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Gastrointestinal Endoscopy Apr 2024Increasing evidence support endoscopic ultrasound-guided biliary drainage (EUS-BD) as a potential alternative to endoscopic retrograde cholangiopancreatography-guided... (Review)
Review
BACKGROUND AND AIMS
Increasing evidence support endoscopic ultrasound-guided biliary drainage (EUS-BD) as a potential alternative to endoscopic retrograde cholangiopancreatography-guided biliary drainage (ERCP-BD) in the primary treatment of malignant biliary obstruction (MBO). This systematic review and meta-analysis aimed to compare the efficacy and safety of both techniques as the initial approach for MBO.
METHODS
We searched MEDLINE, Embase, and Cochrane databases for randomized controlled trials (RCTs) comparing both techniques and reporting at least one of the outcomes of interest. The pooled estimates were calculated using the random-effects model and I statistics were used to evaluate heterogeneity.
RESULTS
We included six RCTs (577 patients). There were no significant differences between groups in stent patency (MD 8.18 days; 95% CI -22.55, 38.91), procedure time (MD -6.31 minutes; 95% CI -12.68, 0.06), and survival (MD 4.59 days; 95% CI -34.23, 43.40). Technical success (RR 1.04; 95% CI 0.96, 1.13), clinical success (RR 1.02; 95% CI 0.96, 1.08), overall adverse events (RR 0.58; 95% CI 0.24, 1.43), and cholangitis (RR 1.19; 95% CI 0.39, 3.61) were also similar between groups. However, hospital stay was significantly shorter (MD -1.03 days; 95% CI -1.53, -0.53), and risk of reintervention (RR 0.57; 95% CI 0.37, 0.88), post-procedure pancreatitis (RR 0.15; 95% CI 0.03, 0.66), and tumor in/overgrowth (RR 0.28; 95% CI 0.11, 0.70) were significantly lower with EUS-BD.
CONCLUSIONS
EUS-BD and ERCP-BD had similar efficacy and safety as the initial approach for MBO. However, EUS-BD had a significantly lower risk of reintervention, post-procedure pancreatitis, tumor in/overgrowth, and reduced hospital stay.
PubMed: 38648989
DOI: 10.1016/j.gie.2024.04.019 -
Journal of Vascular Surgery Apr 2024This study aimed to investigate the incidence of cerebrospinal fluid drainage (CSFD)-related complications specifically in patients who underwent fenestrated and... (Review)
Review
OBJECTIVE
This study aimed to investigate the incidence of cerebrospinal fluid drainage (CSFD)-related complications specifically in patients who underwent fenestrated and branched endovascular aortic repair (F/B-EVAR). This objective was chosen considering the limitations and uncertainties surrounding its efficacy in preventing spinal cord injury.
METHODS
A systematic review following Cochrane Handbook and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted (PROSPERO; #CRD42022359223). Literature searches of MEDLINE, Embase, and Scopus were performed until May 1, 2023, focusing on studies published after January 1, 2000. The inclusion criteria encompassed studies reporting on F/B-EVAR, CSFD, and drain-related complications. Data extraction and quality assessment using the Newcastle-Ottawa Scale were performed by multiple reviewers to ensure accuracy and reliability. A proportion meta-analysis was conducted to calculate the pooled rate and 95% confidence interval (CI). The primary and secondary outcomes were CSFD-related mortality and morbidity, respectively.
RESULTS
Six retrospective, observational, single-center studies were included, totaling 1079 patients and 730 CSFD placements (all prophylactic except for one). The Newcastle-Ottawa Scale showed a high to moderate risk of bias. The analysis revealed a CSFD-related mortality rate of 1.4% (95% CI: 0.0-4.8; I = 67.7%) and an overall morbidity rate of 25.6% (95% CI: 13.6-39.7; I = 83.2%). The overall major, moderate, and minor estimated complication rates were 6.1% (95% CI: 4.1-8.5; I = 0%), 4.6% (95% CI: 2.4-7.3; I = 33.5%), and 26.4% (95% CI: 16.5-37.7; I = 84.9%), respectively. Severe complications included intracranial hemorrhage (2.8%), spinal hematoma (1.4%), subarachnoid hemorrhage (1.4%), and CSFD-related neurological deficits (1.1%). A pooled estimate of 11.4% for nonfunctioning drainage was found.
