Price Institute of Surgical Research, The Hiram C. Polk, Jr., M.D. Department of Surgery, University of Louisville School of Medicine, Louisville, KY, 40292, USA.
Department of Surgery, Soroka University Medical Center, Beer Sheva, Israel.
J Gastrointest Surg. 2017 Sep;21(9):1491-1499. doi: 10.1007/s11605-017-3462-6. Epub 2017 Jun 12.
Perforated diverticulitis carries the risk of significant comorbidity and mortality. Although colon resection provides adequate source control, the procedure itself carries morbidity, as well as later stoma reversal procedures. The effectiveness of laparoscopic lavage to treat perforated diverticulitis remains unclear.
We aimed to conduct a meta-analysis to evaluate current studies comparing laparoscopic lavage with colon resection in cases of perforated diverticulitis for the effectiveness in source control, without the need for subsequent interventions, stoma formation, and death.
Electronic database searches were conducted using EMBASE, Pubmed, CINAHL, Cochrane databases, and clinicaltrials.gov following PRISMA guidelines.
Randomized controlled trials (RCTs) were included that compared laparoscopic lavage against colon resection for perforated diverticulitis.
Risk of bias in RCT's was assessed the Cochrane Assessment of Bias risk tool and Jadad scale. A meta-analysis was performed using random-effects risk ratios (RR) and 95% confidence intervals (CI).
Outcome measures included the total rate of reoperation, rate of reoperation for infection, need for subsequent percutaneous drainage, stoma formation, and mortality rate within 90 days.
Three eligible randomized controlled studies were identified, with a combined total of 372 patients. Laparoscopic lavage carried an increased rate of total reoperations (RR 2.07; CI 1.12-3.84; p = 0.021) and an increased rate of reoperation for infection (RR 5.56; CI 1.97-15.69; p = 0.001) compared with colon resection. In addition, laparoscopic lavage increased the rate of subsequent percutaneous drainage (RR 6.54; CI 1.77-24.16; p = 0.005) compared with colon resection, but a lesser risk of stoma formation within 90 days (RR 0.18; CI 0.12-0.27; p < 0.001). No difference in mortality rate was observed between treatments (RR 1.03; CI 0.45-2.34; p = 0.950).
Despite decreased rates of stoma formation and equivalent mortality rates as compared with colon resection, laparoscopic lavage for Hinchey III diverticulitis fails to completely control the source of infection. Our data show that laparoscopic lavage is associated with increased rates of total reoperations, increased rates of reoperation for infections, and need for subsequent percutaneous drainage.
穿孔性憩室炎存在显著合并症和死亡率的风险。虽然结肠切除术可提供充分的源头控制，但该手术本身也存在一定的发病率，还需要后续进行造口逆转手术。腹腔镜灌洗治疗穿孔性憩室炎的效果仍不清楚。
我们旨在进行一项荟萃分析，以评估比较腹腔镜灌洗与结肠切除术治疗穿孔性憩室炎的现有研究，评估两种方法在源头控制方面的有效性，无需后续干预、造口形成和死亡。
按照 PRISMA 指南，我们通过 EMBASE、Pubmed、CINAHL、Cochrane 数据库和 clinicaltrials.gov 进行电子数据库检索。
纳入了比较腹腔镜灌洗与结肠切除术治疗穿孔性憩室炎的随机对照试验（RCT）。
使用 Cochrane 评估偏倚风险工具和 Jadad 量表评估 RCT 的偏倚风险。使用随机效应风险比（RR）和 95%置信区间（CI）进行荟萃分析。
观察指标包括总再手术率、感染再手术率、后续经皮引流的需要、造口形成率和 90 天内死亡率。
确定了三项符合条件的随机对照研究，共纳入 372 例患者。与结肠切除术相比，腹腔镜灌洗的总再手术率（RR 2.07；95%CI 1.12-3.84；p=0.021）和感染再手术率（RR 5.56；95%CI 1.97-15.69；p=0.001）均增加。此外，与结肠切除术相比，腹腔镜灌洗增加了后续经皮引流的需要（RR 6.54；95%CI 1.77-24.16；p=0.005），但 90 天内造口形成率较低（RR 0.18；95%CI 0.12-0.27；p<0.001）。两种治疗方法的死亡率无差异（RR 1.03；95%CI 0.45-2.34；p=0.950）。
尽管与结肠切除术相比，腹腔镜灌洗降低了造口形成率和死亡率，但未能完全控制感染源。我们的数据表明，腹腔镜灌洗与总再手术率增加、感染再手术率增加和后续经皮引流的需要有关。
