Medial approach versus lateral approach in laparoscopic colorectal resection: a meta-analysis / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare the safety and efficacy of the medial approach(MA) and the lateral approach (LA) in the treatment of colorectal disease.</p><p><b>METHODS</b>Studies published from January 1994 to April 2013 that compared MA to LA in laparoscopic colorectal resection were collected. Publications in English were mainly identified from Medline, Embase, Cochrane Library, and those in Chinese from Wanfang database and CNKI database. Conversion rate, operative time, blood loss, number of harvested lymph nodes, hospital stay, complication, mortality, recurrence, and hospitalization costs of MA and LA were meta-analyzed using fixed-effect and random-effect models.</p><p><b>RESULTS</b>Five cohort studies (2 randomized controlled trials and 3 retrospective studies) including 881 patients were enrolled and analyzed. Of these patients, 416 and 465 underwent laparoscopic colorectal resection with MA and LA respectively. As compared to LA, MA had significantly lower conversion rate (OR=0.42, 95%CI:0.25-0.72, P=0.001), shorter operative time (WMD=-52.62, 95%CI:-63.23--42.01, P<0.01), less number of harvested lymph nodes (WMD=-1.17, 95%CI:-1.89--0.45, P=0.001), while blood loss was less and hospitalization cost lower. Significant differences in intraoperative complications and postoperative complications were not found between the two group (OR:0.57, 95%CI:0.15-2.18, P=0.41; OR:0.78, 95%CI:0.52-1.17, P=0.23).</p><p><b>CONCLUSIONS</b>Compared with LA, MA has the advantages of shorter operative time and lower conversion rate with similar safety. Differences in blood loss, hospitalization cost and oncological safety between the two approaches warrant further investigation.</p>

Meta analysis on the necessity for indwelling gastrointestinal decompression after gastrectomy / 中华普通外科杂志

Objective To evaluate the necessity of indwelling gastrointestinal decompression after gastrectomy. Methods Eight publications on the necessity of gastrointestinal decompression after gastrecomy were colleted, data on recovery time of gastrointestinal function and hospital stay, complications,and motality were Meta-analyzed using fixed effect model and random effect model. Results Eight randomized trails including 975 patients were qualified and included in this study. The differences in time to oral intake ( WMD =0. 61, 95% CI: 0. 17 - 1.05, P ＜ 0. 05 ) and hospital stay ( WMD = 1.20, 95% CI:0. 05 -2. 36, P ＜ 0. 05 ) between the decompression group and non-decompression group were statistically significant, but the difference in time to flatus (WMD = 0. 31,95% CI: -0. 07- 0. 69, P ＞ 0. 05 ) was not significant. There were no significant differences in complications such as nausea and vomiting ( OR = 1.43,95% CI: 0. 61 - 3.31, P ＞ 0. 05 ), pulmonary infection and atelectasis ( OR = 1.43, 95 % CI: 0. 82 - 2. 49,P＞0.05), anastomotic leakage (OR = 1.17, 95%CI: 0.54-2.49, P ＞0.05), abdominal abscess ( OR = 1.08, 95% CI: 0. 50 - 2. 34, P ＞ 0. 05 ), wound dehiscence ( OR = 1.47, 95% CI: 0. 43 - 4. 95,P ＞ 0. 05 ) between the two groups, except for fever ( OR = 1.76, 95% CI: 1.11 - 2. 78, P ＜ 0. 05 ), which was found more frequent in decompression group than in non-decompression group. Conclusions Routine gastrointestinal decompression after gastrectomy was not conductive to the recovery of gastrointestinal function, and could not reduce the incidence of postoperative complications. Postoperative GI decompression increased fever incidence rate and prolonged hospital stay.