CONCLUSIONS
F/B-EVAR patients showed a notable incidence of CSFD-related death and substantial morbidity. This study highlights the limitations of the available data, the high prevalence of complications associated with CSFD, and the need for further research to better understand the risks and benefits of CSFD in F/B-EVAR. This calls for careful consideration regarding the routine use of prophylactic drainage due to the accumulating evidence of the risks associated with CSFD without proven benefit in this specific context.
PubMed: 38636609
DOI: 10.1016/j.jvs.2024.04.038 -
The American Surgeon Dec 2023There is no level 1a evidence testing quilting suture (QS) technique after mastectomy on wound outcomes. The aim of this systematic review and meta-analysis evaluates QS... (Meta-Analysis)
Meta-Analysis
BACKGROUND
There is no level 1a evidence testing quilting suture (QS) technique after mastectomy on wound outcomes. The aim of this systematic review and meta-analysis evaluates QS and association with surgical site occurrences as compared to conventional closure (CC) for mastectomy.
METHODS
MEDLINE, PubMed, and Cochrane Library were systematically searched to include adult women with breast cancer undergoing mastectomy. The primary endpoint was postoperative seroma rate. Secondary endpoints included rates of hematoma, surgical site infection (SSI), and flap necrosis. The Mantel-Haenszel method with random-effects model was used for meta-analysis. Number needed to treat was calculated to assess clinical relevance of statistical findings.
RESULTS
Thirteen studies totaling 1748 patients (870 QS and 878 CC) were included. Seroma rates were statistically significantly lower in patients with QS (OR [95%CI] = .32 [.18, .57]; < .0001) than CC. Hematoma rates (OR [95%CI] = 1.07 [.52, 2.20]; = .85), SSI rates (OR [95%CI] = .93 [.61, 1.41]; = .73), and flap necrosis rates (OR [95%CI] = .61 [.30, 1.23]; = .17) did not significantly vary between QS and CC.
CONCLUSION
This meta-analysis found that QS was associated with significantly decreased seroma rates when compared to CC in patients undergoing mastectomy for cancer. However, improvement in seroma rates did not translate into a difference in hematoma, SSI, or flap necrosis rates.
Topics: Adult; Humans; Female; Mastectomy; Breast Neoplasms; Seroma; Surgical Flaps; Drainage; Surgical Wound Infection; Suture Techniques; Hematoma; Necrosis; Postoperative Complications
PubMed: 37144600
DOI: 10.1177/00031348231173995 -
Head & Neck Dec 2023Despite the established benefits of negative-pressure wound therapy (NPWT) in various wound healing contexts, its application in head and neck surgical cases remains... (Review)
Review
Despite the established benefits of negative-pressure wound therapy (NPWT) in various wound healing contexts, its application in head and neck surgical cases remains under-explored. This study aimed to systematically review its effectiveness, safety, and comparative efficacy. Thirty-one studies from a systematic literature search were identified and analyzed for wound healing response, overall success rate, improvements compared to conventional wound care, and variation in pressure settings, treatment lengths, and dressing change frequency. NPWT showed enhanced outcomes across diverse head and neck wounds, particularly complex post-reconstructive wounds and severe infections. Despite the predominantly case report/series evidence and lack of standardized NPWT protocols, its benefits over conventional care were clear. NPWT emerges as a promising approach for head and neck wound management, potentially improving patient outcomes and reducing complications. More randomized controlled trials are needed to solidify the evidence and standardize NPWT application protocols.
