Celentano Valerio, Giglio Mariano Cesare, Bucci Luigi
Department of General, Oncologic and Video-Assisted Surgery, Colorectal Unit, Federico II University, Naples, Italy.
Int J Colorectal Dis. 2015 Dec;30(12):1603-15. doi: 10.1007/s00384-015-2325-4. Epub 2015 Jul 19.
Hartmann's reversal is a major surgical procedure with consistent morbidity and mortality rates. Laparoscopy has been extensively applied to colorectal surgery providing significant benefits on short- and long-term outcomes. We performed a meta-analysis of the current evidence comparing the short-term outcomes of laparoscopic Hartmann's reversal (LHR) to open Hartmann's reversal (OHR).
A systematic search of Medline, Scopus, Web of Science, Embase, and the Cochrane database was performed. Comparative studies reporting short-term outcomes of LHR versus OHR with an intention-to-treat analysis were considered for eligibility. Primary outcome was 30-day morbidity. Secondary outcomes were 30-day mortality, 30-day reoperations, length of hospital stay (LOS), operating time, and estimated blood loss.
Thirteen studies comparing 862 patients (403 LHR vs 459 OHR) were included. There was no difference in mortality, while LHR was associated with a reduced overall postoperative 30-day morbidity (OR, 0.24; 95 % CI, 0.16 to 0.34). Wound infections (OR, 0.54; 95 % CI, 0.35 to 0.85) and ileus (OR, 0.47; 95 % CI, 0.25 to 0.87) were more common after OHR. LOS was shorter in the laparoscopic group as it was the time to flatus. Meta-regression analysis showed that the results were independent from potential effect modifiers.
LHR has less short-term complications than OHR in terms of overall morbidity, wound infection, and postoperative ileus. LOS is shorter in the LHR group, while no significant difference exists in the operating time. Randomized controlled trials are needed to confirm these findings on unbiased populations.
哈特曼氏回纳术是一种具有一定发病率和死亡率的大型外科手术。腹腔镜检查已广泛应用于结直肠手术，对短期和长期预后均有显著益处。我们对当前证据进行了一项荟萃分析，比较腹腔镜哈特曼氏回纳术（LHR）与开放性哈特曼氏回纳术（OHR）的短期预后。
对医学文献数据库（Medline）、Scopus、科学网（Web of Science）、Embase和考克兰数据库进行了系统检索。纳入有意向性治疗分析的比较LHR与OHR短期预后的对照研究。主要结局为30天发病率。次要结局为30天死亡率、30天再次手术率、住院时间（LOS）、手术时间和估计失血量。
纳入了13项比较862例患者（403例LHR vs 459例OHR）的研究。死亡率无差异，而LHR与术后30天总体发病率降低相关（比值比[OR]，0.24；95%置信区间[CI]，0.16至0.34）。OHR术后伤口感染（OR，0.54；95%CI，0.35至0.85）和肠梗阻（OR，0.47；95%CI，0.25至0.87）更为常见。腹腔镜组的LOS较短，因为这是出现胃肠排气的时间。Meta回归分析表明，结果不受潜在效应修饰因素的影响。
在总体发病率、伤口感染和术后肠梗阻方面，LHR的短期并发症比OHR少。LHR组的LOS较短，而手术时间无显著差异。需要进行随机对照试验，以在无偏倚人群中证实这些发现。
