A Cochrane review [Abstract] 1 included 11 studies (only 1 RCT, n=60) with a total of 607 subjects (516 with ulcerative colitis and 89 with familial adenomatous polyposis). Mortality was reported in 9 studies; there was zero mortality in both groups in 8 studies and in 1 study, 1 death occurred in the open group and no deaths in the laparoscopic group (no statistically significant difference). In the only RCT, there were 47% and 53% complication rates in the laparoscopic and open group, respectively (not statistically significant). There weren't differences in complication rates between the two groups in the non-RCTs either (37.6% in laparoscopic group vs. 41.5% in open group; RR 0.91, 95% CI 0.73 to 1.14; 8 studies, n=519). Readmission rates did not differ statistically significantly between the groups in the 2 studies reporting this outcome (in the RCT 22% and 13%, and in the non-RCT 21% and 22% in the laparoscopic and open group, respectively). The RCT reported 17% reoperations in both groups. In the non-RCTs there were 4.0% reoperations in the laparoscopic and 5.8% in the open group (RR 0.74, 95% CI 0.32 to 1.71; 6 studies, n=447). Operative time was significantly longer in the laparoscopic group both in the RCT and in meta-analysis of non-RCTs (WMD 91 minutes, 95% CI 53 to 130). There were no significant differences between the two groups regarding postoperative recovery parameters. Total incision length was significantly shorter in the laparoscopic group. Cosmesis scores were reported by 2 studies. The RCT showed a significant increase from a mean of 14.7 points in the open group to 18.5 in the laparoscopic groups (p=0.01). The non-RCT study reported an increase from a mean of 16 points in the open to 19.8 in the laparoscopic group (p=0.03). Other long-term outcomes were poorly reported.
Comment: The quality of evidence is downgraded by indirectness (lack of long-term outcomes) and by imprecise results (few outcome events).
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