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

Background It 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. Methods Multiple comprehensive databases were searched systematically to identify relevant studies and meta-analysis was done. Results Meta-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%). Conclusions Laparoscopic colorectal surgery significantly reduced the rates of adhesive SBO and subsequent surgery for adhesive SBO, compared with open surgery.