HALS and LAS have similar outcomes with the exception that HALS may reduce operative time (especially in more complex cases) and conversion to open. More data are needed regarding hernia formation and other patience-centered outcomes.

Although the quality of reviews and significant bias in patient selection limit direct comparison, perioperative outcomes are similar between SILS, LAS, and HALS. SILS remains more technically demanding but newer devices may reduce the technical demands of working through one port.

Six studies [48–53] evaluated the role of laparoscopy in the treatment of diverticulitis with a total of 13,875 patients, 6,150 of which were treated through a laparoscope. The studies demonstrated that laparoscopic procedures required significantly more time to perform [49, 51, 53] in diverticulitis patients, with one study [49] estimating an hour difference in operative time. No significant differences in intraoperative complications were noted between the LAS and OS groups, and only one study [50] commented on blood loss, noting that there was significantly less blood loss in LAS procedures without significant differences in transfusion requirements.

Morbidity was measured in several of the manuscripts reviewing diverticulitis surgery. Overall morbidity was significantly lower for the laparoscopic procedures in two studies [48, 51] but not in other studies [49–53]. In a large retrospective study, Mbadiwe et al. found that patients in the LAS group experienced significantly fewer postoperative complications, but no difference in a subgroup analysis of emergent cases [52]. Similarly, in a study evaluating long-term outcomes, Klarenbeek et al. identified no differences in the number of late complications after diverticulitis surgery [51]. Others have described no differences in the rates of anastomotic leak [48, 49, 53], anastomotic stricture [51, 53], anastomotic bleeding [48], enterocutaneous fistula [51], intra-abdominal abscess [48, 51], postoperative small bowel obstruction [48, 51], recurrent diverticulitis [51], reoperation, and incisional hernia [51, 53]. Although the data on surgical site infections has been mixed [48, 53], there are substantial data demonstrating no difference in mortality with either approach [48–52]. In addition, despite evidence in other studies that postoperative ileus is significantly reduced with a laparoscopic approach, others found no difference for diverticulitis patients treated either with open of laparoscopic techniques [48, 49].

Three studies [49, 50, 53] considered the effect of laparoscopic surgery for diverticulitis on postoperative pain. The data were somewhat mixed [49, 50, 53], but maximal pain levels were noted to be significantly less for patients with diverticulitis-treated laparoscopically [49] as was narcotic use [49, 50]. Given the reduction in narcotics, time to bowel activity was significantly lower for the LAS group [49] as well as length of stay [49, 50]. Quality of life is an important consideration and the data are somewhat mixed here as one study [50] revealed significant improvements in quality of life during the early postoperative period, while two studies [51, 53] identified similar outcomes for long-term postoperative quality of life.

In summary, outcomes following LAS in diverticulitis appear to be at least equivalent as OS, with operative times generally longer for LAS. In procedures for complications of diverticulitis, laparoscopy may be technically demanding.

Both ulcerative colitis and Crohn’s disease are conditions of younger people who are more likely to be interested in the aesthetic advantages as well as the traditional benefits of minimally invasive techniques [54]. For this reason, laparoscopic techniques are often sought out by these patients; however, both conditions can be challenging to treat with minimally invasive methods, particularly during the acute inflammatory phases. There are three meta-analyses [55–57] comparing LAS and OS in patients with Crohn’s disease for a total of 1,515 patients, with 795 treated laparoscopically. Length of procedure was noted to be significantly longer for the LAS group in three studies [56, 57] and blood loss similar in one study [57]. Early postoperative complication rates were noted to be similar [57], while in two other studies [56] the overall complication rate was significantly lower for the LAS group. There was no difference between the LAS and OS in rates of surgical site infection [55–57], anastomotic leak [56, 57], abscess [56, 57], bowel obstruction [57], postoperative ileus [55], inflammatory bowel disease recurrence [56], and overall reoperation rates [55, 56]. Postoperatively, there was no significant difference in the use of narcotics [57] and two studies [56, 57] noted that bowel function returned more quickly in the LAS group. Most studies [56, 57] found that patients in the LAS group experienced a significantly shorter hospital stay.

Few randomized controlled trials [54, 58, 59] have sought to identify the value of laparoscopy in patients with Crohn’s disease. These studies demonstrated significantly longer procedure times for the LAS group [54, 58], shorter incision length for LAS patients [54], and no difference in blood loss [59]. Postoperatively, there was no difference in pain scores [58] or narcotic use [54], time to passage of flatus [54], or to first bowel movement [54]. One study [58] revealed significantly longer length of hospital stay for open surgery patients; although the researchers estimated evidence of bias. In a study by Milsom et al. [54], the LAS patients experienced significantly fewer minor complications, but the LAS and OS groups experienced similar rates for major complications without differences in recurrence. In another follow-up study, Stocchi et al. [59] found that rates of anorectal disease, anorectal surgery, endoscopic or radiologic recurrence, medication, and average number of operations per patient were similar between LAS and open groups. However, patients in the open surgery group were significantly more likely to undergo multiple operations. Lastly, Maartense et al. [58] found that quality of life was no different between the two groups at 2 weeks.

There are a limited number of high-quality studies evaluating the outcomes of LAS for ulcerative colitis with small sample sizes [60–62]. Surgeries analyzed were restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) [16, 39, 60, 63, 64] and total colectomy [61, 62]. Three studies found that the length of procedure was significantly longer for patient who underwent LAS over OS [16, 60, 62]. There was no difference in postoperative morbidity for patients who underwent restorative proctocolectomy with IPAA in the LAS and OS groups [16, 61, 64] and in the HALS and OS groups [39]. Postoperative morbidity was noted to be significantly lower for laparoscopic colectomy [61, 62]. There was no difference in surgical site infection [16, 62], anastomotic leak [16, 62, 64], abscess [16, 62], bowel obstruction [62, 64], prolonged ileus [16, 64], pouch failure [64], reoperation [16, 61, 62], readmission [16], and mortality [61, 62]. Importantly, rate of incisional hernia was significantly lower for patients who underwent LAS as compared to OS [64].

In comparing LAS versus OS, patients who underwent laparoscopic restorative proctocolectomy with IPAA had significantly shorter time to return of oral intake [16, 61, 62, 64] and return of bowel function [16, 60, 64] over the open procedure, although the two meta-analyses noted similar time to bowel function between the LAS and OS groups [61, 62]. Four studies found that the length of stay was significantly shorter for patients in the LAS group than the OS groups [16, 60–62] while one noted no difference [64]. There was no difference in quality of life between the LAS and OS groups [63, 64] and between the LAS and HALS groups [39], although Polle et al. [63] found that cosmesis scores were significantly higher for patients who underwent LAS than OS, especially for females. There was no difference in long-term defecatory function between the LAS and OS groups [63, 64] and long-term morbidity between the LAS and OS groups [63]. In a study by Fichera et al. [64], the long-term benefits of laparoscopic restorative proctocolectomy with IPAA were significantly less liquid bowel movements, pad wearing during the daytime and nighttime, and perianal rash.