SUPPLEMENTAL MATERIAL
A comparison of laparoscopy and laparotomy
for the
management of abdominal trauma: a systematic review and
meta-analysis
Yueli Li1, 2 *, Ying Xiang1, 2 *, Na Wu1, 2, Long Wu1, 2, Zubin Yu3, Mengxuan Zhang1, 2,
Minghao Wang 4, Jun Jiang 4 #, Yafei Li1, 2 #
1
Department of Epidemiology, College of Preventive Medicine, Third Military
Medical University, Chongqing 400038, People’s Republic of China
2
Center for Clinical Epidemiology and Evidence-based Medicine, Third Military
Medical University, Chongqing, People’s Republic of China
3
Department of Thoracic Surgery, Xinqiao Hospital, Third Military Medical
University, Chongqing, People’s Republic of China
4
Breast Disease Center, Southwest Hospital, Third Military Medical University,
Chongqing 400038, People’s Republic of China
*
These authors contributed equally to this work.
#
These authors jointly directed the project.
Correspondence:
Yafei Li Ph.D.
Department of Epidemiology, College of Preventive Medicine, Third Military
Medical University, Chongqing 400038, People’s Republic of China
E-mail: liyafei2008@hotmail.com
Telephone: +86 23 68752293
Supplementary Table 1. Newcastle-Ottawa Quality assessment score scale
Supplementary Table 2. Characteristics of case report studies included for meta-analysis
Supplementary Table 3. Newcastle-Ottawa Scale score of included cohort studies
Supplementary Table 4. Cochrane Collaboration’s risk of bias assessment results of included
RCTs
Supplementary Table 5. The publication bias of RCT and cohort studies by Begg’s tests
Supplementary Table 6. The publication bias of case series reports by Begg’s tests
Supplementary Figure 1. Flow diagram of literature search and study selection
Supplementary Figure 2. The pooled incidence of postoperative complications in treating
patients with abdominal trauma
Supplementary Figure 3. The pooled perioperative mortality rate in treating patients with
abdominal trauma
Supplementary Figure 4. The pooled cure rate in treating patients with abdominal trauma
Supplementary Figure 5. Comparison of time to postoperative exhaust of laparoscopy with
open laparotomy in treating patients with abdominal trauma
Supplementary Figure 6. Comparison of duration of pain of laparoscopy with open
laparotomy in treating patients with abdominal trauma
Supplementary Figure 7. Comparison of time to out of bed of laparoscopy with open
laparotomy in treating patients with abdominal trauma
Supplementary Figure 8. Comparison of time to regular diet of laparoscopy with open
laparotomy in treating patients with abdominal trauma
Supplementary Figure 9. The pooled incidence of missed injuries in treating patients with
abdominal trauma
Supplementary Figure 10. The pooled incidence of conversions in treating patients with
abdominal trauma
Supplementary Table 1. Newcastle-Ottawa Quality assessment score scale
Item
Score
NOS score scale for cohort studies†
Selection
(1) Representativeness of the exposed cohort
Truly representative of the average status in the community
1
Somewhat representative of the average status in the community
1
Selected group of users eg nurses, volunteers
0
No description of the derivation of the cohort
0
(2) Selection of the non exposed cohort
Drawn from the same community as the exposed cohort
1
Drawn from a different source
0
No description of the derivation of the non exposed cohort
0
(3) Ascertainment of exposure
Secure record (eg surgical records)
1
Structured interview
1
Written self report
0
No description
0
(4) Demonstration that outcome of interest was not present at start of study
Yes
1
No
0
Comparability
(1) Comparability of cohorts on the basis of the design or analysis
Study controls for the most important factor
1
Study controls for any additional factor
1
Outcome
(1) Assessment of outcome
Independent blind assessment
1
Record linkage
1
Self report
0
No description
0
(2) Was follow-up long enough for outcomes to occur?
Yes
1
No
0
(3) Adequacy of follow up of cohorts
Complete follow up - all subjects accounted for
1
Subjects lost to follow up unlikely to introduce bias
1
Item
Score
Follow up rate is low and no description of those lost
0
No statement
0
A study can be awarded a maximum of one score for each numbered item within the Selection
and Outcome categories. A maximum of two scores can be given for Comparability.
