Academic Editor: Zhonghua Sun
Objectives: Type II endoleak (T2E), often generated by persistent
retrograde flow through the inferior mesenteric artery (IMA) is the most frequent
complication following endovascular aortic aneurysm repair (EVAR). T2E treatment
revolves around transarterial and translumbar embolization of the feeding artery
and/or sac, with mediocre results. The aim of this study is to assess the safety
feasibility and efficacy of laparoscopic IMA ligation for the treatment of T2E.
Methods: We conducted a systematic electronic research on Medline,
Scopus, EMBASE, and Cochrane Library according to Preferred Reporting Items for
Systematic Review and Meta-Analysis protocol (PRISMA) for articles published up
to February 2022, describing laparoscopic IMA ligation for the treatment of T2E.
Publications describing hand assisted or prophylactic IMA ligation were excluded.
A metanalysis was performed utilizing both the random and common effects model
and the DerSimonian and Laird method. Additionally, we carried out a post hoc
power analysis. Results: Fifteen studies, including one prospective case
series (CS), five retrospective CS and nine case reports, including 33 patients
(91% male) met the inclusion criteria. The mean abdominal aortic aneurysm
diameter at the time of diagnosis was 58.8 mm. The mean operational duration was
117.5 minutes. The mean follow-up for the included studies was 17 months. The
mean reported time of T2E identification was 9.1 months post-intervention, while
the mean reported aneurysmal sac diameter increase at the time of diagnosis was
11.5 mm. T2E type a (T2aE) and type b (T2bE) patterns were 57.6% and 42.4%
respectively. Six CS incorporating 24 patients were included in the
meta-analysis. The pooled technical success and postoperative mortality rates are
100% (95% CI: 93.13–100), (I