scholarly journals O38: TACKING VERSUS NO TACKING IN LAPAROSCOPIC TOTALLY EXTRAPERITONEAL REPAIR OF PRIMARY INGUINAL HERNIA - A SYSTEMATIC REVIEW AND META-ANALYSIS

2021 ◽  
Vol 108 (Supplement_1) ◽  
Author(s):  
J Horan ◽  
S M Sahebally ◽  
A Rogers ◽  
D Winter
Keyword(s):  
Systematic Review ◽  
Inguinal Hernia ◽  
Postoperative Pain ◽  
Length Of Stay ◽  
Operative Time ◽  
Meta Analysis ◽  
Mean Difference ◽  
Tep Repair ◽  
Pain Scores ◽  
Laparoscopic Tep

Abstract Introduction The necessity of mesh fixation in laparoscopic totally extraperitoneal (TEP) inguinal hernia repair remains controversial. We performed a systematic review and meta-analysis to compare the effectiveness of mesh tacking versus no tacking in laparoscopic TEP repair for primary inguinal hernia. Materials and Methods PubMed, EMBASE and Cochrane databases were searched for relevant articles from inception until November 2019. All studies that compared tacking versus no tacking in TEP repairs for inguinal herniae were included. Recurrent and femoral herniae were excluded from the current analysis. The primary outcome measure was recurrence, while secondary outcomes included postoperative pain scores at discharge and at 1 month, mean operative time, length of stay and seroma rates. Random effects models were used to calculate pooled effect size estimates. Result Eight randomised controlled trials were included capturing 557 patients and 715 inguinal herniae. On random effects analysis, there were no significant differences between tacking and no tacking in terms of recurrence (OR 0.94, 95% CI=0.10 to 9.28, p=0.96), postoperative pain scores on discharge (Mean difference 0.82, 95% CI=-0.35 to 2.00, p=0.17) or at 1 month (Mean difference 0.53, 95% CI=-0.75 to 1.82, p=0.41), mean operative time (Mean difference 1.58 mins, 95% CI=-0.22 to 3.37, p=0.09), seroma (OR=0.70, 95% CI=0.28 to 1.74, p=0.44) or length of stay (Mean difference 0.11 days, 95% CI=-0.04 to 0.25, p=0.14). Conclusion Mesh tacking in laparoscopic TEP repair for primary inguinal herniae does not translate into improved postoperative outcomes and may be omitted. Take-home message Mesh tacking in laparoscopic TEP repair for primary inguinal herniae does not translate into improved postoperative outcomes and may be omitted.

scholarly journals The Safety and Efficacy of Pre- and Post-Medication for Postoperative Endo- dontic Pain: A Systematic Review and Network Meta-analysis

2020 ◽  
Vol 14 (1) ◽  
pp. 563-599
Author(s):  
Muthhin Almuthhin ◽  
Marwa Afify ◽  
Yasmeen Alshammari ◽  
Nasser Alkatheeri ◽  
Sahar Maziad Altuwaijri ◽  
...  
Keyword(s):  
Systematic Review ◽  
Postoperative Pain ◽  
Meta Analysis ◽  
Mean Difference ◽  
Current Evidence ◽  
Safety And Efficacy ◽  
Significant Control ◽  
Pain Scores ◽  
Cox 2 ◽  
Cox 2 Inhibitors