Supplementary Table 2. Characteristics of case report studies included for meta-analysis
First author
Year
Country
Subtype of
abdominal
trauma
Study
design
Treatment method
VAL
Control
Number of
participants
VAL
Zhao GQ [30]
2013
China
Traumatic splenic
rupture
Case report
Laparoscopic
surgery
68
Yang YL [31]
2013
China
Case report
2013
China
Laparoscopic
surgery
Laparoscopic
surgery
80
Ni KY [32]
Blunt abdominal
trauma
Blunt abdominal
trauma
Yin YH [33]
2012
China
Blunt abdominal
trauma
Case report
Laparoscopic
surgery
56
Lan MY [34]
2011
China
Blunt abdominal
trauma
Case report
Laparoscopic
surgery
52
Guo SW [35]
2010
China
Blunt abdominal
trauma
Case report
Laparoscopic
surgery
59
Chen QW [36]
2010
China
Case report
2008
China
Laparoscopic
surgery
Laparoscopic
surgery
98
Yin J [37]
Blunt abdominal
trauma
Blunt abdominal
trauma
Case report
Case report
56
57
The main results
reported*
Control
Missed injuries 0,conversions
6,complications 2,mortality
0,cure rate 91.2%(62/68)
Missed injuries 0,conversions
15,complications 0
Missed injuries 0,conversions
16,complications 0,mortality
0,cure rate 71.4%(40/56)
Missed injuries 0,conversions
10,complications 0,mortality
0,cure rate 82.1%(46/56)
Missed injuries 0,conversions
24,complications 0,mortality
0,cure rate 53.8%(28/52)
Missed injuries 0,conversions
15,mortality 0,cure rate
74.6%(44/59)
Conversions 22,mortality
0,cure rate 77.6%(76/98)
Missed injuries 0,conversions
19,complications 1,mortality
Li CY [38]
2007
China
Blunt abdominal
trauma
Abdominal
trauma
Case report
Laparoscopic
surgery
Laparoscopic
surgery
58
Zhou ZG [39]
2013
China
Gao YD [40]
2006
China
Abdominal
trauma
Case report
Laparoscopic
surgery
68
Chen WY [41]
2013
China
Abdominal
trauma
Case report
Laparoscopic
surgery
60
Ke LX [42]
2012
China
Abdominal
trauma
Case report
Laparoscopic
surgery
100
Kou BY [43]
2011
China
Abdominal
trauma
Case report
Laparoscopic
surgery
74
Hu XP [44]
2012
China
Case report
2011
China
Laparoscopic
surgery
Laparoscopic
surgery
54
Zhao YT [45]
Abdominal
trauma
Abdominal
trauma
Yang ZQ [46]
2011
China
Abdominal
trauma
Case report
Laparoscopic
surgery
326
Case report
Case report
55
72
1,cure rate 66.7%(38/57)
Missed injuries 1,conversions
8,complications 0,mortality 0
Missed injuries 3,conversions
10,complications 2,cure rate
81.8%(45/55)
Missed injuries 6,conversions
31,complications 5,mortality
0,cure rate 54.4%(37/68)
Missed injuries 0,conversions
11,mortality 0,cure rate
81.7%(49/60)
Missed injuries 0,conversions
51,complications 3,mortality
0,cure rate 46%(46/100)
Missed injuries 0,conversions
25,complications 1,mortality
0,cure rate 66.2%(49/74)
Missed injuries 0,conversions
21,complications 8,mortality 0
Missed injuries 0,conversions
11,complications 1,mortality
0,cure rate 84.7%(61/72)
Missed injuries 0,conversions
42,mortality 0,cure rate
87.1%(284/326)
Wei JB [47]
2011
China
Abdominal
trauma
Case report
Laparoscopic
surgery
102
Shi JQ [48]
2011
China
Abdominal
trauma
Case report
Laparoscopic
surgery
87
Gao ZJ [49]
2011
China
Abdominal
trauma
Case report
Laparoscopic
surgery
60
Xu GC [50]
2011
China
Abdominal
trauma
Case report
Laparoscopic
surgery
62
Zhao CS [51]
1998
China
Case report
1998
China
Laparoscopic
