BACKGROUND Small bowel obstruction (SBO) due to adhesions is a common acute surgical presentation. Laparoscopic adhesiolysis is being performed more frequently. However, the clear benefits of laparoscopic adhesiolysis (LA) compared with traditional open adhesiolysis (OA) remain uncertain. The aim of this study was to compare the outcomes of LA versus OA for SBO due to adhesions. METHODS A systemic literature review was conducted using PRISMA guidelines. A search was conducted using MEDLINE, EMBASE, PubMed and Cochrane Databases of all randomised controlled trials (RCT) and case-controlled studies (CCS) that compared LA with OA for SBO. Data were extracted using a standardised form and subsequently analysed. RESULTS There were no RCT. Data from 18 CCS on 38,927 patients (LA = 5,729 and OA = 33,389) were analysed. A meta-analysis showed that LA for SBO has decreased overall mortality (LA = 1.6% vs. OA = 4.9%, p < 0.001) and morbidity (LA = 11.2% vs. OA = 30.9%, p < 0.001). Similarly, the incidences of specific complications are significantly lower in the LA group. There are significantly lower reoperation rate (LA = 4.5% vs. OA = 6.5%, p = 0.017), shorter average operating time (LA = 89 min vs. OA = 104 min, p < 0.001) and a shorter length of stay (LOS) (LA = 6.7 days vs. OA = 11.6 days, p < 0.001) in the LA group. In the CCS, there is likely to be a selection bias favouring less complex adhesions in the LA group that may contribute to the better outcomes in this group. CONCLUSIONS Although there is a probable selection bias, these results suggest that LA for SBO in selected patients has a reduced mortality, morbidity, reoperation rate, average operating time and LOS compared with OA. LA should be considered in appropriately selected patients with acute SBO due to adhesions.

中文翻译：

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腹腔镜与开放性手术治疗粘连性小肠梗阻：病例对照研究的系统回顾和荟萃分析。

背景技术由于粘连引起的小肠梗阻（SBO）是常见的急性外科手术表现。腹腔镜黏附溶解术越来越频繁。但是，与传统的开放式粘连术（OA）相比，腹腔镜粘连术（LA）的明显优势仍然不确定。这项研究的目的是比较由于粘连导致的SBO的LA和OA结果。方法使用PRISMA指南进行系统的文献综述。使用MEDLINE，EMBASE，PubMed和Cochrane数据库进行了所有随机对照试验（RCT）和病例对照研究（CCS）的搜索，这些研究比较了LA和OA的SBO。使用标准化表格提取数据，然后进行分析。结果没有RCT。分析了来自18个CCS的38,927例患者的数据（LA = 5,729和OA = 33,389）。荟萃分析显示，SBO的LA降低了总死亡率（LA = 1.6％vs. OA = 4.9％，p <0.001）和发病率（LA = 11.2％vs. OA = 30.9％，p <0.001）。同样，LA组中特定并发症的发生率也明显较低。再手术率显着降低（LA = 4.5％vs. OA = 6.5％，p = 0.017），较短的平均手术时间（LA = 89 min vs. OA = 104 min，p <0.001）和较短的住院时间（洛杉矶组（LOS = 6.7天，而OA = 11.6天，p <0.001）。在CCS中，在LA组中可能存在选择偏倚，倾向于较少复杂的粘连，这可能有助于该组中更好的结果。结论尽管可能存在选择偏倚，但这些结果表明，某些患者的SBO的LA死亡率，发病率，再次手术率降低，与OA相比，平均操作时间和LOS。LA应适当选择病人急性SBO因粘连考虑。