Laparoscopic versus open surgery for colonoscopic perforation: A systematic review and meta-analysis

Abstract

Background: The efficacy of laparoscopic surgery (LS) for the treatment of colonoscopic perforation is still controversial. The purpose of this meta-analysis was to evaluate the effectiveness and safety of LS versus open surgery (OS) for colonoscopic perforation.Methods: All clinical trials that compared laparoscopic with OS for colonoscopic perforation published in English were identified in PubMed, EMBASE, Web of Science, and Cochrane Library searches. A modified scale was used to assess the quality of the literature. We analyzed the age, sex ratio, aim of colonoscopy, history of abdominopelvic surgery, type of procedure, size of perforation, operation time, postoperative fasting time, hospital stay, postoperative complication morbidity, and postoperative mortality. Meta-analyses were performed using weighted mean differences for continuous variables, and odds ratios for dichotomous variables.Results: No eligible randomized trials were identified, but eleven nonrandomized trials were analyzed. In the pooled data of 192 patients who underwent LS and 131 OS, there were no significant differences in age, sex ratio, aim of colonoscopy, history of abdominopelvic surgery, perforation size, and operative time between the groups. LS group had shorter time of hospital stay and postoperative fasting time, less postoperative complication morbidity, but there were no significant difference in postoperative mortality rate between LS group and OS group.Conclusions: Based on the current meta-analysis, we conclude that LS is a safe and efficacious technique for colonoscopic perforation, with fewer postoperative complications, less hospital mortality, and faster recovery compared with OS.

Methods of Surgical Repair for Iatrogenic Sigmoid Colon Perforation Following Colonoscopy: A Case Report and Literature Review

“…A comprehensive meta-analysis involving 11 non-randomized controlled trials has yielded intriguing insights into the comparison of open and laparoscopic repair [ 7 ]. This analysis unveils a notable absence of discernible differences in critical parameters, including the intended colonoscopy objective, history of prior abdominopelvic surgery, perforation dimensions, and operative duration between these distinct surgical strategies [ 7 ]. However, compared to laparotomy, laparoscopic repair is associated with shorter incisions, hospital stays, postoperative fasting, recovery, and lower morbidity [ 4 , 7 , 13 ].…”

“…This analysis unveils a notable absence of discernible differences in critical parameters, including the intended colonoscopy objective, history of prior abdominopelvic surgery, perforation dimensions, and operative duration between these distinct surgical strategies [ 7 ]. However, compared to laparotomy, laparoscopic repair is associated with shorter incisions, hospital stays, postoperative fasting, recovery, and lower morbidity [ 4 , 7 , 13 ]. Nonetheless, it is noteworthy that approximately 10% of laparoscopic repairs necessitate conversion to open surgery [ 13 ].…”

“…The most common site of perforation is the sigmoid colon or rectosigmoid junction with studies reporting as high as 70% of perforations occurring at these anatomic locations [ 2 , 3 ]. Complications of perforation include peritonitis, sepsis, and death [ 7 ]. Given the urgency of iatrogenic colonic perforation, surgical repair is often necessary, although conservative management is a consideration.…”