surgery
Laparoscopic
surgery
68
Shao RQ [52]
Abdominal
trauma
Abdominal
trauma
Chou HM [53]
2010
China
Abdominal
trauma
Case report
Laparoscopic
surgery
62
Mei GS [54]
2009
China
Abdominal
trauma
Case report
Laparoscopic
surgery
80
Nu HQ [55]
2009
China
Abdominal
trauma
Case report
Laparoscopic
surgery
52
Case report
60
Missed injuries 0,conversions
18,complications 3,mortality
0,cure rate 82.4%(84/102)
Missed injuries 0,conversions
20,complications 3,mortality
0,cure rate 77%(67/87)
Missed injuries 12,conversions
5,mortality 0,cure rate
91.7%(55/60)
Missed injuries 0,conversions
16,complications 3,mortality
0,cure rate 74.2%(46/62)
Conversions 4
Missed injuries 1,conversions
8,complications 1,mortality
1,cure rate 85%(51/60)
Missed injuries 0,conversions
13,complications 0,mortality
0,cure rate 79%(49/62)
Missed injuries 0,conversions
4,complications 0,mortality
0,cure rate 95%(76/80)
Missed injuries 0,conversions
16,complications 1,mortality
0,cure rate 69.2%(36/52)
Tian SL [56]
2009
China
Abdominal
trauma
Case report
Laparoscopic
surgery
60
Ran QH [57]
2009
China
Abdominal
trauma
Case report
Laparoscopic
surgery
76
Shi XZ [58]
2009
China
Case report
2009
China
Zhang XH
[60]
2008
China
Laparoscopic
surgery
Laparoscopic
surgery
Laparoscopic
surgery
61
Chen XX [59]
Abdominal
trauma
Abdominal
trauma
Abdominal
trauma
Sun ZG [61]
2006
China
Abdominal
trauma
Case report
Laparoscopic
surgery
85
Ma D [62]
2005
China
Abdominal
trauma
Case report
Laparoscopic
surgery
58
Huang H [63]
2003
China
Abdominal
trauma
Case report
Laparoscopic
surgery
50
Zhou C [64]
2011
China
Case report
2011
China
Laparoscopic
surgery
Laparoscopic
surgery
72
Qin C [65]
Abdominal stab
wounds
Abdominal
trauma with
Case report
Case report
Case report
58
52
60
Missed injuries 0,conversions
22,complications 0,mortality
0,cure rate 63.3%(38/60)
Missed injuries 0,conversions
11,complications 0,mortality
0,cure rate 85.5%(65/76)
Missed injuries 0,conversions
13,complications 4,mortality 0
Missed injuries 0,conversions
10,complications 2,mortality 0
Missed injuries 0,conversions
13,complications 9,mortality
0,cure rate 75%(39/52)
Missed injuries 0,conversions
22,complications 4,mortality
0,cure rate 74.1%(63/85)
Missed injuries 0,conversions
15,complications 0,mortality
0,cure rate 74.1%(43/58)
Missed injuries 5,conversions
27,complications 8,mortality
0,cure rate 46%(23/50)
Missed injuries 0,conversions
14,complications 5,mortality 0
Missed injuries 0,complications
2
Ahmed N [66]
2005
USA
Saribeyoqlu K
[67]
2007
Turkey
Ivatury RR
[68]
1993
New York
Sitnikov V
[69]
2009
Russia
Chol YB [70]
2003
Korea
Zantut LF [71]
1997
Brazil
Sosa JL [72]
1995
USA
*VAL,video-assisted laparoscopy; "
gastrointestinal
injuries
Penetrating
abdominal
wounds
Abdominal stab
injuries
Case report
Laparoscopic
surgery
52
Missed injuries 0,conversions
12,complications 3,mortality 0
Case report
Diagnostic
and
therapeutic
laparoscopy
Laparoscopic
surgery
88
Missed injuries 1,conversions
18,mortality 0
100
Conversions 54,complications
10,mortality 3
Penetrating
abdominal
wounds
Small bowel
injuries in
abdominal trauma
Abdominal
trauma
Penetrating
abdominal
wounds
Case report
Abdominal
gunshot wounds
Case report
", not applicable.
