Fourteen studies (n=729) were evaluated in the review: 2 RCTs, 10 controlled clinical studies and 2 case-matched studies.
Twelve studies were judged to be of fair to good quality: the total quality scores ranged from 7 to 18. None of the studies was blinded for outcome assessors. Two studies scored only 1 point and were not considered in the analysis.
Operating times were longer for laparoscopy in 9 of the 12 studies and shorter in 3 studies. Actual operating times varied across the studies, ranging from a reduction of 23 minutes to an increase of 80 minutes in the laparoscopy group. There was evidence of significant statistical heterogeneity (p<0.05; I-squared 91.2%) for this outcome, therefore statistical pooling was not carried out. Estimated blood loss was higher for laparoscopy in 2 studies and lower in another 2 trials. The rate of conversion from laparoscopy to open surgery ranged from 0 to 16.7%.
The number of complications requiring reoperation was comparable for laparoscopy and control groups, as was overall morbidity. However, a subgroup analysis limited to RCTs showed a lower morbidity in patients treated with laparoscopy (RD -0.21, 95% CI: -0.36, -0.06). The laparoscopic approach was associated with an earlier return to normal gut function, a shorter time to a normal diet (1.12 days, 95% CI: 0.64, 1.61; 4 studies) and a shorter hospital stay (1.9 days, 95% CI: 0.83, 2.97; 5 studies). However, this latter outcome was associated with significant statistical heterogeneity (p=0.006; I-squared 72.0%).