Background: Postoperative Endodontic Pain is a major concern for dentists and their patients, with pain having been reported to occur in 25%–40% of patients treated. Therefore, the aim of this systematic review and Network Meta-analysis (NMA) was to identify the safety and efficacy of pre- and post-medication for reducing postoperative endodontic pain. Methods: A literature search was performed in the SCOPUS, MEDLINE, and ScienceDirect, and Cochrane Central databases until December 2019 with no language restriction. Randomized controlled trials evaluating the efficacy of pre- or post-medications compared with other agents, placebo, or no treatment in adult patients who underwent endodontic surgery for postoperative pain were included. The mean difference of postoperative pain was measured using the Standardized Mean Difference (SMD) with its 95% confidence interval (95% CI). Results: This Systematic Review included 62 Articles. Of them, 50 studies were included in the NMA. Among all medications, corticosteroids were ranked as the best treatment for the reduction of postoperative pain at 6 and 12 hours with a significant reduction in postoperative pain scores [SMD= -1.18, 95% CI (-1.51: -0.85)] and [SMD= -1.39, 95% CI (-1.77: -1.02)], respectively. Cyclooxygenase-2 (COX-2) inhibitors were ranked as the best treatment for the reduction of postoperative pain at 8 and 24 hours with a significant reduction in postoperative pain scores [SMD= -2.86, 95% CI (-6.05: -1.66)] and [SMD= -1.27, 95% CI (-2.10: -0.43)], respectively. Non-steroidal anti-inflammatory drugs (NSAIDs) significantly reduced the postoperative pain scores in all durations. For postoperative pain at 6 hours, Indomethacin, Novafen, Naproxen, Prednisolone, Ketorolac, Betamethasone, Dexamethasone, Deflazacort, Rofecoxib, Piroxicam, and Ibuprofen significantly reduced the pain score when compared with a placebo. All of these drugs demonstrated a significant reduction at 12 hours except Ketorolac. Conclusion: The current evidence suggests that pre- and post-medication can reduce postoperative pain after nonsurgical root canal treatment. Corticosteroids and COX-2 inhibitors showed significant control of the pain up to 12 hours after administration. However, NSAIDs demonstrated a high efficacy from administration and until two days after treatment. Indomethacin, Novafen, prednisolone, and Naproxen were ranked first in most analyzed durations.

The analgesic efficacy of liposomal bupivacaine compared with bupivacaine hydrochloride for the prevention of postoperative pain: a systematic review and meta-analysis with trial sequential analysis

2021 ◽  
pp. rapm-2020-102427
Author(s):  
Hanns-Christian Dinges ◽  
Thomas Wiesmann ◽  
Berit Otremba ◽  
Hinnerk Wulf ◽  
Leopold H Eberhart ◽  
...  
Keyword(s):  
Systematic Review ◽  
Postoperative Pain ◽  
Pain Score ◽  
Meta Analysis ◽  
End Points ◽  
Liposomal Bupivacaine ◽  
Bupivacaine Hydrochloride ◽  
Pain Scores ◽  
Score Difference ◽  
The Mean

Background/ImportanceLiposomal bupivacaine (LB) is a prolonged release formulation of conventional bupivacaine designed for prolonging local or peripheral regional single injection anesthesia. To this day, the benefit of the new substance on relevant end points is discussed controversial.ObjectiveThe objective was to determine whether there is a difference in postoperative pain scores and morphine consumption between patients treated with LB and bupivacaine hydrochloride in a systematic review and meta-analysis.Evidence reviewRandomized controlled trials (RCT) were identified in Embase, CENTRAL, MEDLINE and Web of Science up to May 2020. Risk of bias was assessed using Cochrane methodology. Primary end points were the mean pain score difference and the relative morphine equivalent (MEQ) consumption expressed as the ratio of means (ROM) 24 and 72 hours postoperatively.Findings23 RCTs including 1867 patients were eligible for meta-analysis. The mean pain score difference at 24 hours postoperatively was significantly lower in the LB group, at −0.37 (95% CI −0.56 to −0.19). The relative MEQ consumption after 24 hours was also significantly lower in the LB group, at 0.85 (0.82 to 0.89). At 72 hours, the pain score difference was not significant at −0.25 (−0.71 to 0.20) and the MEQ ratio was 0.85 (0.77 to 0.95).ConclusionThe beneficial effect on pain scores and opioid consumption was small but not clinically relevant, despite statistical significance. The effect was stable among all studies, indicating that it is independent of the application modality.

scholarly journals The Comparison of Short-Term Postoperative Pain in Single- versus Multiple-Visit Root Canal Treatment: A Systematic Review and Meta-Analysis Study

2021 ◽  
Vol 2021 ◽  
pp. 1-12
Author(s):  
Armin Izadpanah ◽  
Ailar Javaheripour ◽  
Azam Maleki ◽  
Mahdieh Alipour ◽  
Hossein Hosseinifard ◽  
...  
Keyword(s):  
Systematic Review ◽  
Postoperative Pain ◽  
Root Canal ◽  
Meta Analysis ◽  
Mean Difference ◽  
Single Visit ◽  
Multiple Visit ◽  
Statistical Heterogeneity ◽  
The Times