Case report
VAL
819
Complications 97,mortality 19
Case report
Therapeutic
laparoscopy
Diagnostic
and
therapeutic
laparoscopy
Laparoscopic
surgery
78
Missed injuries 0,conversions
0,complications 3,mortality 0
Conversions 207,complications
10,mortality 4
Case report
510
121
Missed injuries 0,conversions
39,mortality 0
Supplementary Table 3. Newcastle-Ottawa Scale score of included cohort studies
Selection
First
author
Ouyang M
Tian LF
Yang T
Li YC
Liang TC
Cai W
Hou QZ
Zheng JJ
Liao CH
Khubutiya
MSh
Streck CJ
Feliz A
Lin HF
Cherkasov
M
Cherry RA
Lee PC
Comparability
Outcome
Total
score
Representati
-veness of
the exposed
cohort
Selection
of the
non
exposed
cohort
Ascertainment
of exposure
Demonstration
that outcome of
interest was not
present at start
of study
Comparability of
cohorts on the basis
of the design or
analysis
Assessment
of outcome
Was follow-up
long enough
for outcomes to
occur
Adequacy of
follow up of
cohorts
0
0
0
0
0
0
0
0
0
0
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
2
2
2
2
2
2
1
1
2
2
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
8
8
8
8
8
8
7
7
8
8
0
0
0
0
1
1
1
1
1
1
1
1
1
1
1
1
2
1
2
2
1
1
1
1
1
1
1
1
1
1
1
1
8
7
8
8
0
0
1
1
1
1
1
1
2
2
1
1
1
1
1
1
8
8
Supplementary Table 4. Cochrane Collaboration’s risk of bias assessment results of
included RCTs
First
Random
Allocation
Blinding of
author
sequence
concealment
generation
Blinding of
Incomplete
Selective
Other
participants
outcome
outcome
reporting
bias
and
assessment
data
personnel
Li XY
Zuo CH
Low risk
Unclear
Low risk
Low risk
Low risk
Low risk
Low risk
Unclear
Unclear
Low risk
Low risk
Low risk
Low risk
Low risk
Leppaniemi A
Karateke
F
Kawahara
NT
Unclear
Unclear
Low risk
Low risk
Low risk
Low risk
Low risk
High risk
Unclear
Low risk
Low risk
Low risk
Low risk
Low risk
High risk
Unclear
Low risk
Low risk
Low risk
Low risk
Low risk
Supplementary Table 5.The publication bias of RCT and cohort studies by Begg’s tests
Outcome
Coef
t value
P value
95% CI
Postoperative complications
-0.439
-1.95
0.075
[-0.93,0.05]
Perioperative mortality rate
-0.246
-0.69
0.560
[-1.78,1.29]
Length of hospital stay
-1.748
-0.69
0.501
[-7.11,3.62]
Operation time
0.561
0.10
0.925
[-12.59,13.72]
Amount of intraoperative blood loss
-11.442
-4.55
0.045
[-22.27,-0.62]
Time to postoperative exhaust
-16.179
-0.97
0.385
[-62.27,29.91]
Duration of postoperative pain
4.492
74.10
0.009
[3.72,5.26]
Length of ICU stay
-24.520
-8.94
0.071
[-59.36,10.32]
Time to out of bed
1.399
34.29
0.001
[1.22,1.58]
Time to regular diet
-55.881
-5.22
0.035
[-101.95,-9.81]
Coef, coefficient; CI, confidence interval
Supplementary Table 6.The publication bias of case series reports by Begg’s tests
Outcome
Coef
t value
P value
95% CI
Postoperative complications
1.698
2.22
0.036
[0.12,3.28]
Missed injuries
3.372
5.98
0.002
[1.92,4.82]
Conversions
3.542
2.65
0.012
[0.84,6.25]
Perioperative mortality rate
0.746
1.02
0.382
[-1.58,3.07]
Cure rate
-5.819
-5.80
0.000
[-7.88,-3.76]
Coef, coefficient; CI, confidence interval
Articles identified
(n=1753)
Articles excluded after reading titles and
abstracts, which do not contain abdominal
trauma or laparoscopy (n=1534)
through
database
searching
Articles excluded that are
duplicate (n=7)
Articles included before reading the full text(n=212)
148 articles were not relevant or the
subjects were insufficient
64 articles included in the systematic review and
meta-analysis
Supplementary Figure 1. Flow diagram of literature search and study selection
Supplementary Figure 2. The pooled incidence of postoperative complications in
treating patients with abdominal trauma. Forest plots of proportion and overall
proportion with 95% CI in case series reports. Black square indicates the proportion,
with the size of the square inversely proportional to its variance, and horizontal lines
represent 95% CI. The pooled results are indicated by the gray diamond. CI,
confidence interval.
