Laparoscopic versus open surgery in small bowel obstruction

  • Review
  • Intervention

Authors


Abstract

Background

Acute intestinal obstruction is one of the most common surgical emergencies. The small bowel obstruction (SBO) is the site of obstruction in most patients (76%) and adhesions are the most common etiology (65%). Laparoscopy in SBO has no clear role yet as it may have a therapeutic and diagnostic function. In some settings laparoscopic or laparoscopy-assisted surgery is considered feasible and convenient more than conventional surgery for SBO; however little is known if laparoscopic or laparoscopy-assisted surgery is more suitable with respect to open surgery for patients with SBO.

Objectives

The aim of this systematic review is to assess whether laparoscopic or laparoscopy-assisted surgery is feasible and safe for acute SBO, and whether laparoscopic and laparoscopy-assisted surgery present advantages compared to open surgery in terms of short-term and long-term outcomes.

Search methods

We searched for published randomised and prospective controlled clinical trials without language restrictions using the following electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1950 onwards) and EMBASE (1980 onwards).

Selection criteria

Randomised controlled trials and non randomised controlled prospective trials evaluating laparoscopic and laparoscopy-assisted surgery versus traditional open surgery for acute SBO were considered.

Data collection and analysis

We conducted the review according to the recommendations of The Cochrane Collaboration and the Cochrane Colorectal Group as well, using Review Manager 5 to conduct the review.

Main results

No published or unpublished randomised controlled trials or prospective controlled clinical trials comparing laparoscopy with open surgery for patients with SBO were identified.

Authors' conclusions

Although data from retrospective clinical controlled trials suggest that laparoscopy seems feasible and better in terms of hospital stay and mortality reduction, high quality randomised controlled trials assessing all clinically relevant outcomes including overall mortality, morbidity, hospital stay and conversion are needed.

摘要

小腸阻塞之腹腔鏡手術治療與傳統開腹式手術治療之比較

研究背景

急性腸阻塞是常見的外科急症之一。其中小腸是最容易發生的位置(佔76%),而最常見的致病原因則是沾黏(佔65%)。腹腔鏡檢查雖然同時具有診斷及治療的功能,但對於小腸阻塞方面仍有著不明確的角色。在某些情況下,治療小腸阻塞時,腹腔鏡輔助手術或者腹腔鏡手術被認為比傳統手術更可行而且便利。然而究竟何者孰優目前尚無足夠研究可資參考。

研究目的

本篇系統性研究之目標即為評估治療急性小腸阻塞時腹腔鏡/腹腔鏡輔助手術之可行性及安全性,以及在短期/長期追蹤成果上,是否比開腹式手術來得有優勢。

检索策略

我們在下列幾個資料庫搜尋了不限語言種類的所有發表過隨機且前瞻性控制的臨床試驗:包括考科藍中央資料庫(Cochrane Central Register of Controlled Trials ),MEDLINE (1950 ~) and EMBASE (1980 ~).

标准/纳入排除标准

所有關於評估比較腹腔鏡/腹腔鏡輔助手術與開腹式手術治療小腸阻塞之隨機控制試驗與非隨機控制前瞻性試驗均納入研究。

数据收集与分析

本研究依據考科藍協作組織及考科藍大腸直腸組之建議實施,並使用Review Manager 5 進行審核。

主要结果

研究結果並未搜尋到任何已發表或未發表的關於比較腹腔鏡/腹腔鏡輔助手術與開腹式手術治療小腸阻塞之隨機控制試驗或前瞻性控制試驗。

作者结论

雖然目前從回溯性臨床控制試驗得到的資料看來,腹腔鏡似乎是可行的,而且在住院天數及死亡率降低方面似乎也有較佳的結果,但我們仍需要進一步優質的隨機臨床試驗來評估總體死亡率、併發症、住院日數及轉變開腹手術比例。

Plain language summary

Should laparoscopic adhesiolysis be used in patients with acute small bowel intestinal obstruction?

Abdominal laparoscopy is a minimally invasive surgical technique in which operations are achieved through incision (usually 2-3 cm) using a laparoscope which is connected to a video camera. Small bowel obstruction is an event that may follow open surgery. According to several studies laparoscopic surgery is technically feasible and safe for the treatment of small bowel obstruction, however little is known about its efficacy in terms of mortality and morbidity.

This review addresses the question if laparoscopic surgery is effective with respect to traditional laparotomy. No randomised controlled trials or prospective controlled clinical trials that compared laparoscopy with laparotomy for small bowel obstruction were identified. Although there was some evidence from case series reports, observational studies and retrospective controlled clinical trial, high quality randomised controlled trials are required on the potential benefit and harms associated with the use of laparoscopy in small bowel obstruction.

概要

腹腔鏡腸沾黏剝離手術是否適用於急性小腸阻塞? 腹腔鏡是一種微創外科技術,使用接上攝影機的腹腔鏡,在小切口(約2-3公分)進行手術。而小腸阻塞過去通常需要開腹式手術治療。許多研究顯示治療此一疾病使用腹腔鏡應該是可行且安全的,但是關於死亡率及併發症比率則仍不清楚。此系統分析原是為評估腹腔鏡是否優於傳統開腹式手術,但目前仍沒有隨機控制試驗或前瞻式控制試驗可供分析比較。即便目前已有回溯性、觀察性研究證實腹腔鏡的優點,我們仍需要優質隨機控制試驗來評估腹腔鏡手術治療小腸阻塞的優缺點。

翻译注解