Reoch Jennifer, Mottillo Salvatore, Shimony Avi, Filion Kristian B, Christou Nicolas V, Joseph Lawrence, Poirier Paul, Eisenberg Mark J
Divisions of Cardiology and Clinical Epidemiology, Jewish General Hospital/McGill University, Quebec, Canada.
Arch Surg. 2011 Nov;146(11):1314-22. doi: 10.1001/archsurg.2011.270.
To perform a systematic review and meta-analysis evaluating the risk of reoperation, wound infection, incisional hernia, anastomotic leak, and all-cause mortality associated with laparoscopic vs open bariatric surgery at a minimum of 12 months' follow-up.
We systematically searched the Cochrane Library, EMBASE, and MEDLINE databases through June 1, 2010, for randomized controlled trials comparing laparoscopic with open bariatric surgery.
We included all randomized controlled trials that reported weight loss outcomes and complications at a minimum of 12 months' follow-up and had a minimum of 50 patients. We identified 6 randomized controlled trials, which randomized 510 patients.
Data were extracted by 2 reviewers on study design, baseline characteristics, and surgical procedure. The outcome data extracted included change in weight and body mass index and the incidence of reoperation, wound infection, incisional hernia, anastomotic leak, and all-cause mortality.
We used random-effects models, which accounted for within-study and between-study variability, to estimate pooled risk ratios (95% CIs). Compared with open surgery, laparoscopic surgery was associated with lower risk of wound infection (relative risk [RR], 0.21; 95% CI, 0.07-0.65) and incisional hernia (RR, 0.11; 95% CI, 0.03-0.35). The risk of reoperation (RR, 1.06; 95% CI, 0.70-1.61), anastomotic leak (RR, 0.64; 95% CI, 0.14-2.95), and all-cause mortality (RR, 0.86; 95% CI, 0.22-3.28) may be similar for laparoscopic and open bariatric surgery.
Laparoscopic surgery may be a safer treatment than open surgery for patients requiring bariatric surgery.
进行一项系统评价和荟萃分析，评估在至少12个月的随访期内，与开腹减肥手术相比，腹腔镜减肥手术的再次手术风险、伤口感染、切口疝、吻合口漏和全因死亡率。
我们系统检索了截至2010年6月1日的Cochrane图书馆、EMBASE和MEDLINE数据库，以查找比较腹腔镜减肥手术与开腹减肥手术的随机对照试验。
我们纳入了所有在至少12个月的随访期内报告体重减轻结果和并发症且至少有50例患者的随机对照试验。我们确定了6项随机对照试验，共随机分配了510例患者。
由2名审阅者提取关于研究设计、基线特征和手术过程的数据。提取的结局数据包括体重和体重指数的变化以及再次手术、伤口感染、切口疝、吻合口漏和全因死亡率的发生率。
我们使用随机效应模型（该模型考虑了研究内和研究间的变异性）来估计合并风险比（95%可信区间）。与开腹手术相比，腹腔镜手术的伤口感染风险较低（相对风险[RR]，0.21；95%可信区间，0.07 - 0.65）和切口疝风险较低（RR，0.11；95%可信区间，0.03 - 0.35）。腹腔镜减肥手术和开腹减肥手术的再次手术风险（RR，1.06；95%可信区间，0.70 - 1.61）、吻合口漏风险（RR，0.64；95%可信区间，0.14 - 2.95）和全因死亡率风险（RR，0.86；95%可信区间，0.22 - 3.28）可能相似。
对于需要减肥手术的患者，腹腔镜手术可能比开腹手术更安全。
