ABSTRACT
Objective To systematically evaluate the efficacy and safety of laparoscopic adhesiolysis versus open surgery for adhesive small bowel obstruction.Methods The databases including PubMed,EMbase,The Cochrane Library (Issue 3,2017),ICTRP,CNKI,VIP,CBM and Wanfang Data were electronically searched to collect randomized controlled trials (RCTs) about laparoscopic adhesiolysis versus open surgery for adhesive small bowel obstruction patients from inception to March 2017.Two reviewers independently screened literature,extracted data and assessed the risk of bias of included studies.Then meta-analysis was conducted by RevMan 5.3 software.Results A total of 31 studies involving 3293 patients were included.The results of meta-analysis showed that,compared with the open surgery group,the laparoscopic adhesiolysis group could significantly reduce the recurrence rate (OR=0.18,95％CI 0.12-0.25,P＜0.000 01),overall complications (OR=0.17,95％CI 0.13-0.23,P＜0.000 01),wound infection (OR=0.21,95％CI 0.13-0.35,P＜0.000 01),pneumonia (OR=0.35,95％CI 0.15-0.82,P=0.02) and intestinal fistula (OR=0.32,95％CI 0.15-0.70,P=0.005).Conclusions Current evidence shows that laparoscopic adhesiolysis can reduce the recurrence rate and complications in adhesive small bowel obstruction.Due to the limited quality of included studies,more high quality studies are needed to verify the above conclusion.
ABSTRACT
Objective To evaluate the clinical efficacy and safety of laparoscopic adhesiolysis for patients with adhesive ileus. Methods Clinical data and follow-up data of 95 cases of adhesive ileus were retrospectively analyzed. Based on the surgical approach, patients were divided into laparotomy group (43 cases) and laparoscopic group (52 cases), and the intraoperative situation postoperative complications and recurrence were compared. Results The operation time of laparoscopy group was less than the laparotomy group [(68.35 ± 36.47) vs (82.54 ± 23.27) min, t = 2.21, P = 0.029]; blood loss was less than the laparotomy group [(69.51 ± 20.33) vs (198.37 ± 50.04) ml, t = 16.97, P = 0.000]; postoperative analgesic dosage was less than the laparotomy group [(1.01 ± 0.99) vs (3.46 ± 1.53), t = 9.41, P = 0.000]; time of posterior ambulation was less than the laparotomy group [(11.05 ± 1.32) vs (20.36 ± 2.59) d, t = 16.97, P = 0.000]; gastrointestinal function recovery time was less than laparotomy group [(2.30 ± 1.38) vs (4.05 ± 1.74) d, t = 5.47, P = 0.000]; catheter removal time was lower than the laparotomy group [(3.04 ± 2.11) vs (5.36 ± 2.24) d, t = 5.19, P = 0.000]; hospital stay was less than the laparotomy group [(5.89 ± 1.57) vs (10.36 ± 2.65) d, t = 10.02, P = 0.000]; the postoperative complication rate of laparoscopy group and laparotomy group was 3.84% (2 cases) and 16.27% (7 cases), respectively, the difference was not statistically significance (χ2 = 4.24, P = 0.074); followed up from 8 to 36 months, there were 2 cases, 6 cases of intractable abdominal pain and intestinal obstruction recurrence in laparoscopy group and laparotomy group respectively, the relapse outcomes of laparotomy group was higher than laparoscopy group, but the difference was not statistically significant (χ2 = 3.64, P = 0.056). Conclusion Laparoscopic adhesiolysis is safe, effective, and have the characteristics with less trauma, less interference on the abdominal cavity, it is better than open surgery.