Laparoscopic adhesiolysis versus open surgery for adhesive small bowel obstruction: A meta-analysis

Objective To systematically evaluate the efficacy and safety of laparoscopic adhesiolysis versus open surgery for adhesive small bowel obstruction. Methods The databases including PubMed, EMbase, The Cochrane Library (Issue 3, 2017), ICTRP, CNKI, VIP, CBM and Wanfang Data were electronically searched to collect randomized controlled trials (RCTs) about laparoscopic adhesiolysis versus open surgery for adhesive small bowel obstruction patients from inception to March 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta- analysis was conducted by RevMan 5.3 software. Results A total of 31 studies involving 3293 patients were included. The results of meta-analysis showed that, compared with the open surgery group, the laparoscopic adhesiolysis group could significantly reduce the recurrence rate (OR=0.18, 95%CI 0.12-0.25, P<0.000 01), overall complications (OR=0.17, 95%CI 0.13-0.23, P<0.000 01), wound infection (OR=0.21, 95%CI 0.13-0.35, P<0.000 01), pneumonia (OR=0.35, 95%CI 0.15-0.82, P=0.02) and intestinal fistula (OR=0.32, 95%CI 0.15-0.70, P=0.005). Conclusions Current evidence shows that laparoscopic adhesiolysis can reduce the recurrence rate and complications in adhesive small bowel obstruction. Due to the limited quality of included studies, more high quality studies are needed to verify the above conclusion. DOI: 10.11855/j.issn.0577-7402.2018.02.10