Adhesive small bowel obstruction after laparoscopic and open colorectal surgery: a systematic review and meta-analysis

• It remains unclear whether laparoscopy has benefit for reducing incidence of adhesive SBO.
• This review identifies reduced incidence of adhesive SBO in laparoscopic colorectal surgery.
• Despite these findings, RCTs are needed to confirm the benefit of laparoscopy.

BackgroundIt is considered that laparoscopic surgery is associated with a much lower rate of postoperative formation of adhesions than open surgery. This meta-analysis assessed the incidence of adhesion-related readmissions and surgery for adhesive small bowel obstruction (SBO) in patients who underwent laparoscopic or open colorectal surgery.MethodsMultiple comprehensive databases were searched systematically to identify relevant studies and meta-analysis was done.ResultsMeta-analysis showed that laparoscopic surgery was associated with a lower rate of adhesive SBO, both for randomized clinical trials (relative risk [RR] .26, 95% confidence interval [CI] .10 to .67, I2=41%) and nonrandomized studies (RR .49, 95% CI .32 to .76, I2=91%). Laparoscopic surgery was also associated with a lower rate of subsequent surgery for adhesive SBO, both for randomized clinical trials (RR .25, 95% CI .06 to .96, I2=0%) and nonrandomized studies (RR .56, 95% CI .33 to .94, I2=77%).ConclusionsLaparoscopic colorectal surgery significantly reduced the rates of adhesive SBO and subsequent surgery for adhesive SBO, compared with open surgery.