The role of laparoscopic surgery for ulcerative colitis: systematic review with meta-analysis.
OBJECTIVE
Crohn's disease is established in laparoscopic surgery due to partial bowel dissection and low postoperative complication rate. However, laparoscopic surgery for ulcerative colitis remains further discussed even if the trend of minimally invasive technique exists. This study is to figure out how laparoscopic surgery works for ulcerative colitis.


METHODS
Sixteen controlled trials were identified through the search strategy mentioned below. There was only one prospective randomized study among the studies selected. A meta-analysis pooled the outcome effects of laparoscopic surgery and open surgery was performed. Fixed effect model or random effect model was respectively used depending on the heterogeneity test of trials.


RESULTS
Postoperative fasting time and postoperative hospital stay were shorter in laparoscopic surgery for ulcerative colitis (-1.37 [-2.15, -0.58], -3.22 [-4.20, -2.24], respectively, P < 0.05). Overall complication rate was higher in open surgery, compared with laparoscopic surgery (54.8% versus 39.3%, P = 0.004). However, duration of laparoscopic surgery for ulcerative colitis was extended compared with open surgery (weighted mean difference 69.29 min, P = 0.04). As to recovery of bowel function, peritoneal abscess, anastomotic leakage, postoperative bowel obstruction, wound infection, blood loss, and mortality, laparoscopic surgery did not show any superiority over open surgery. Re-operation rate was almost even (5.2% versus 7.3%). The whole conversion to open surgery was 4.2%.


CONCLUSIONS
Laparoscopic surgery for ulcerative colitis was at least as safe as open surgery, even better in postoperative fasting time, postoperative hospital stay, and overall complication rate. However, clinical value of laparoscopic surgery for ulcerative colitis needed further evaluation with more well-designed and long-term follow-up studies.
Wu
Xiao-Jian
XJ
Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
He
Xiao-Sheng
XS
Zhou
Xu-Yu
XY
Ke
Jia
J
Lan
Ping
P
D000038:Abscess / Q000150:complications; D000714:Anastomosis, Surgical; D016063:Blood Loss, Surgical; D003093:Colitis, Ulcerative / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D005215:Fasting; D006801:Humans; D007415:Intestinal Obstruction / Q000150:complications; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D011183:Postoperative Complications / Q000209:etiology; D020127:Recovery of Function; D012086:Reoperation; D013530:Surgical Wound Infection / Q000150:complications; D013997:Time Factors; D016896:Treatment Outcome