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World Journal of Emergency Surgery
Published in: World Journal of Emergency Surgery 1/2017

Open Access 01-12-2017 | Review

Laparoscopic vs. open surgery for the treatment of iatrogenic colonoscopic perforations: a systematic review and meta-analysis

Authors: Aleix Martínez-Pérez, Nicola de’Angelis, Francesco Brunetti, Yann Le Baleur, Carmen Payá-Llorente, Riccardo Memeo, Federica Gaiani, Marco Manfredi, Paschalis Gavriilidis, Giorgio Nervi, Federico Coccolini, Aurelien Amiot, Iradj Sobhani, Fausto Catena, Gian Luigi de’Angelis

Published in: World Journal of Emergency Surgery | Issue 1/2017

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Abstract

Aims

Iatrogenic colonoscopy perforations (ICP) are a rare but severe complication of diagnostic and therapeutic colonoscopies. The present systematic review and meta-analysis aims to investigate the operative and post-operative outcomes of laparoscopy vs. open surgery performed for the management of ICP.

Methods

A literature search was carried out on Medline, EMBASE, and Scopus databases from January 1990 to June 2016. Clinical studies comparing the outcomes of laparoscopic and open surgical procedures for the treatment for ICP were retrieved and analyzed.

Results

A total of 6 retrospective studies were selected, including 161 patients with ICP who underwent surgery. Laparoscopy was used in 55% of the patients, with a conversion rate of 10%. The meta-analysis shows that the laparoscopic approach was associated with significantly fewer post-operative complications compared to open surgery (18.2% vs. 53.5% respectively; Relative risk, RR: 0.32 [95%CI: 0.19–0.54; p < 0.0001; I2 = 0%]) and shorter hospital stay (mean difference −5.35 days [95%CI: −6.94 to −3.76; p < 0.00001; I2 = 0%]). No differences between the two surgical approaches were observed for postoperative mortality, need of re-intervention, and operative time.

Conclusion

The present study highlights the outcomes of the surgical management of an endoscopic complication that is not yet considered in clinical guidelines. Based on the current available literature, the laparoscopic approach appears to provide better outcomes in terms of postoperative complications and length of hospital stay than open surgery in the case of ICP surgical repair. However, the creation of large prospective registries of patients with ICP would be a step forward in addressing the lack of evidence concerning the surgical treatment of this endoscopic complication.
Appendix
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Metadata
Title
Laparoscopic vs. open surgery for the treatment of iatrogenic colonoscopic perforations: a systematic review and meta-analysis
Authors
Aleix Martínez-Pérez
Nicola de’Angelis
Francesco Brunetti
Yann Le Baleur
Carmen Payá-Llorente
Riccardo Memeo
Federica Gaiani
Marco Manfredi
Paschalis Gavriilidis
Giorgio Nervi
Federico Coccolini
Aurelien Amiot
Iradj Sobhani
Fausto Catena
Gian Luigi de’Angelis
Publication date
01-12-2017
Publisher
BioMed Central
Published in
World Journal of Emergency Surgery / Issue 1/2017
Electronic ISSN: 1749-7922
DOI
https://doi.org/10.1186/s13017-017-0121-x

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