Comparison between different approaches applied in laparoscopic right hemi-colectomy: A systematic review and network meta-analysis. (December 2017) - Li, Fei
Abstract: Aim: Several different operative approaches have been applied nowadays in laparoscopic right hemi-colectomy. This study aims to evaluate the potential benefits of different approaches by conducting a network meta-analysis (NMA). Method: A comprehensive literature research of the PubMed, Embase, Medline, the Cochrane Central Library, Wan Fang and China National Knowledge Infrastructure (CNKI) databases was performed. Original articles comparing two of three different approaches including medial to lateral (MtL) approach, lateral to medial (LtM) approach and cranial to caudal (CtC) approach of laparoscopic right colon resection for patients with both neoplastic and benign diseases were included. Results: 3 RCTs and 3 NRCTs with a total of 571 patients were included in this NMA. The result revealed that LtM approach needs shorter postoperative flatus recovery time than both MtL approach with a WMD of 1.40 (95% CI: 0.13 to 2.67, P < 0.05) and CtC approach (WMD = −1.25, 95% CI: −1.90 to −0.61, P < 0.05). The length of hospital stay of LtM approach is shorter than that of MtL approach (WMD = 0.29, 95% CI: 0.08 to 0.50, P < 0.05). CtC approach can achieve less postoperative complications (OR = 3.37, 95% CI: 1.06 to 10.70, P < 0.05) compared with MtL approach. Conclusion: All three approaches are safe and acceptable in laparoscopic right hemi-colectomy since the pooled evidence revealed that most aspects of different approaches are comparable in general. The postoperative flatus recovery time and hospitalization time of LtM approach is shorter compared with MtL approach. And CtC approach may have slight superiority in postoperative complications compared with MtL approach. Highlights: Standardization of the operative procedure can help to flatten the learning curve. MtL approach, LtM approach and CtC approach are all safe and acceptable for laparoscopic right hemi-colectomy. LtM approach and CtC approach may achieve slightly superiority over MtL approach on rehabilitation after surgery.