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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 [Internet].

Elective laparoscopic sigmoid resection for diverticular disease has fewer complications than conventional surgery: a meta-analysis

MR Siddiqui, MS Sajid, S Qureshi, E Cheek, and MK Baig.

Review published: 2010.

Link to full article: [Journal publisher]

CRD summary

The authors concluded that compared to open resection, laparoscopic sigmoid resection was safe and had fewer postoperative surgical complications. The reliability of the conclusion is uncertain as the synthesis approach may have been inappropriate and few randomised controlled trials were included.

Authors' objectives

To compare rates of complications of open sigmoid resections and laparoscopic sigmoid resections for diverticular disease.

Searching

MEDLINE, The Cochrane Library, EMBASE and CINAHL were searched between January 1991 to March 2009. No language restrictions were applied. Publications in languages other than English were translated. Search terms were reported. Reference lists of relevant articles were handsearched.

Study selection

Studies that compared open sigmoid and laparoscopic sigmoid resections for diverticular disease were eligible for inclusion. Outcome measures were rates of complications (anastomotic leak, anastomotic stricture, enterotomy, need for blood transfusion, intra-abdominal abscess formation, bleeding, incisional hernias, ileus, small-bowel obstruction, wound dehiscence, wound infection, myocardial infarction, pneumonia, pulmonary emboli, urinary tract infections, rehospitalisation and need for reoperation).

No details about study settings were reported. Treatment protocols were varied (lap-intracorporeal anastomosis, intracorporeal anastomosis with air check, intracorporeal anastomosis; further details reported in paper).

Two reviewers independently assessed studies for inclusion. Differences were resolved before final analysis.

Assessment of study quality

Quality of randomised controlled trials (RCTs) was assessed using modified Jadad and Chalmers et al. criteria. Key domains assessed included allocation concealment, randomisation, blinding, withdrawals and drop-outs and intention-to-treat analyses. Scores were awarded up to a maximum of 15.

Quality of prospective and retrospective studies was assessed using Scottish Intercollegiate Guidelines Network and Rangel et al. criteria. Scores were awarded up to a maximum of 21 (<8 was considered poor quality, 8 to 14 was fair and ≥15 was good).

The authors did not state how many reviewers assessed study quality.

Data extraction

Two reviewers independently extracted data to calculate risk ratios (RRs) and 95% confidence intervals (CIs). A third reviewer double-checked extracted data.

Methods of synthesis

Pooled risk ratios and corresponding 95% CIs were calculated using fixed-effect (Mantel-Haenszel) meta-analysis where there was no evidence of heterogeneity and random-effects (DerSimonian and Laird) meta-analysis where there was heterogeneity. Heterogeneity was assessed using X2. Sensitivity analysis with 0.5 correction was used where no events were reported for treatments examined.

Results of the review

Nineteen studies (2,383 participants, range nine to 332) were included: one RCT, 10 prospective designs and eight retrospective designs. The RCT was rated as good quality. Most of the prospective and retrospective studies were rated as fair quality.

Compared to open sigmoid resections, laparoscopic sigmoid resection was associated with significantly lower rates of wound infections (fixed-effect RR 0.54, 95% CI 0.36 to 0.80; 15 studies), blood transfusions (fixed-effect RR 0.25, 95% CI 0.10 to 0.60; four studies), ileus (fixed-effects RR 0.37, 95% CI 0.20 to 0.66; eight studies) and incisional hernia (fixed-effect RR 0.27, 95% CI 0.12 to 0.64; seven studies). Random effects effect sizes did not differ significantly from fixed-effect estimates.

No significant differences between groups were found for anastomotic leak and stricture, bowel perforation and enterotomy, intra-abdominal bleeding and abscess formation, small-bowel obstruction, wound dehiscence, myocardial infarction, pneumonias, pulmonary emboli, urinary tract infections, need for rehospitalisation and need for reoperation.

There was no evidence of heterogeneity in all complications analysed.

Authors' conclusions

Compared to open resection, laparoscopic sigmoid resection was safe and had fewer postoperative surgical complications.

CRD commentary

The review question was clearly stated with regard to eligible interventions and outcomes. Eligible study designs and participants were not stated clearly. Four major databases were searched without language restrictions, which minimised potential language bias. It was not clear that unpublished studies were sought and so some relevant papers may have been missed. Study selection and data extraction were performed in duplicate, which minimised potential for reviewer error and bias; it was unclear whether similar processes were used in quality assessment and this raised the possibility of error and bias. Quality of included studies was assessed using modified tools and results were reported; most were non-randomised trials. The decision to combine studies with mixed designs in a meta-analysis was inappropriate.

The reliability of the authors’ conclusion is uncertain as the synthesis approach may have been inappropriate and few randomised controlled trials were included.

Implications of the review for practice and research

Practice: The authors stated that compared to open resection, laparoscopic sigmoid resection was safe and had fewer postoperative surgical complications and should be considered for elective cases.

Research: The authors stated that further RCTs were needed to compare rates of complications for open and laparoscopic elective sigmoidectomy for diverticular disease.

Funding

Not stated.

Bibliographic details

Siddiqui MR, Sajid MS, Qureshi S, Cheek E, Baig MK. Elective laparoscopic sigmoid resection for diverticular disease has fewer complications than conventional surgery: a meta-analysis. American Journal of Surgery 2010; 200(1): 144-161. [PubMed: 20637347]

Other publications of related interest

Siddiqui MR, Sajid MS, Khatri K, Cheek E, Baig MK. Elective open versus laparoscopic sigmoid colectomy for diverticular disease: a meta-analysis with the Sigma trial. World Journal of Surgery 2010; 34(12): 2883-2901.

Indexing Status

Subject indexing assigned by NLM

MeSH

Colectomy /adverse effects /methods; Diverticulum, Colon /surgery; Humans; Laparoscopy /adverse effects; Sigmoid Diseases /surgery; Elective Surgical Procedures /adverse effects

AccessionNumber

12010005966

Database entry date

30/11/2011

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

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

Copyright © 2014 University of York.

PMID: 20637347

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