Topics: Humans; Device Removal; Negative-Pressure Wound Therapy; Plastic Surgery Procedures; Surgical Wound Infection; Wound Healing
PubMed: 37860929
DOI: 10.1002/hed.27547 -
Neurocritical Care Aug 2023The insertion of an external ventricular drain (EVD) is one of the most common neurosurgical procedures. Whether the weaning method (gradual or rapid) influences the... (Meta-Analysis)
Meta-Analysis
The insertion of an external ventricular drain (EVD) is one of the most common neurosurgical procedures. Whether the weaning method (gradual or rapid) influences the ventriculoperitoneal shunt (VPS) insertion rate has not been conclusively established. The aim of this study is to provide a systematic literature review and conduct a meta-analysis of studies comparing gradual with rapid EVD weaning regarding VPS insertion rate. Articles were identified by searching the Pubmed/Medline, Embase, and Web of Science databases throughout October 2022. Two independent researchers assessed the studies for inclusion and quality. We included randomized trials, prospective cohort studies, and retrospective cohort studies, which compared gradual and rapid EVD weaning. The primary outcome was VPS insertion rate, whereas secondary outcomes were EVD-associated infection (EVDAI) rate and length of stay in the hospital and intensive care unit (ICU). Four studies directly comparing rapid versus gradual EVD weaning, with 1337 patients suffering from subarachnoid hemorrhage, were identified and included in the meta-analysis. VPS insertion rate was 28.1% and 32.1% in patients with gradual and rapid EVD weaning, respectively (relative risk 0.85, 95% confidence interval 0.49-1.46, p = 0.56). Further, the EVDAI rate was comparable between the groups (gradual group 11.2%, rapid group 11.5%, relative risk 0.67, 95% confidence interval 0.24-1.89, p = 0.45), whereas length of stay in the ICU and hospital were significantly shorter in the rapid weaning group (2.7 and 3.6 days, respectively; p < 0.01). Rapid EVD weaning seems comparable to gradual EVD weaning concerning VPS insertion rates and EVDAI, whereas hospital and ICU length of stay is significantly reduced.
Topics: Humans; Drainage; Hydrocephalus; Prospective Studies; Retrospective Studies; Subarachnoid Hemorrhage; Ventriculoperitoneal Shunt; Weaning
PubMed: 37308728
DOI: 10.1007/s12028-023-01766-6 -
Aesthetic Surgery Journal Oct 2023Tranexamic acid (TXA) has become widely utilized in different specialities including facelift surgery. The aim of this review was to robustly evaluate the quality of...
Tranexamic acid (TXA) has become widely utilized in different specialities including facelift surgery. The aim of this review was to robustly evaluate the quality of available evidence on the efficacy and safety of TXA use in facelift surgery. We searched the MEDLINE (National Institutes of Health, Bethesda, MD), Embase (Elsevier, Amsterdam, the Netherlands), CINAHL (EBSCO Information Services, Ipswich, MA), Cochrane Central Register of Controlled Trials (CENTRAL; Wiley, Hoboken, NJ), Google Scholar (Alphabet Inc. Mountain View, CA), Science Citation Index (Clarivate, London, UK), and Latin American and Caribbean Center on Health Sciences Information (LILACS; São Paulo, Brazil) databases for randomized controlled trials (RCTs) and observational studies. Primary outcomes were blood loss, postoperative hematoma, ecchymosis, and swelling, in addition to technical considerations and complications. We assessed review quality with the AMSTAR 2 tool, study quality with Grading of Recommendations, Assessment, Development, and Evaluations approach (GRADE) tool, and the risk of bias with Cochrane's RoB 2.0 tool for RCTs and ROBINS-I for nonrandomized studies. Of the 368 articles, a total of 3 studies including 150 patients met the inclusion criteria. The RCT reported a significant reduction in postoperative serosanguineous collections in the TXA group (P < .01), and in surgeon-rated postoperative ecchymosis and bruising. The prospective cohort study reported reduced drainage output in first 24 hours in the TXA group (P < .01). The retrospective cohort study reported lower intraoperative blood loss, mean postoperative day 1 drain output, percentage of drain removal on postoperative day 1, and number of days to drain removal in the TXA group (all P < .01). The quality of studies was moderate, and this review was the highest rated compared to previous reviews, as per the AMSTAR 2 tool. Based on limited literature, TXA improves clinical outcomes regardless of the route of administration. Topical TXA is an emerging route, expediting drain removal and reducing blood loss. Future Level I high-quality studies are required.
PubMed: 37402636
DOI: 10.1093/asj/sjad213 -
BMJ Open Jul 2023To compare the effectiveness and safety of percutaneous catheter drainage (PCD) against percutaneous needle aspiration (PNA) for liver abscess. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To compare the effectiveness and safety of percutaneous catheter drainage (PCD) against percutaneous needle aspiration (PNA) for liver abscess.
