Elective open versus laparoscopic sigmoid colectomy for diverticular disease: a meta-analysis with the Sigma trial.

BACKGROUND: A meta-analysis of published literature comparing open versus laparoscopic elective sigmoid resections for diverticular disease was conducted. METHODS: Electronic databases were searched for data from January 1991 to March 2009. A systematic review was performed to obtain a summative outcome. RESULTS: Twenty-two comparative studies involving 10,898 patients were analyzed; 1538 patients were in the laparoscopic group and 9360 were in the open group. The operative time for laparoscopic sigmoid resection (LSR) is longer than open resections (OSR) [random-effects model: SMD = 1.94, 95% CI = (1.14, 2.74), z = 4.74, p < 0.001]. However, patients who undergo LSR have earlier return to passage of feces [random-effects model: SMD = -1.01, 95% CI (-1.80, -0.22), z = -2.50, p = 0.013] and shorter hospital stay [random-effects model: SMD = -7.65, 95% CI (-10.96, -4.32), z = -4.52, p < 0.001]. Overall morbidity was higher in the OSR group [random-effects model: RR = 0.56, 95% CI (0.40, 0.80), z = -3.24, p < 0.001] and no difference in mortality rates was observed (p = 0.81). CONCLUSIONS: Laparoscopic sigmoid resection takes longer to perform than open procedures; however, it is safe and has lower overall morbidity, earlier return of bowel function, and shorter hospital stays. This approach should be considered for elective cases but more randomized controlled trials are required to strengthen the evidence.

A meta-analysis on the clinical effectiveness of transversus abdominis plane block.

STUDY OBJECTIVE: To study the efficacy of the transversus abdominal plane (TAP) block. DESIGN: Meta-analysis. SETTING: District general hospital. PATIENTS: 86 patients in the TAP block group and 88 in the non-TAP block group. MEASUREMENTS: Statistical analyses were performed using Microsoft Excel 2007 for Windows XP. Hedges g statistic was used for the calculation of standardized mean differences (SMD). Binary data (nausea) were summarized as risk ratios (RR). MAIN RESULTS: Patients with TAP block required less morphine after 24 hours than those who did not have the block (random effects model: SMD -4.81, 95% CI [-7.45, -2.17], z = -3.57, P < 0.001). There was less time to first request of morphine in the non-TAP block group (random effects model: SMD 4.80, 95% CI [2.16, 7.43], z = 3.57, P < 0.001). Patients in the TAP block group had less pain up to 24 hours postoperatively. No statistical differences were found with respect to nausea. CONCLUSIONS: TAP block reduces the need for postoperative opioid use, it increases the time first request for further analgesia, it provides more effective pain relief, and it reduces opioid-associated side effects.