Hand-assisted or laparoscopic-assisted approach in colorectal surgery: a systematic review and meta-analysisReport as inadecuate




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Surgical Endoscopy

, 22:1769

First Online: 24 April 2008Received: 23 July 2007Revised: 21 January 2008Accepted: 07 February 2008

Abstract

BackgroundEvidence of benefits of laparoscopic and laparoscopic-assisted colectomies LAC over open procedures in gastrointestinal surgery has continued to accumulate. With its wide implementation, technical difficulties and limitations of LAC have become clear. Hand-assisted laparoscopic surgery HALS was introduced in an attempt to facilitate the transition from open techniques to minimally invasive procedures. Continuing debate exists about which approach is to be preferred, HALS or LAC. Several studies have compared these two techniques in colorectal surgery, but no single study provided evidence which procedure is superior. Therefore, a systematic review was carried out comparing HALS with LAC colorectal resection.

MethodsEligible studies were identified from electronic databases Medline, Embase Cochrane and cross-reference search. The database search, quality assessment, and data extraction were independently performed by two reviewers. Minimal outcome criteria for inclusion were operating time, conversion rate, hospital stay, and morbidity.

ResultsOut of 468 studies a total of 13 studies were selected for comprehensive review. Two randomized controlled trials RCT and 11 non-RCTs, comprising 1017 patients, met the inclusion criteria. Because of possible clinical heterogeneity two groups of procedures were created: segmental colectomies and total proctocolectomies. In the segmental colectomy group significant differences in favor of the HALS group were seen in operating time WMD 19 min and conversion rate OR of 0.3 conversions. In the total proctocolectomy group a significant difference in favor of the HALS group was seen in operating time WMD 61 min.

ConclusionsThis systematic review indicates that HALS provides a more efficient segmental colectomy regarding operating time and conversion rate, particularly accounting for diverticulitis. A significant operating time advantage exists for HALS total proctocolectomy. HALS must therefore be considered a valuable addition to the laparoscopic armamentarium to avoid conversion and speed up complicated colectomies.

KeywordsSystematic review Meta-analysis Colon Colorectal Intestinal surgery Laparoscopy Hand-assisted  Download fulltext PDF



Author: A. G. J. Aalbers - S. S. A. Y. Biere - M. I. van Berge Henegouwen - W. A. Bemelman

Source: https://link.springer.com/article/10.1007/s00464-008-9857-4







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