DESIGN
Systematic review, meta-analysis and trial sequential analysis.
DATA SOURCES
PubMed, Web of Science, Cochrane Library, Embase, Airiti Library and ClinicalTrials.gov were searched from their inception up to 16 March 2022.
ELIGIBILITY CRITERIA
Randomised controlled trials that compared PCD to PNA for liver abscess were considered eligible, without restriction on language.
DATA EXTRACTION AND SYNTHESIS
Primary outcome was treatment success rate. Depending on heterogeneity, either a fixed-effects model or a random-effects model was used to derive overall estimates. Review Manager V.5.3 software was used for meta-analysis. Trial sequential analysis was performed using the Trial Sequential Analysis software. Certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluation system.
RESULTS
Ten trials totalling 1287 individuals were included. Pooled analysis revealed that PCD, when compared with PNA, enhanced treatment success rate (risk ratio 1.16, 95% CI 1.07 to 1.25). Trial sequential analysis demonstrated this robust finding with required information size attained. For large abscesses, subgroup analysis favoured PCD (test of subgroup difference, p<0.001). In comparison to PNA, pooled analysis indicated a significant benefit of PCD on time to achieve clinical improvement or complete clinical relief (mean differences (MD) -2.53 days; 95% CI -3.54 to -1.52) in six studies with 1000 patients; time to achieve a 50% reduction in abscess size (MD -2.49 days; 95% CI -3.59 to -1.38) in five studies with 772 patients; and duration of intravenous antibiotic use (MD -4.04 days, 95% CI -5.99 to -2.10) in four studies with 763 patients. In-hospital mortality and complications were not different.
CONCLUSION
In patients with liver abscess, ultrasound-guided PCD raises the treatment success rate by 136 in 1000 patients, improves clinical outcomes by 3 days and reduces the need for intravenous antibiotics by 4 days.
PROSPERO REGISTRATION NUMBER
CRD42022316540.
Topics: Humans; Drainage; Suction; Liver Abscess; Biopsy, Needle; Anti-Bacterial Agents; Catheters
PubMed: 37518084
DOI: 10.1136/bmjopen-2023-072736 -
The British Journal of Surgery Oct 2023Previous studies have reported conflicting results of prolonged antibiotic prophylaxis on infectious complications after pancreatoduodenectomy. This study evaluated the...
BACKGROUND
Previous studies have reported conflicting results of prolonged antibiotic prophylaxis on infectious complications after pancreatoduodenectomy. This study evaluated the effect of prolonged antibiotics on surgical-site infections (SSIs) after pancreatoduodenectomy.
METHODS
A systematic review and meta-analysis was undertaken of SSIs in patients with perioperative (within 24 h) versus prolonged antibiotic (over 24 h) prophylaxis after pancreatoduodenectomy. SSIs were classified as organ/space infections or superficial SSI within 30 days after surgery. ORs were calculated using a Mantel-Haenszel fixed-effect model.
RESULTS
Ten studies were included in the qualitative analysis, of which 8 reporting on 1170 patients were included in the quantitative analysis. The duration of prolonged antibiotic prophylaxis varied between 2 and 10 days after surgery. Four studies reporting on 782 patients showed comparable organ/space infection rates in patients receiving perioperative and prolonged antibiotics (OR 1.35, 95 per cent c.i. 0.94 to 1.93). However, among patients with preoperative biliary drainage (5 studies reporting on 577 patients), organ/space infection rates were lower with prolonged compared with perioperative antibiotics (OR 2.09, 1.43 to 3.07). Three studies (633 patients) demonstrated comparable superficial SSI rates between patients receiving perioperative versus prolonged prophylaxis (OR 1.54, 0.97 to 2.44), as well as in patients with preoperative biliary drainage in 4 studies reporting on 431 patients (OR 1.60, 0.89 to 2.88).
CONCLUSION
Prolonged antibiotic prophylaxis is associated with fewer organ/space infection in patients who undergo preoperative biliary drainage. However, the optimal duration of antibiotic prophylaxis after pancreatoduodenectomy remains to be determined and warrants confirmation in an RCT.