Supplementary Figure 3. The pooled perioperative mortality rate in treating
patients with abdominal trauma. Forest plots of proportion and overall proportion
with 95% CI in case series reports. Black square indicates the proportion, with the
size of the square inversely proportional to its variance, and horizontal lines represent
95% CI. The pooled results are indicated by the gray diamond. CI, confidence interval.
Supplementary Figure 4. The pooled cure rate in treating patients with
abdominal trauma. Forest plots of proportion and overall proportion with 95% CI in
case series reports. Black square indicates the proportion, with the size of the square
inversely proportional to its variance, and horizontal lines represent 95% CI. The
pooled results are indicated by the gray diamond. CI, confidence interval.
Supplementary Figure 5. Comparison of time to postoperative exhaust of
laparoscopy with open laparotomy in treating patients with abdominal trauma.
Forest plots of MD and overall MD with 95% CI between group of laparoscopy and
group of open laparotomy. Green square indicates the MD, with the size of the square
inversely proportional to its variance, and horizontal lines represent 95% CI. The
pooled results are indicated by the black diamond. MD, mean difference; CI,
confidence interval.
Supplementary Figure 6. Comparison of duration of pain of laparoscopy with
open laparotomy in treating patients with abdominal trauma. Forest plots of MD
and overall MD with 95% CI between group of laparoscopy and group of open
laparotomy. Green square indicates the MD, with the size of the square inversely
proportional to its variance, and horizontal lines represent 95% CI. The pooled results
are indicated by the black diamond. MD, mean difference; CI, confidence interval.
Supplementary Figure 7. Comparison of time to out of bed of laparoscopy with
open laparotomy in treating patients with abdominal trauma. Forest plots of MD
and overall MD with 95% CI between group of laparoscopy and group of open
laparotomy. Green square indicates the MD, with the size of the square inversely
proportional to its variance, and horizontal lines represent 95% CI. The pooled results
are indicated by the black diamond. MD, mean difference; CI, confidence interval.
Supplementary Figure 8. Comparison of time to regular diet of laparoscopy with
open laparotomy in treating patients with abdominal trauma. Forest plots of MD
and overall MD with 95% CI between group of laparoscopy and group of open
laparotomy. Green square indicates the MD, with the size of the square inversely
proportional to its variance, and horizontal lines represent 95% CI. The pooled results
are indicated by the black diamond. MD, mean difference; CI, confidence interval.
Supplementary Figure 9. The pooled incidence of missed injuries in treating
patients with abdominal trauma. Forest plots of proportion and overall proportion
with 95% CI in case series reports. Black square indicates the proportion, with the
size of the square inversely proportional to its variance, and horizontal lines represent
95% CI. The pooled results are indicated by the gray diamond. CI, confidence interval.
Supplementary Figure 10. The pooled incidence of conversions in treating
patients with abdominal trauma. Forest plots of proportion and overall proportion
with 95% CI in case series reports. Black square indicates the proportion, with the
size of the square inversely proportional to its variance, and horizontal lines represent
95% CI. The pooled results are indicated by the gray diamond. CI, confidence interval.