.

Bibliographic details: Reoch J, Mottillo S, Shimony A, Filion KB, Christou NV, Joseph L, Poirier P, Eisenberg MJ.  Safety of laparoscopic vs open bariatric surgery: a systematic review and meta-analysis. Archives of Surgery 2011; 146(11): 1314-1322. [PubMed: 22106325]

Quality assessment

This review found that laparoscopic bariatric surgery was associated with less risk of incisional hernia and wound infection compared with open surgery in patients with morbid obesity. In general, the results should be interpreted with some caution because of the middling to poor quality of the included trials, but the authors' cautious conclusions are likely to be reliable. Full critical summary

Abstract

OBJECTIVE: To perform a systematic review and meta-analysis evaluating the risk of reoperation, wound infection, incisional hernia, anastomotic leak, and all-cause mortality associated with laparoscopic vs open bariatric surgery at a minimum of 12 months' follow-up.

DATA SOURCES: We systematically searched the Cochrane Library, EMBASE, and MEDLINE databases through June 1, 2010, for randomized controlled trials comparing laparoscopic with open bariatric surgery.

STUDY SELECTION: We included all randomized controlled trials that reported weight loss outcomes and complications at a minimum of 12 months' follow-up and had a minimum of 50 patients. We identified 6 randomized controlled trials, which randomized 510 patients.

DATA EXTRACTION: Data were extracted by 2 reviewers on study design, baseline characteristics, and surgical procedure. The outcome data extracted included change in weight and body mass index and the incidence of reoperation, wound infection, incisional hernia, anastomotic leak, and all-cause mortality.

DATA SYNTHESIS: We used random-effects models, which accounted for within-study and between-study variability, to estimate pooled risk ratios (95% CIs). Compared with open surgery, laparoscopic surgery was associated with lower risk of wound infection (relative risk [RR], 0.21; 95% CI, 0.07-0.65) and incisional hernia (RR, 0.11; 95% CI, 0.03-0.35). The risk of reoperation (RR, 1.06; 95% CI, 0.70-1.61), anastomotic leak (RR, 0.64; 95% CI, 0.14-2.95), and all-cause mortality (RR, 0.86; 95% CI, 0.22-3.28) may be similar for laparoscopic and open bariatric surgery.

CONCLUSION: Laparoscopic surgery may be a safer treatment than open surgery for patients requiring bariatric surgery.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2014 University of York.

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