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Is laparoscopy a reliable alternative to laparotomy in Hartmann's reversal? An updated meta-analysis

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Abstract

Background

The aim of this study was to perform a systematic review of the literature on and updated meta-analysis of surgical postoperative complications after laparoscopic Hartmann’s reversal (LHR) and open Hartmann’s reversal (OHR).

Methods

Studies comparing LHR versus OHR published from inception until June 2020 were selected and submitted to a systematic review and meta-analysis. Articles were searched in the MEDLINE and Cochrane Trials Register databases. Meta-analysis was performed with Review Manager 5.0.

Results

Twenty-three retrospective comparative studies (including 5 case-controlled studies) with a total of 3139 patients with LHR and a total of 10,325 patients with OHR were included. Meta-analysis showed that LHR was significantly associated with a decreased rate of revision surgery (OR = 0.73, 95% CI = 0.60–0.89, p < 0.001), anastomotic leakage (OR = 0.61, 95% CI = 0.49–0.75, p < 0.00001), postoperative morbidity (OR = 0.53, 95% CI = 0.47–0.58, p < 0.00001), intra-abdominal abscess (OR = 0.67 [0.52–0.87], 95% CI = , p = 0.003), wound abscess (OR = 0.53 [0.46–0.61], 95% CI = , p < 0.00001), and postoperative ileus (OR = 0.46, 95% CI = 0.29–0.72, p = 0.0008), respectively. Conversely, mortality was comparable between LHR and OHR.

Conclusions

These results suggest that LHR significantly improved surgical postoperative outcomes. However, considering the low level of evidence, further randomized trials are required to validate these findings.

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Authors and Affiliations

  1. Department of Digestive Surgery, University Hospital of Caen, Avenue de La Côte de Nacre, 14032, Caen cedex, France

    D. Chavrier, A. Alves & B. Menahem

  2. ANTICIPE INSERM U, 1086, Avenue du Général Harris, Centre François Baclesse, Caen, France

    A. Alves & B. Menahem

  3. Pôle de Formation Et de Recherche en Santé, Caen, France

    D. Chavrier, A. Alves & B. Menahem

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Chavrier, D., Alves, A. & Menahem, B. Is laparoscopy a reliable alternative to laparotomy in Hartmann's reversal? An updated meta-analysis. Tech Coloproctol 26, 239–252 (2022). https://doi.org/10.1007/s10151-021-02560-2

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