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P461. Is laparoscopy safe and useful in patients with acute colitis complicating inflammatory bowel disease? A first meta-analysis in 478 patients

L. Maggiori1, A. Khayat1, X. Tréton2, F. Bretagnol1, Y. Bouhnik2, Y. Panis1, 1Hôpital Beaujon, Colorectal surgery, Clichy, France, 2Hôpital Beaujon, Gastroenterology & Nutritive Assistance, Clichy, France

Background

Safety and benefits of laparoscopy over laparotomy for elective surgery in inflammatory bowel disease (IBD) have been demonstrated in several randomized controlled trials. However, reports comparing these two approaches for acute colitis are scarce. This first meta-analysis aimed to assess and compare short-term results of laparoscopic and open abdominal colectomy for acute colitis.

Methods

A systematic review of the medical literature has been conducted using electronic databases. All studies comparing laparoscopic and open abdominal colectomy for acute colitis and published until September 2012 have been included.

Results

Eight studies, comprising a total of 478 abdominal colectomies (laparoscopic approach: n = 206; open approach: n = 272) have been identified and included. All studies were retrospectives and 3 performed according to a case-match design. Pooled conversion rate were 8/206 (4%). After meta-analysis, laparoscopic approach was associated to a significantly lower overall postoperative morbidity than open approach (32% versus 48% respectively; Odds-ratio (OR): 0.67 [0.30;1.49]; p < 0.001) although neither severe postoperative (9% versus 15%, respectively; OR: 0.59 [0.30;1.13]; p = 0.11) nor reoperation rate (5% versus 9% respectively; OR: 0.67 [0.30;1.49]; p = 0.33) showed no difference between the 2 groups. Furthermore, hospital stay was significantly shorter in the laparoscopic group, as compared to the open approach (Weighted Mean Difference: −3.27 days [−4.60; −1.95]; p < 0.001).

Conclusion

Although quality of the included study was limited and no randomized trial was availed, this first meta-analysis suggested that laparoscopic abdominal colectomy for acute colitis is associated with reduced morbidity rate and hospital stay as compared to the open approach.