Postoperative pain after root canal therapy (RoCT) is an unpleasant experience for patients, and it could be affected by different factors. The times of visits could be one of these factors that were evaluated in various studies. However, there is inconsistent evidence on the relation between postoperative pain and the times of visits. Therefore, the current systematic review aimed to summarize the results of these studies and meta-analyze them. For this purpose, a comprehensive search was conducted in four main databases (Cochrane Database of Systematic Reviews, Web of Science, PubMed, and Scopus databases) for related English articles from 1978 to August 2020. The quality of studies was evaluated using the Delphi checklist. The heterogeneity of studies was determined by I2 statistic, and publication bias was assessed using the funnel plot and the Begg test. The results were presented by using relative ratio (RR) estimates and standard mean difference (SMD) with its 95% confidence intervals (CI) using a random-effects model. Initial searches from mentioned databases identified 1480 papers; of which only 27 of them met the inclusion criteria. In quality assessment, thirteen studies had quality scores of more than 7, two studies had 4 scores, and the rest had 5 scores. Overall, based on the available evidence, the meta-analysis showed that the risk of postoperative pain in single-visit was 1.02 times (CI 95% (0.99, 1.19), I2 = 60.7%, p = 0.001 ) higher than that of the multiple-visit treatment. The mean difference of postoperative pain in single-visit was −0.30 (CI 95% (−0.36, −0.25), I2 = 0.94.4, p = 0.001 ) compared with the multiple-visit treatment. Based on the results of this meta-analysis, the risk of postoperative pain in single-visit RoCT was higher than that in multiple-visit RoCT with acceptable statistical heterogeneity and moderate quality of the studies.

Emergent urinary decompression in acute stone-related urinary obstruction: A systematic review and meta-analysis

2021 ◽  
pp. 205141582110170
Author(s):  
David Eugenio Hinojosa-Gonzalez ◽  
Mauricio Torres-Martinez ◽  
Sergio Uriel Villegas-De Leon ◽  
Cecilia Galindo-Garza ◽  
Andres Roblesgil-Medrano ◽  
...  
Keyword(s):  
Systematic Review ◽  
Length Of Stay ◽  
Operative Time ◽  
Meta Analysis ◽  
Treatment Strategies ◽  
Percutaneous Nephrostomy ◽  
Complication Rates ◽  
Success Rates ◽  
Level Of Evidence ◽  
Cell Counts

Introduction: Emergent urinary decompression through percutaneous nephrostomy (PCN) or ureteric stent (URS) remains a mainstay in the management of urethral calculi-related obstruction with associated signs of infection or renal injury. Available evidence has shown similar performance, and current guidelines endorse both treatment strategies. Methods: A systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analysis criteria up until August 2020. Studies included data on stone size and location, operative time, complications, length of stay, analgesic consumption, quality of life (QoL), and clinical outcomes between URS and PCN. Results: Ten studies with a total population of 772, of which 420 were treated with URS and 352 with PCN, were included. No statistical difference in operative time between both techniques was found. Nevertheless, length of stay in PCN was longer than in USR, with a mean difference of −1.87 days ((95% CI −2.69 to −1.06), Z=4.50, p=0.00001). No differences were found in the time to normalization of temperature or white blood cell counts. There were no significant differences in success rates, with an overall odds ratio (OR) of 0.60 ((95% CI 0.26 to −1.40), Z=1.17, p=0.24), or spontaneous passage after emergent drainage between groups. Complication rates ranged from 5% to 25% in URS and from 0% to 38% in PCN. In the studied population, out of the 157 patients from four studies describing complications, only 5% of URS procedures presented complications compared to 2% in PCN, showing a relatively low complication rate for either group (OR=2.07 (95% CI 0.89–4.84), Z=1.68, p=0.09). Differences in QoL were not significant. Conclusion: Both methods are equally effective, with no clear advantage for PCN over URS. Level of evidence: IV

Single-Incision Laparoscopic Inguinal Hernioplasty Versus Conventional Laparoscopic Inguinal Hernioplasty

2017 ◽  
Vol 24 (2) ◽  
pp. 171-182 ◽  
Author(s):  
Shanshan Luo ◽  
Shike Wu ◽  
Hao Lai ◽  
Xianwei Mo ◽  
Jiansi Chen
Keyword(s):  
Inguinal Hernia ◽  
Postoperative Pain ◽  
Hospital Stay ◽  
Operative Time ◽  
Single Incision ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Cochrane Library ◽  
Inguinal Hernioplasty ◽  
Conventional Laparoscopic

