Meta-analysis of randomised controlled trials comparing intracorporeal versus extracorporeal anastomosis in laparoscopic right hemicolectomy: upgrading the level of evidence

Abstract Objectives To evaluate comparative outcomes of intracorporeal (ICA) and extracorporeal (ECA) anastomosis in laparoscopic right hemicolectomy. Methods We conducted a systematic search of electronic databases and bibliographic reference lists. We applied a combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators and limits in each of the above databases. Overall perioperative morbidity, anastomotic leak, surgical site infection (SSI), paralytic ileus, bleeding, postoperative pain within 5 days, conversion to an open procedure, length of incision and procedure time were the evaluated outcome parameters. Results We identified 4 randomised controlled trials reporting a total of 399 patients evaluating outcomes of ICA (n = 199) and ECA (n = 200) in laparoscopic right hemicolectomy. The ICA was associated with significantly shorter length of incision (MD:-1.82, P < 0.00001), lower postoperative pain score on day 2 (MD:-0.69, P = 0.0007), day 3 (MD:-0.80, P = 0.02), day 4 (MD:-0.83, P = 0.01) and day 5 (MD:-0.49, P < 0.00001) when compared to ECA. Moreover, it was associated with significantly shorter length of hospital stay (MD:-0.27, p = 0.03). However, there was no significant difference in overall perioperative morbidity (RR:0.79, P = 0.47), anastomotic leak (RR:1.29, P = 0.65), SSI (RR:0.61, P = 0.42), bleeding (RR:0.70, P = 0.71), ileus (RR:0.60, P = 0.45), conversion to open (RD:-0.02, P = 0.45), number of harvested lymph nodes (MD:0.82, p = 0.06), and procedure time (MD:16.04, p = 0.06) between two groups. Conclusions The meta-analysis of level 1 evidence demonstrated that ICA and ECA have comparable perioperative outcomes in laparoscopic right colectomy although the former may be associated with less postoperative pain probably due to shorter incision length. Future research may provide stronger evidence in favour of an intervention.

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98 Intracorporeal Versus Extracorporeal Anastomosis in Laparoscopic Right Hemicolectomy: Meta-Analysis of Randomised Controlled Trials

British Journal of Surgery ◽

10.1093/bjs/znab259.604 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

M Qayum ◽

G Nawaz ◽

S Hajibandeh ◽

S Hajibandeh

Keyword(s):

Postoperative Pain ◽

Anastomotic Leak ◽

Randomised Controlled Trials ◽

Meta Analysis ◽

Right Hemicolectomy ◽

Controlled Trials ◽

Procedure Time ◽

Perioperative Morbidity ◽

Laparoscopic Right Hemicolectomy ◽

Randomised Controlled

Abstract Aim To evaluate comparative outcomes of intracorporeal (ICA) and extracorporeal (ECA) anastomosis in laparoscopic right hemicolectomy. Method We conducted a systematic search of electronic databases and bibliographic reference lists. We applied a combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators and limits in each of the above databases. Overall perioperative morbidity, anastomotic leak, surgical site infection (SSI), paralytic ileus, bleeding, postoperative pain within 5 days, conversion to an open procedure, length of incision and procedure time were the evaluated outcome parameters. Combined overall effect sizes were calculated using random-effects models. Results We identified 4 randomised controlled trials reporting a total of 399 patients evaluating outcomes of ICA (n = 199) and ECA (n = 200) in laparoscopic right hemicolectomy. The ICA was associated with significantly shorter length of incision (MD:-1.82, P < 0.00001), lower postoperative pain score on day 2 (MD:-0.69, P = 0.0007), day 3 (MD:-0.80, P = 0.02), day 4 (MD:-0.83, P = 0.01) and day 5 (MD:-0.49, P < 0.00001) when compared to ECA. Moreover, it was associated with significantly shorter length of hospital stay (MD:-0.27, p = 0.03). However, there was no significant difference in overall perioperative morbidity (RR:0.79, P = 0.47), anastomotic leak (RR:1.29, P = 0.65), SSI (RR:0.61, P = 0.42), bleeding (RR:0.70, P = 0.71), ileus (RR:0.60, P = 0.45), conversion to open (RD:-0.02, P = 0.45), number of harvested lymph nodes (MD:0.82, p = 0.06), and procedure time (MD:16.04, p = 0.06) between two groups. Conclusions The meta-analysis of level 1 evidence demonstrated that ICA and ECA have comparable perioperative outcomes in laparoscopic right colectomy although the former may be associated with less postoperative pain probably due to shorter incision length.

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Efficacy and Safety of Regional Citrate Anticoagulation in Critically Ill Patients Undergoing Continuous Renal Replacement Therapy

Journal of the Intensive Care Society ◽

10.1177/175114371301400117 ◽

2013 ◽

Vol 14 (1) ◽

pp. 84-85

Author(s):

James Sheehan ◽

Martyn Ezra

Keyword(s):

Randomised Controlled Trials ◽

Meta Analysis ◽

Risk Of Bias ◽

Regional Citrate Anticoagulation ◽

Controlled Trials ◽

Efficacy And Safety ◽

Level Of Evidence ◽

Citrate Anticoagulation ◽

Risk Of Bleeding ◽

Randomised Controlled

A meta-analysis of randomised controlled trials comparing regional citrate anticoagulation (RCA) to control anticoagulation for haemofiltration revealed that citrate anticoagulation is effective at maintaining circuit patency and reducing the risk of bleeding during haemofiltration. The use of regional citrate anticoagulation also prolongs the haemofiltration circuit life, but this result is not significant when compared to the use of heparin. There was however, marked heterogeneity between trials reported. Level of evidence: 1- (Meta-analysis with a high risk of bias)

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