Systematic review and meta-analysis of acupuncture for postoperative gastrointestinal dysfunction after colorectal cancer surgery

Figure 1  PRISMA flow diagram of study selection.

Figure 2 Risk of bias assessment. A: Traffic light plot summarizing the risk of bias for each domain across individual studies; B: Bar plot showing the proportion of studies with low risk, some concerns, or high risk for each domain. RoB 2.0: Revised Cochrane risk-of-bias tool for randomized trials; D1: Randomization process; D2: Deviations from intended interventions; D3: Missing outcome data; D4: Measurement of the outcome; D5: Selection of the reported result.

Figure 3 Forest plots of the primary metaanalyses for postoperative gastrointestinal recovery. A: The time to first postoperative flatus; B: The time to first postoperative bowel movement; C: Total length of hospital stay. Random-effects models for the time to first postoperative flatus and the time to first postoperative bowel movement; random-effects model for total length of hospital stay.

Figure 4 Subgroup analyses for time to first flatus and time to first defecation stratified by perioperative management setting. A: The time to first postoperative flatus; B: The time to first postoperative bowel movement. Subgroups: Enhanced recovery after surgery vs conventional care.

Figure 5 Subgroup analyses for time to first flatus and time to first defecation stratified by control type. A: The time to first postoperative flatus; B: The time to first postoperative bowel movement. Subgroups: Sham acupuncture/sham stimulation vs usual care.

Figure 6 Subgroup analyses for time to first flatus and time to first defecation stratified by acupuncture modality. A: The time to first postoperative flatus; B: The time to first postoperative bowel movement. Subgroups: Electroacupuncture vs transcutaneous electrical acupoint stimulation vs thumb-tack needle.