Purpose: Additional studies comparing single-incision laparoscopic inguinal hernioplasty (SILH) and conventional laparoscopic inguinal hernioplasty (CLH) have been published, and this study updates the meta-analysis of this subject. Methods: Two reviewers independently searched the PubMed, Embase, Google Scholar, and Cochrane Library electronic databases to locate original articles that compared SILH and CLH for inguinal hernia that were published until October 2015. Operative time, conversions, complications, length of hospital stay, recurrence, postoperative pain at 24 hours, and postoperative pain at 7 days were compared using Stata software, version 12.0. Results: Sixteen studies were selected for this analysis, which included a total of 1672 patients (907 in SILH and 765 in CLH). SILH showed a longer operative time; however, conversions, complications, length of hospital stay, recurrence, postoperative pain at 24 hours, and postoperative pain at 7 days were similar between the 2 groups. Conclusions: Our meta-analysis has shown that inguinal hernia repair using SILH is as safe as CLH. However, based on our evidence, we currently believe that SILH is not an efficacious surgical alternative to CLH for inguinal hernias due to the fact that it does not provide significant benefit in postoperative pain and cosmetic outcomes. However, large-scale, well-designed, and multicenter studies will be needed to further confirm the results of this study.

scholarly journals P28: LAPAROSCOPIC VERSUS ULTRASOUND-GUIDED TRANSVERSUS ABDOMINIS PLANE BLOCK IN LAPAROSCOPIC COLORECTAL SURGERY - A SYSTEMATIC REVIEW AND META-ANALYSIS

2021 ◽  
Vol 108 (Supplement_1) ◽  
Author(s):  
A Copperthwaite ◽  
S Sahebally ◽  
L Devane ◽  
N McCawley ◽  
J Burke ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Operative Time ◽  
Meta Analysis ◽  
Mean Difference ◽  
Transversus Abdominis ◽  
Complication Rates ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Ultrasound Guided ◽  
Pain Scores

Abstract Introduction A multimodal approach to peri-operative analgesia represents a cornerstone of enhanced recovery programmes in minimally invasive colorectal surgery. Transversus abdominis plane (TAP) block is an emerging anaesthetic technique that may reduce postoperative opiod analgesic requirements. It can be performed laparoscopically or percutaneously. We performed a systematic review and meta-analysis to compare the effectiveness of laparoscopic versus ultrasound-guided TAP block in laparoscopic colorectal surgery. Method PubMed, EMBASE and Cochrane databases were searched for relevant articles from inception until November 2019. All studies that compared laparoscopic (LTB) versus ultrasound-guided (UTB) TAP blocks in laparoscopic colorectal resections were included. The primary outcome measure was narcotic consumption at 24 hours postoperatively, while secondary outcomes included pain scores, operative time, postoperative nausea and vomitting (PONV) and complication rates. Random effects models were used to calculate pooled effect size estimates. Result Three randomised controlled trials and one retrospective study were included capturing 309 patients. On random effects analysis, there were no significant differences in narcotic consumption between LTB and UTB (Mean difference -8.12 mg, 95% CI=-22.13 to 5.89, p=0.26). LTB was associated with significantly lower pain scores (Mean difference -0.49, 95% CI=-0.96 to -0.02, p=0.04). There were no differences in operative time (Mean difference -6.67 mins, 95% CI=-29.4 to 16.06, p=0.57), PONV (OR=0.97, 95% CI=0.36 to 2.65, p=0.96) or complication (OR=1.30, 95% CI=0.64 to 2.64, p=0.47) rates. Conclusion LTB is associated with significantly less pain at 24 hours postoperatively but similar narcotic usage, PONV, operative time and complication rates, compared to UTB. Take-home message Laparoscopic transversus abdominis plane block is shown to leave patients with less pain at 24 hours post-op compared to ultrasound guided methods in colorectal patients.

scholarly journals Comparison of laparoscopic totally extraperitoneal mesh hernioplasty with Lichtenstein tension free mesh hernioplasty

2019 ◽  
Vol 6 (10) ◽  
pp. 3590
Author(s):  
Abhishek Thakur ◽  
Dhruv Kumar Sharma ◽  
K. J. S. Jaswal
Keyword(s):  
Inguinal Hernia ◽  
Laparoscopic Surgery ◽  
Postoperative Pain ◽  
Operative Time ◽  
Recurrent Inguinal Hernia ◽  
Lichtenstein Repair ◽  
Tension Free ◽  
Tep Repair ◽  
Early Return ◽  
Mesh Hernioplasty

