Clinical effectiveness of gasless laparoscopic surgery for abdominal conditions: systematic review and meta-analysis
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Published:2021-08-16
Issue:12
Volume:35
Page:6427-6437
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ISSN:0930-2794
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Container-title:Surgical Endoscopy
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language:en
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Short-container-title:Surg Endosc
Author:
Aruparayil N.ORCID, Bolton W., Mishra A., Bains L., Gnanaraj J., King R., Ensor T., King N., Jayne D., Shinkins B.
Abstract
Abstract
Background
In high-income countries, laparoscopic surgery is the preferred approach for many abdominal conditions. Conventional laparoscopy is a complex intervention that is challenging to adopt and implement in low resource settings. This systematic review and meta-analysis evaluate the clinical effectiveness of gasless laparoscopy compared to conventional laparoscopy with CO2 pneumoperitoneum and open surgery for general surgery and gynaecological procedures.
Methods
A search of the MEDLINE, EMBASE, Global Health, AJOL databases and Cochrane Library was performed from inception to January 2021. All randomised (RCTs) and comparative cohort (non-RCTs) studies comparing gasless laparoscopy with open surgery or conventional laparoscopy were included. The primary outcomes were mortality, conversion rates and intraoperative complications. Secondary outcomes: operative times and length of stay. The inverse variance random-effects model was used to synthesise data.
Results
63 studies were included: 41 RCTs and 22 non-RCTs (3,620 patients). No procedure-related deaths were reported in the studies. For gasless vs conventional laparoscopy there was no difference in intraoperative complications for general RR 1.04 [CI 0.45–2.40] or gynaecological surgery RR 0.66 [0.14–3.13]. In the gasless laparoscopy group, the conversion rates for gynaecological surgery were high RR 11.72 [CI 2.26–60.87] when compared to conventional laparoscopy. For gasless vs open surgery, the operative times were longer for gasless surgery in general surgery RCT group MD (mean difference) 10 [CI 0.64, 19.36], but significantly shorter in the gynaecology RCT group MD − 18.74 [CI − 29.23, − 8.26]. For gasless laparoscopy vs open surgery non-RCT, the length of stay was shorter for gasless laparoscopy in general surgery MD − 3.94 [CI − 5.93, − 1.95] and gynaecology MD − 1.75 [CI − 2.64, − 0.86]. Overall GRADE assessment for RCTs and Non-RCTs was very low.
Conclusion
Gasless laparoscopy has advantages for selective general and gynaecological procedures and may have a vital role to play in low resource settings.
Funder
Programme Grants for Applied Research
Publisher
Springer Science and Business Media LLC
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