Systematic review and meta-analysis comparing outcomes of multi-port versus single-incision laparoscopic surgery (SILS) in Hartmann's reversal
Mostafa, Omar E S Zaman, Shafquat Beedham, Williams Kakaniaris, Georgios Husain, Najam Kumar, Lalit Akingboye, Akinfemi Waterland, Peter
Mostafa, Omar E S
Zaman, Shafquat
Beedham, Williams
Kakaniaris, Georgios
Husain, Najam
Kumar, Lalit
Akingboye, Akinfemi
Waterland, Peter
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Affiliation
The Dudley Group NHS Foundation Trust; University Hospital of Dery and Burton NHS Foundation Trust; University of Birmingham
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Publication date
2024-11-28
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Abstract
Colostomy formation as part of the Hartmann's procedure is often performed during emergency surgery as a damage limitation measure where attempts at bowel anastomosis and continuity are contraindicated. Hartmann's reversal (HR) remains challenging and can be attempted through open surgery and various minimally invasive techniques (laparoscopic and robotic platforms). We aimed to analyse outcomes of conventional multi-port laparoscopy (CL) versus single-incision approach (SILS) in patients undergoing HR. A comprehensive online search of various databases was conducted in accordance with PRISMA guidelines including Medline, PubMed, Embase, and Cochrane. Comparative studies of patients undergoing CL and SILS for HR were included. Analysed primary outcomes were total operative time and mortality rate. Secondary outcomes included post-operative complications, length of hospital stay, risk of visceral injury intra-operatively, and re-operation rate. Combined overall effect sizes were calculated using the random-effects model, and the Newcastle-Ottawa Scale (NOS) was used to assess bias. Two observational studies matching our inclusion criteria with a total of 160 patients (SILS 100 vs. CL 60) were included. Statistical difference was observed for one outcome measure: operative duration (MD - 44.79 CI - 65.54- - 24.04, P < 0.0001). No significant difference was seen in mortality rate (OR 1.66 CI 0.17-16.39, P = 0.66), overall post-operative complications (OR 0.60 CI 0.28-1.32, P = 0.20), length of stay (MD - 0.22 CI - 4.25-3.82, P = 0.92), Clavien-Dindo III + complications (OR 0.61 CI 0.15-2.53, P = 0.50), risk of visceral injury (OR 1.59 CI 0.30-8.31, P = 0.58), and re-operation rates (OR 0.73 CI 0.08-6.76, P = 0.78).
Conclusion: Accounting for study limitations, the SILS procedure seems to be quicker with non-inferior outcomes compared with the conventional multi-port approach. This may lead to better patient satisfaction and cosmesis and potentially reduce the risk of future incisional hernia occurrence. However, well-designed, randomised studies are needed to draw more robust conclusions and recommendations.
Citation
Mostafa OES, Zaman S, Beedham W, Kakaniaris G, Husain N, Kumar L, Akingboye A, Waterland P. Systematic review and meta-analysis comparing outcomes of multi-port versus single-incision laparoscopic surgery (SILS) in Hartmann's reversal. Int J Colorectal Dis. 2024 Nov 28;39(1):190. doi: 10.1007/s00384-024-04752-2.