McKechnie Tyler, Tessier Léa, Anpalagan Tharani, Chu Megan, Lee Yung, Logie Kathleen, Doumouras Aristithes, Amin Nalin, Hong Dennis, Eskicioglu Cagla
Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.
Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
Surg Pract Sci. 2023 Mar 23;13:100161. doi: 10.1016/j.sipas.2023.100161. eCollection 2023 Jun.
Loop ileostomies (LIs) are used for temporary fecal diversion to protect downstream colorectal anastomoses. Standard operative approach for LI reversal has been through an open technique. Recently, laparoscopic LI reversal has been employed and studied. The aim of this systematic review was to compare laparoscopic and open LI reversal.
Medline, Embase, and CENTRAL were systematically searched. Articles were included if they compared rate of postoperative morbidity and/or length of stay (LOS) in patients undergoing laparoscopic or open LI reversal. Pairwise meta-analyses using inverse variance random effects was performed. The Grading of Recommendations, Assessment, Development, and Evidence (GRADE) approach was conducted to assess quality of evidence.
From 410 citations, four observational studies with 213 patients undergoing laparoscopic LI reversal and 176 patients undergoing open LI reversal met inclusion. Patients in the laparoscopic group had significantly shorter LOS (MD -0.39, 95%CI -0.73 to -0.04, = 0.03). Laparoscopic and open LI reversal were comparable in postoperative morbidity, aside from a decrease of superficial surgical site infection (sSSI) with the use of laparoscopy (OR 0.22, 95%CI 0.07 to 0.71, = 0.01). Operative time was not significantly different between groups (MD 11.91, 95%CI -1.87 to 25.70, = 0.09). The GRADE quality of evidence was low to very low.
This review presents low quality evidence that laparoscopic LI reversal is a feasible approach that may reduce postoperative LOS and sSSI compared to open LI reversal without increasing operative time. Future prospective comparative studies are required to confirm the findings of the present review.
袢式回肠造口术（LI）用于临时粪便转流，以保护下游结直肠吻合口。LI 还纳的标准手术方法一直是开放技术。最近，腹腔镜下 LI 还纳已被应用并进行了研究。本系统评价的目的是比较腹腔镜和开放 LI 还纳术。
对 Medline、Embase 和 CENTRAL 进行系统检索。纳入比较接受腹腔镜或开放 LI 还纳术患者术后发病率和/或住院时间（LOS）的文章。采用逆方差随机效应进行成对荟萃分析。采用推荐分级、评估、制定和证据（GRADE）方法评估证据质量。
从 410 篇文献中，4 项观察性研究符合纳入标准，其中 213 例患者接受腹腔镜 LI 还纳术，176 例患者接受开放 LI 还纳术。腹腔镜组患者的 LOS 显著缩短（MD -0.39，95%CI -0.73 至 -0.04，P = 0.03）。除腹腔镜手术可降低浅表手术部位感染（sSSI）外，腹腔镜和开放 LI 还纳术在术后发病率方面具有可比性（OR 0.22，95%CI 0.07 至 0.71，P = 0.01）。两组手术时间无显著差异（MD 11.91，95%CI -1.87 至 25.70，P = 0.09）。GRADE 证据质量为低至极低。
本评价提供了低质量证据，表明与开放 LI 还纳术相比，腹腔镜 LI 还纳术是一种可行的方法，可能会缩短术后 LOS 并降低 sSSI，且不增加手术时间。未来需要进行前瞻性比较研究以证实本评价的结果。
