AbstractBackgroundEndoscopic vacuum therapy (EVT) with or without early surgical closure (ESC) is considered an effective option in the management of pelvic anastomotic leakage. This meta-analysis evaluated the effectiveness of EVT in terms of stoma reversal rate and the added value of ESC.MethodsA systematic search of PubMed, MEDLINE, and the Cochrane Library was conducted in November 2021 to identify articles on EVT in adult patients with pelvic anastomotic leakage. The primary outcome was restored continuity rate. Following PRISMA guidelines, a meta-analysis was undertaken using a random-effects model.ResultsTwenty-nine studies were included, accounting for 827 patients with leakage who underwent EVT. There was large heterogeneity between studies in design and reported outcomes, and a high risk of bias. The overall weighted mean restored continuity rate was 66.8 (95 per cent c.i. 58.8 to 73.9) per cent. In patients undergoing EVT with ESC, the calculated restored continuity rate was 82 per cent (95 per cent c.i. 50.1 to 95.4) as compared to 64.7 per cent (95 per cent c.i. 55.7 to 72.7) after EVT without ESC. The mean number of sponge exchanges was 4 (95 per cent c.i. 2.7 to 4.6) and 9.8 (95 per cent c.i. 7.3 to 12.3), respectively. Sensitivity analysis showed a restored continuity rate of 81 per cent (95 per cent c.i. 55.8 to 99.5) for benign disease, 69.0 per cent (95 per cent c.i. 57.3 to 78.7) for colorectal cancer, and 65 per cent (95 per cent c.i. 48.8 to 79.1) if neoadjuvant radiotherapy was given.ConclusionEVT is associated with satisfactory stoma reversal rates that may be improved if it is combined with ESC.

中文翻译：

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盆腔吻合口瘘后内镜真空治疗和早期手术闭合：肠道连续率的荟萃分析

摘要背景内镜真空治疗（EVT）联合或不联合早期手术闭合（ESC）被认为是治疗盆腔吻合口漏的有效选择。该荟萃分析评估了 EVT 在造口逆转率和 ESC 附加值方面的有效性。方法2021 年 11 月对 PubMed、MEDLINE 和 Cochrane 图书馆进行了系统检索，以查找有关成年盆腔吻合口瘘患者 EVT 的文章。主要结果是恢复的连续率。遵循 PRISMA 指南，使用随机效应模型进行荟萃分析。结果纳入 29 项研究，涉及 827 名接受 EVT 的渗漏患者。研究的设计和报告的结果之间存在很大的异质性，并且偏倚风险很高。总体加权平均恢复连续率为 66.8（95% CI 58.8 至 73.9）%。在接受 ESC 的 EVT 患者中，计算出的恢复连续性率为 82%（95% ci 50.1 至 95.4），而没有 ESC 的 EVT 后恢复连续性率为 64.7%（95% ci 55.7 至 72.7）。海绵交换的平均次数分别为 4 次（95% ci 2.7 至 4.6）和 9.8 次（95% ci 7.3 至 12.3）。敏感性分析显示，良性疾病的连续性恢复率为 81%（95% CI 55.8 至 99.5），结直肠癌的连续性恢复率为 69.0%（95% CI 57.3 至 78.7），而结肠直肠癌的连续性恢复率为 65%（95% CI 48.8）。至79.1）如果给予新辅助放疗。结论EVT 与令人满意的造口逆转率相关，如果与 ESC 结合使用，造口逆转率可能会得到改善。