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- Title
Meta-analysis of hybrid natural-orifice transluminal endoscopic surgery versus laparoscopic surgery.
- Authors
Steinemann, D. C.; Müller, P. C.; Probst, P.; Schwarz, A.‐C.; Büchler, M. W.; Müller‐Stich, B. P.; Linke, G. R.
- Abstract
Background Hybrid natural-orifice transluminal endoscopic surgery ( NOTES), combining access through a natural orifice with small-sized abdominal trocars, aims to reduce pain and enhance recovery. The objective of this systematic review and meta-analysis was to compare pain and morbidity in hybrid NOTES and standard laparoscopy. Methods A systematic literature search was performed to identify RCTs and non- RCTs comparing hybrid NOTES and standard laparoscopy. The main outcome was pain on postoperative day ( POD) 1. Secondary outcomes were pain during the further postsurgical course, rescue analgesia, complications, and satisfaction with the cosmetic result. The results of meta-analysis in a random-effects model were presented as odds ratio ( ORs) or standard mean differences ( MDs) with 95 per cent confidence intervals. Results Six RCTs and 21 non-randomized trials including 2186 patients were identified. In hybrid NOTES the score on the numerical pain scale was lower on POD 1 (−0·75, 95 per cent c.i. −1·09 to −0·42; P = 0·001) and on POD 2-4 (−0·58, −0·91 to −0·26; P < 0·001) than that for standard laparoscopy. The need for rescue analgesia was reduced in hybrid NOTES ( OR 0·36, 0·24 to 0·54; P < 0·001). The reduction in complications found for hybrid NOTES compared with standard laparoscopy ( OR 0·52, 0·38 to 0·71; P < 0·001) was not significant when only RCTs were considered ( OR 0·83, 0·43 to 1·60; P = 0·570). The score for cosmetic satisfaction was higher after NOTES ( MD 1·14, 0·57 to 1·71; P < 0·001). Conclusion Hybrid NOTES reduces postoperative pain and is associated with greater cosmetic satisfaction in selected patients.
- Subjects
ENDOSCOPIC surgery; LAPAROSCOPIC surgery; META-analysis; ODDS ratio; SURGICAL complications; PATIENTS
- Publication
British Journal of Surgery, 2017, Vol 104, Issue 8, p977
- ISSN
0007-1323
- Publication type
Article
- DOI
10.1002/bjs.10564