Hand-assisted laparoscopic surgery versus open surgery for colorectal disease: a systematic review and meta-analysis

Abstract Background Laparoscopic colorectal surgery remains one of the most challenging techniques to learn. Methods The authors collected studies that have compared hand-assisted laparoscopic surgery (HALS) and open surgery for the treatment of colorectal disease over the past 17 years. Data of int...

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Bibliographic Details
Published in:The American journal of surgery 2014, Vol.207 (1), p.109-119
Main Authors: Ding, Jie, M.D, Xia, Yu, M.D, Liao, Guo-qing, M.D, Zhang, Zhong-min, M.D, Liu, Sheng, M.D, Zhang, Yi, M.D, Yan, Zhong-shu, M.D
Format: Article
Language:English
Subjects:
Abdomen
Breasts
Clinical trials
Colon
Colorectal
Colorectal surgery
Colorectal Surgery - adverse effects
Colorectal Surgery - economics
Colorectal Surgery - instrumentation
Colorectal Surgery - methods
Colorectal Surgery - mortality
Confidence intervals
Conversion to Open Surgery
Disease
Hand-assisted laparoscopic surgery
Hand-Assisted Laparoscopy - adverse effects
Hand-Assisted Laparoscopy - economics
Hand-Assisted Laparoscopy - mortality
Hospital Costs
Humans
Infections
Laparoscopy
Length of Stay
Meta-analysis
Mortality
Open surgery
Operative Time
Pneumonia
Sensitivity analysis
Studies
Surgery
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Summary:Abstract Background Laparoscopic colorectal surgery remains one of the most challenging techniques to learn. Methods The authors collected studies that have compared hand-assisted laparoscopic surgery (HALS) and open surgery for the treatment of colorectal disease over the past 17 years. Data of interest for HALS and open surgery were subjected to meta-analysis. Results Twelve studies that included 1,362 patients were studied. In total, 2.66% of HALS procedures were converted to laparotomy. Compared with the open surgery group, blood loss, rate of wound infection, and ileus in the HALS group decreased, and incision length, recovery of gastrointestinal function, and hospitalization period were shorter. There were no significant differences in operating time, hospitalization costs, mortality, and complications, including urinary tract infection, pneumonia, and anastomotic leak, between the groups. Conclusions HALS has the advantages of minimal invasion, lower blood loss, shorter incision length, and faster recovery, and it can shorten the length of hospitalization without an increase in costs. The drawbacks are that a small number of patients who undergo HALS may need to be converted to laparotomy, and the oncologic safety and long-term prognosis are not clear.
ISSN:0002-9610
1879-1883
DOI:10.1016/j.amjsurg.2013.04.013