Published online Jul 27, 2016. doi: 10.4240/wjgs.v8.i7.533
Peer-review started: October 21, 2015
First decision: December 28, 2015
Revised: April 2, 2016
Accepted: April 14, 2016
Article in press: April 18, 2016
Published online: July 27, 2016
Processing time: 265 Days and 18.2 Hours
AIM: To perform a systematic review focusing on short-term outcomes after colorectal surgery in patients with previous abdominal open surgery (PAOS).
METHODS: A broad literature search was performed with the terms “colorectal”, “colectomy”, “PAOS”, “previous surgery” and “PAOS”. Studies were included if their topic was laparoscopic colorectal surgery in patients with PAOS, whether descriptive or comparative. Endpoints of interest were conversion rates, inadvertent enterotomy and morbidity. Analysis of articles was made according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
RESULTS: From a total of 394 citations, 13 full-texts achieved selection criteria to be included in the study. Twelve of them compared patients with and without PAOS. All studies were retrospective and comparative and two were case-matched. The selected studies comprised a total of 5005 patients, 1865 with PAOS. Among the later, only 294 (16%) had history of a midline incision for previous gastrointestinal surgery. Conversion rates were significantly higher in 3 of 12 studies and inadvertent enterotomy during laparoscopy was more prevalent in 3 of 5 studies that disclosed this event. Morbidity was similar in the majority of studies. A quantitative analysis (meta-analysis) could not be performed due to heterogeneity of the studies.
CONCLUSION: Conversion rates were slightly higher in PAOS groups, although not statistical significant in most studies. History of PAOS did not implicate in higher morbidity rates.
Core tip: So far, there is no substantial evidence in the literature to recommend laparoscopic surgery instead of laparotomy for patients previously submitted to abdominal surgery, concerning short-term benefits, such as conversion rates and morbidity. This review, although without a meta-analysis, brings new light into this matter.