Background: The purpose of the study was to observe the differences between the two methods of inguinal hernia repair in terms of operative time, postoperative pain, need for analgesia, hospital stay and postoperative complications.Methods: This prospective study conducted in the department of Surgery, IGMC Shimla, included 40 patients of inguinal hernia who were randomized to TEP and Lichtenstein tension free mesh hernioplasty groups randomly. After thorough clinical examination, whereas all patients with unilateral incomplete inguinal hernia fit for laparoscopic surgery were included in the present study, those with bilateral inguinal hernia, unwilling for laparoscopic surgery or who had complicated and recurrent inguinal hernia, poor cardiopulmonary reserve or were immunocompromised were excluded from the study.Results: Laparoscopic TEP is significantly lengthier procedure than open Lichtenstein repair especially in the learning phase as the mean operative time of TEP repair was 75.6 minutes and that of open Lichtenstein repair was 54 minutes. Not only postoperative pain recorded by using VAS was significantly less in the in the first 4 postoperative hours there was significantly less consumption of post-operative analgesic in TEP as compared to Lichtenstein group. No major complications in either group but only minor complications were observed in TEP group.Conclusions: TEP can be recommended to those desiring better cosmetic results and early return to work as TEP was found to be associated with less pain in the first 4 hours after surgery. 

scholarly journals A Single Surgeon’s Experience of Total Extra Peritoneal Repair Vs Transabdominal Preperitoneal Repair- A Prospective Cohort Study

2021 ◽  
Author(s):  
Tharun Ganapathy Chitrambalam ◽  
Koshy Mathew Panicker ◽  
Jeyakumar Sundaraj ◽  
Sidhu Rajasekhar ◽  
Pradeep Joshua Christopher
Keyword(s):  
Inguinal Hernia ◽  
Postoperative Pain ◽  
Hospital Stay ◽  
Pain Score ◽  
Operative Time ◽  
P Value ◽  
Tep Repair ◽  
Duration Of Hospital Stay ◽  
Tapp Repair ◽  
The Mean

Introduction: Hernia surgery has evolved over a period of 2500 years from the Bassini-Shouldice era to conventional Lichenstein’s meshplasty to the laparoscopic era. Since, inception of the laparoscopic approach 25 years ago, there were several advancements in the techniques of inguinal hernia repairs. The two most commonly practiced laparoscopic approaches are the Total Extra Peritoneal (TEP) and Transabdominal Preperitoneal (TAPP) repair. Aim: To compare the outcomes for TEP and TAPP approaches in laparoscopic inguinal hernia surgery in terms of operative time consumed, postoperative pain, duration of hospital stay, complications and recurrence rate when performed by a single surgeon. Materials and Methods: A prospective interventional cohort study was carried out among 70 patients with uncomplicated inguinal hernia. Patients were divided equally into two groups of 35 patients and underwent TAPP and TEP repairs depending on group randomisation. All surgeries were performed by the same surgeon. Factors including operative time, postoperative pain, duration of hospital stay, complications and recurrence were documented and compared for both the groups. The statistical analysis was done using Statistical Package for the Social Sciences (SPSS) software version 21. Unpaired t-test was used to compare the mean between the two groups. The p-value of <0.05 was considered to be statistically significant. Results: The mean operative time measured in minutes for TEP repair was 31.03 minutes and TAPP repair was 42.26 showing a difference of 11.23 minutes which was statistically significant (p-0.001). The mean Standard Deviation (SD) pain score at 24 hours for TEP repair was 2.43 (1.195) and TAPP repair was 3.43 (0.917). The mean (SD) pain score at 48 hours for TEP repair was 1.31 (1.051) and TAPP repair was 2.20 (0.901). The mean (SD) pain score at one week for TEP repair was 0.37 (0.690) and TAPP repair was 0.91 (0.781). The mean (SD) duration of hospital stay in TEP repair was 2.60 days (0.553) when compared to 3.49 days (0.658) in TAPP repair. All the results were statistically significant with a p-value of 0.001. Conclusion: TEP repair had superior outcomes in terms of reduction in operative time, less postoperative pain and shorter hospital stay than TAPP repair.

scholarly journals Efficacy of milrinone and dobutamine in low cardiac output states: Systematic review and meta-analysis

