Department of Surgery (A), Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, Bldg. 12.46, 40225, Duesseldorf, Germany.
Langenbecks Arch Surg. 2022 Dec;407(8):3259-3274. doi: 10.1007/s00423-022-02698-z. Epub 2022 Oct 10.
The aim of this meta-analysis was to investigate the optimal time point of elective sigmoidectomy regarding the intraoperative and postoperative course in diverticular disease.
A comprehensive literature research was conducted for studies comparing the operative outcome of early elective (EE) versus delayed elective (DE) minimally invasive sigmoidectomy in patients with acute or recurrent diverticular disease. Subsequently, data from eligible studies were extracted, qualitatively assessed, and entered into a meta-analysis. By using random effect models, the pooled hazard ratio of outcomes of interest was calculated.
Eleven observational studies with a total of 2096 patients were included (EE group n = 828, DE group n = 1268). Early elective sigmoidectomy was associated with a significantly higher conversion rate as the primary outcome in comparison to the delayed elective group (OR 2.48, 95% CI 1.5427-4.0019, p = 0.0002). Of the secondary outcomes analyzed only operative time (SMD 0.14, 95% CI 0.0020-0.2701, p = 0.0466) and time of first postoperative bowel movement (SMD 0.57, 95% CI 0.1202-1.0233, p = 0.0131) were significant in favor of the delayed elective approach.
Delayed elective sigmoid resection demonstrates benefit in terms of reduced conversion rates and shortened operative time as opposed to an early approach. Conversely, operative morbidities seem to be unaffected by the timing of surgery. However, a final and robust conclusion based on the included observational cohort studies must be cautiously made. We therefore highly advocate larger randomized controlled trials with homogenous study protocols.
本荟萃分析旨在探讨在憩室病中，择期行乙状结肠切除术的最佳时间点，以评估手术期间和术后的过程。
对比较急性或复发性憩室病患者行早期择期（EE）与延迟择期（DE）微创乙状结肠切除术的手术结果的研究进行了全面的文献检索。随后，提取合格研究的数据，对其进行定性评估，并将其纳入荟萃分析。通过使用随机效应模型，计算出感兴趣结局的汇总风险比。
共纳入 11 项观察性研究，总计 2096 例患者（EE 组 n=828，DE 组 n=1268）。早期择期乙状结肠切除术与延迟择期组相比，作为主要结局的转换率显著更高（OR 2.48，95%CI 1.5427-4.0019，p=0.0002）。在分析的次要结局中，只有手术时间（SMD 0.14，95%CI 0.0020-0.2701，p=0.0466）和首次术后排便时间（SMD 0.57，95%CI 0.1202-1.0233，p=0.0131）有显著差异，且有利于延迟择期手术。
与早期手术相比，延迟择期乙状结肠切除术在降低转换率和缩短手术时间方面具有优势。相反，手术并发症似乎不受手术时间的影响。然而，基于纳入的观察性队列研究得出最终和可靠的结论必须谨慎。因此，我们强烈主张采用具有同质研究方案的更大规模的随机对照试验。
