Laparoscopic versus Open Surgery for Diverticulitis: A Systematic Review and Meta-Analysis

Abstract

Background/Aims: The study aimed to perform a meta-analysis comparing laparoscopic and open surgery for diverticulitis. Methods: Studies comparing the outcomes of laparoscopic surgery versus open surgery for diverticulitis that reported quantitative data were included. Outcome measures were mortality and morbidity rates and length of hospital stay. Results: Four randomized controlled trials - 3 prospective and 21 retrospective - were included in the analysis. The total numbers of patients ranged from 5 to 14,562 in the laparoscopic groups and from 4 to 110,172 in the open surgery groups, and the mean patient age ranged from 38.9 to 78 years. Overall analysis revealed that laparoscopic surgery was associated with lower mortality (pooled OR 0.40, 95% CI 0.25-0.63, p < 0.001) and a lower overall morbidity rate (pooled OR 0.65, 95% CI 0.51-0.82, p < 0.001) than open surgery. Laparoscopic surgery was associated with a higher anastomotic bleeding rate, but lower rates of ileus, anastomotic leakage, small bowel obstruction, wound infection, fascial dehiscence and intra-abdominal abscesses. Length of hospital stay was less with laparoscopic surgery. Conclusions: The current meta-analysis supports the use of laparoscopy for the treatment of diverticulitis. The results, however, should be interpreted with caution.

Equivalency of short-term perioperative outcomes after open, laparoscopic, and robotic ileal pouch anal anastomosis. Does procedure complexity override operative approach?

“…The patient-related benefits of laparoscopy in terms of earlier return in bowel function, shorter length of stay, and fewer postoperative complications due to less surgical trauma are well established. Patients undergoing various advanced laparoscopic procedures such as paraesophageal hernia repair [ 19 ], Roux-en-Y gastric bypass [ 20 , 21 ], and segmental colectomy [ 22 ] have consistently been found to have measurably better perioperative outcomes compared to patients undergoing the same operation by an open approach. These corresponding findings have also been confirmed when these procedures were performed on a robotic platform [ 20 , 23 , 24 ].…”

Doença Diverticular e Diverticulite Aguda: atualização de manejo e métodos cirúrgicos indicados / Diverticular Disease and Acute Diverticulitis: updated management and indicated surgical methods

“…Ao estender essa comparação à processos laparoscópicos é possível entender a preferência que há em cirurgias por vídeos. Em um estudo de meta-análise sistematizado por Wu (15) foram analisados um total de grupo de até 14.562 pacientes submetidos a cirurgia laparoscópica e um total de até 110.172 pacientes submetidos a cirurgia aberta.…”

Management of complicated diverticulitis of the colon

“…Results of the meta‐analysis indicate that laparoscopic surgery is associated with an overall lower mortality rate and a lower overall morbidity rate than open surgery for diverticulitis. However, laparoscopic surgery is associated with a higher rate of anastomotic bleeding compared to open surgery . There is no place today for laparoscopic resection for Hinchey stage III or IV disease…”