title: A systematic review and meta-analysis of laparoscopic vs open restorative proctocolectomy.
abstract: OBJECTIVE
  The benefits of a laparoscopic approach to restorative proctocolectomy (RPC) are controversial. The aim of this meta-analysis was to compare the outcome following laparoscopic and open RPC, with particular attention to adverse events and long-term function.
  
  
  METHODS
  A systematic search of the MEDLINE, EMBASE and Ovid databases was performed for studies published until March 2012. The primary end-point was long-term function. Secondary end-points were intra-operative details, short-term postoperative outcome and postoperative adverse events. Weighted mean difference (WMD) and odds ratio (OR) were calculated using fixed/random effect meta-analytic techniques.
  
  
  RESULTS
  The final analysis included 27 comparative studies of 2428 patients, of whom 1097 (45.1%) underwent laparoscopic surgery. A laparoscopic approach was associated with a significantly longer operation time (WMD 70.1 min, P < 0.001), shorter length of hospital stay (WMD -1.00 day, P < 0.001), reduced intra-operative blood loss (WMD -89.10 ml, P < 0.001) and a lower incidence of wound infection (OR 0.60, P < 0.005). No significant differences were observed in the rate of pouch failure. Although there was no significant difference in the number of daily bowel movements (OR 0.04, P = 0.950), laparoscopic surgery led to fewer nocturnal bowel movements (WMD -1.14, P < 0.001) and reduced pad usage during the day (OR 0.22, P < 0.001) and night (OR 0.33, P < 0.001). The post hoc power to detect differences in adverse event rates ranged from 5% to 42%.
  
  
  CONCLUSIONS
  Laparoscopic and open approaches to RPC produced equivalent adverse event rates and long-term functional results. However, the present evidence is underpowered to detect true differences in adverse event rates.
authors.affiliation: Faculty of Medicine, Imperial College London, London, UK.
authors.forename: P
authors.initials: P
authors.lastname: Singh
authors.forename: A
authors.initials: A
authors.lastname: Bhangu
authors.forename: R J
authors.initials: RJ
authors.lastname: Nicholls
authors.forename: P
authors.initials: P
authors.lastname: Tekkis
mesh_terms: D006801:Humans; D057868:Anastomotic Leak / Q000453:epidemiology; D003093:Colitis, Ulcerative / Q000601:surgery; D003108:Colonic Diseases / Q000601:surgery; D039021:Colonic Pouches; D015179:Colorectal Neoplasms / Q000601:surgery; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay / Q000706:statistics & numerical data; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology; D016737:Proctocolectomy, Restorative / Q000379:methods; D016896:Treatment Outcome
keywords: Ileal pouch anal anastomosis; ileal pouch; meta-analysis; restorative proctocolectomy