eP499 - Open versus Minimally Invasive Emergency Colectomy: A Systematic Review and Meta-Analysis

Sunday, June 2, 2024

4:30 PM – 4:35 PM ET, USA

Location: Baltimore Convention Center, Room 318-320

Author(s)

YD

Yasmin Dias, MD

Research Assistant
Washington University in St. Louis
Washington University in St. Louis
St. Louis, MO, United States

Disclosure information not submitted.

ePoster Presenter(s)

Rafael R H Martin, MD (he/him/his)

Postdoctoral Research Fellow
Beth Israel Deaconess Medical Center
Boston, MA, United States

Disclosure information not submitted.

Author(s)

CB

Carlos André Balthazar da Silveira, n/a

Medical Student
Bahiana School of Medicine and Public Health
Salvador, Bahia, Brazil

Disclosure information not submitted.
MG

Miguel Godeiro Fernandez, n/a

Medical Student
Bahiana School of Medicine and Public Health
Salvador, Bahia, Brazil

Disclosure information not submitted.
AR

Ana Caroline Dias Rasador, n/a

Medical Student
Bahiana School of Medicine and Public Health
Salvador, Bahia, Brazil

Disclosure information not submitted.

Senior Author(s)

SM

Sergio M. poli de Figueiredo, Md

Fellow
Cleveland clinic
Cleveland, Ohio, United States

Disclosure information not submitted.

Purpose/Background: Although minimally invasive surgery (MIS) has been widely adopted in elective colectomy, the impact of MIS remains unclear for an emergency colectomy surgery. Therefore, we aim to perform a meta-analysis of postoperative outcomes comparing minimally invasive surgery to open surgery in emergency colectomy.Methods/Interventions: Cochrane Central, Embase, and PubMed were systematically searched for studies comparing minimally invasive surgery versus open colectomy for emergency colectomy. Two independent authors conducted study screening and selection, with discordances solved through a third author and consensus between the reviewers. Outcomes assessed were mortality (30 days), length of stay in the hospital (days), blood loss (ml), time to oral intake (days), operative time (min), ileus, reoperation (30 days) and surgical site infection. Statistical analysis was performed using Review Manager 5.4.1. Heterogeneity was assessed with I2 statistics and random-risk effect model was used if 𝐼2 > 25%.Results/Outcomes: 1955 studies were screened and 179 were thoroughly reviewed. A total of thirty studies met inclusion criteria, with 36 480 patients included of whom 3 768 were minimally invasive surgery. Mortality (30 days) was significantly lower with MIS (OR 0.33; 95% CI 0.23-0.49; p=0.00001; I2=0%). In addition, length of stay (MD -3.64 days; 95% CI -4.68, -2.61; p=0.00001; I2=93%), time to oral intake (MD -1.54 days; 95% CI -2.75,-0.32; p < 0.01; I2=93%), ileus (OR 0.62; 95% CI 0.40-0.98; p=0.04; I2=44%), blood loss (MD -63.10 ml; 95% CI -95.62, -30.58; p=0.00001; I2=80%), and reoperation (30 days) (OR 0.71; 95% CI 0.56-0.90; p=0.004; I2=30%), surgical site infection (OR 0.60; 95% CI 0.56-0.64; p < 0.00001; I2=6%) were also significantly lower with MIS. However, operative time was significantly lower with open surgery (MD 42.01 min; 95% CI 17.89-66.13; p=0.0006; I2=99%).Conclusion/

Discussion: MIS for patients undergoing emergency colectomy was associated with decreased overall complication rates, mortality, shorter hospital stay and faster recovery. Therefore, minimally invasive colectomy should be preferred for emergency colectomy if patient condition allows and appropriate expertise available."Forest Plot

Forest Plot