Intervention Of Minimally Invasive Techniques Versus Traditional Laparotomy In Patient With Severe Acute Pancreatitis:a Meta-Analysis

Objective:To evaluate the clinical efficacy and safety of minimally invasive techniques versus traditional laparotomy in patient with severe acute pancreatitis (SAP).Methods:Papers in reporting SAP which treated with minimally invasive techniques and traditional laparotomy were searched from database such as MEDLINE, CENTRAL, EMBASE, WEB OF SCIENCE, CBMdisc, CNKI, VIP and so on. Relevant journals and conference proceeding were also hand searched from January,1970to April,2012. Randomized controlled trials (RCTs) comparing minimally invasive techniques with traditional laparotomy for SAP were collected and assessed according to the included criteria and excluded criteria. The primary data extraction and analysis such as hospital mortality, the incidence of pancreatic or intestinal fistula, the incidence of postoperative ARDS、the rates of postoperative pancreatic absess、the rates of reoperation the rates of postoperative hyperglycemia and days in hospital were undertaken by two reviewers independently. Reviews of interventions,Meta-analysis were performed with RevMan5.1.5which provided by Cochrane corperation net.Results:8randomized controlled trial studies were included, involving351SAP patients. But a majoraty of the included RCTs were of small sample and low quality. Overall, the rates of postoperative pancreatic absess were not different (RR=0.52,95%CI=[0.21,1.29], P>0.05), the rates of reoperation were not different (RR=0.18,95%CI=[0.02,1.71], P>0.05) and the rates of postoperative hyperglycemia were not different (RR=0.67,95%CI=[0.29,1.53], P>0.05); but minimally invasive techniques are better than traditional laparotomy over hospital mortality, the incidence of pancreatic or intestinal fistula, the incidence of postoperative ARDS and days in hospital. However, since some of the low-quality trials and publications bias, the evidence is not strong enough. More rigorous designs, randomized, large sample, multicentre, double-blind trials are desired to further assess the effect.Conclusion:The results of meta-analysis show that compared with traditional laparotomy, minimally invasive techniques for the treatment of patient with severe acute pancreatitis (SAP), will be able to reduce mortality, produce fewer complications and shorter hospital stays, we recommend that minimally invasive techniques can be consider as a priority measure for the patient with SAP when needed to select surgical treatment.