2019 ◽  
Vol 42 (2) ◽  
pp. E26-32 ◽  
Author(s):  
Rebecca Mathew ◽  
Sarah M. Visintini ◽  
F. Daniel Ramirez ◽  
Pietro DiSanto ◽  
Trevor Simard ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiac Output ◽  
Length Of Stay ◽  
Meta Analysis ◽  
Mean Difference ◽  
Low Cardiac Output ◽  
Icu Length Of Stay ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Eligibility Requirements

Purpose: Patients in cardiac intensive care units (ICU) are admitted with increasingly higher disease acuity and a larger burden of non-cardiac critical illness. Accordingly, positive inotropes are being used with increased frequency and little comparative data to support drug selection. We compared the effectiveness and safety of dobutamine and milrinone in low cardiac output states (LCOS) and/or cardiogenic shock (CS). Methods: We performed a systematic review comparing dobutamine to milrinone on all-cause mortality, length of stay in the ICU (LOS-ICU), length of stay in hospital (LOS-H) and significant arrhythmias in hospitalized patients with LCOS and/or CS. Results: We identified 11 studies that meet eligibility requirements and which were published between 2001 and 2016 and included 23,056 patients. Only one randomized clinical trial was identified, with the remaining studies comprising observational cohort studies. The primary outcome, all-cause mortality, trended towards a benefit with milrinone but did not meet pre-specified significance (OR 1.13, 95% CI 1.00-1.29, p=0.06). While LOS-ICU (mean difference -0.72, 95% CI -1.10- -0.34, p=0.0002) was shorter with dobutamine, there was no difference in LOS-H (mean difference -1.22, 95% CI -4.68 – 2.24, p=0.49). Significant arrhythmias, specifically symptomatic and/or requiring antiarrhythmic therapy, were no different between the groups (OR 1.78, 95% CI 0.85-3.76, p=0.13). Conclusions: Currently available data comparing milrinone to dobutamine in patients requiring inotropic support is limited. Dobutamine may be associated with a shorter LOS in the ICU, with a worrisome signal of increased risk of allcause mortality. Randomized data are needed to guide inotrope selection in patients with LCOS and/or CS.

scholarly journals The Safety of Selective Use of Splenic Flexure Mobilization in Sigmoid and Rectal Resections—Systematic Review and Meta-Analysis

2018 ◽  
Vol 7 (11) ◽  
pp. 392 ◽  
Author(s):  
Michał Nowakowski ◽  
Piotr Małczak ◽  
Magdalena Mizera ◽  
Mateusz Rubinkiewicz ◽  
Anna Lasek ◽  
...  
Keyword(s):  
Systematic Review ◽  
Length Of Stay ◽  
Minimally Invasive ◽  
Lymph Nodes ◽  
Hospital Stay ◽  
Splenic Flexure ◽  
Operative Time ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Splenic Flexure Mobilization

Background: According to traditional textbooks on surgery, splenic flexure mobilization is suggested as a mandatory part of open rectal resection. However, its use in minimally invasive access seems to be limited. This stage of the procedure is considered difficult in the laparoscopic approach. The aim of this study was to systematically review literature on flexure mobilization and perform meta-analysis. Methods: A systematic review of the literature was performed using the Medline, Embase and Scopus databases to identify all eligible studies that compared patients undergoing rectal or sigmoid resection with or without splenic flexure mobilization. Inclusion criteria: (1) comparison of groups of patients with and without mobilization and (2) reports on overall morbidity, anastomotic leakage, operative time, length of specimen, number of harvested lymph nodes, or length of hospital stay. The outcomes of interest were: operative time, conversion rate, number of lymph nodes harvested, overall morbidity, mortality, leakage rate, reoperation rate, and length of stay. Results: Initial search yielded 2282 studies. In the end, we included 10 studies in the meta-analysis. Splenic flexure is associated with longer operative time (95% confidence interval (CI) 23.61–41.25; p < 0.001) and higher rate of anastomotic leakage (risk ratios (RR): 1.02; 95% CI 1.10–3.35; p = 0.02), however the length of hospital stay is shorter by 0.42 days. There were no differences in remaining outcomes. Conclusions: Not mobilizing the splenic flexure results in a significantly shorter operative time and a longer length of stay. Further research is required to establish whether flexure mobilization is required in minimally invasive surgery.

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