PubMed: 37440361
DOI: 10.1093/bjs/znad213 -
Journal of Pediatric Urology Oct 2023Ureteroceles are a congenital abnormality of the ureter that can cause significant complications. Endoscopic treatment is a commonly used treatment approach. The aim of... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Ureteroceles are a congenital abnormality of the ureter that can cause significant complications. Endoscopic treatment is a commonly used treatment approach. The aim of this review is to assess the results of endoscopic treatment for ureteroceles with consideration to their location and system anatomy.
METHODS
A meta-analysis was conducted by searching electronic databases for studies comparing outcomes of endoscopic treatment for ureteroceles. Newcastle-Ottawa Scale (NOS) was employed to evaluate the potential for bias. The primary outcome was the rate of secondary procedures required following endoscopic treatment. Secondary outcomes were inadequate drainage and post-operative vesicoureteral reflux (VUR) rates. A subgroup analysis was performed to investigate possible causes of heterogeneity in the primary outcome. The statistical analysis was conducted using Review Manager 5.4.
RESULTS
There were 28 retrospective observational studies, published between 1993 and 2022, including 1044 patients with primary outcomes in this meta-analysis. The quantitative synthesis showed that ectopic and duplex system ureteroceles were significantly associated with higher rate of secondary operation compared to intravesical and single system ureteroceles, respectively (OR: 5.42, 95% CI: 3.93-7.47; and OR: 5.10, 95% CI: 3.31-7.87). The associations were still significant in subgroup analysis based on follow up duration, average age at surgery, and duplex system only. For secondary outcomes, incidence of inadequate drainage were significantly higher in ectopic (OR: 2,01, 95% CI: 1.18-3.43), but not in duplex system ureteroceles (OR: 1.94, 95% CI: 0,97-3.86). Post-operative VUR rates were higher in both ectopic (OR: 1.79, 95% CI: 1.29-2.47) and duplex system ureteroceles group (OR: 1.88, 95% CI: 1.15-3.08).
CONCLUSION
Ectopic ureteroceles and duplex system ureteroceles were associated with worse outcomes following endoscopic treatment compared to intravesical and single system ureteroceles, respectively. It is recommended to carefully select patients, conduct pre-operative evaluations, and closely monitor patients with ectopic and duplex system ureteroceles.
Topics: Humans; Infant; Ureterocele; Retrospective Studies; Ureter; Endoscopy; Vesico-Ureteral Reflux; Observational Studies as Topic
PubMed: 37244837
DOI: 10.1016/j.jpurol.2023.05.003 -
Children (Basel, Switzerland) Jul 2023to systematically review and meta-analyze the impact on morbidity and mortality of peritoneal drainage (PD) compared to laparotomy (LAP) in preterm neonates with... (Review)
Review
Laparotomy versus Peritoneal Drainage as Primary Treatment for Surgical Necrotizing Enterocolitis or Spontaneous Intestinal Perforation in Preterm Neonates: A Systematic Review and Meta-Analysis.
AIM
to systematically review and meta-analyze the impact on morbidity and mortality of peritoneal drainage (PD) compared to laparotomy (LAP) in preterm neonates with surgical NEC (sNEC) or spontaneous intestinal perforation (SIP).
METHODS
Medical databases were searched until June 2022 for studies comparing PD and LAP as primary surgical treatment of preterm neonates with sNEC or SIP. The primary outcome was survival during hospitalization; predefined secondary outcomes included need for parenteral nutrition at 90 days, time to reach full enteral feeds, need for subsequent laparotomy, duration of hospitalization and complications.
RESULTS
Three RCTs (N = 493) and 49 observational studies (N = 19,447) were included. No differences were found in the primary outcome for RCTs, but pooled observational data showed that, compared to LAP, infants with sNEC/SIP who underwent PD had lower survival [48 studies; N = 19,416; RR 0.85; 95% CI 0.79-0.90; GRADE: low]. Observational studies also showed that the subgroup of infants with sNEC had increased survival in the LAP group (30 studies; N = 9370; RR = 0.82; 95% CI 0.72-0.91; GRADE: low).
CONCLUSIONS
Compared to LAP, PD as primary surgical treatment for sNEC or SIP has similar survival rates when analyzing data from RCTs. PD was associated with lower survival rates in observational studies.
PubMed: 37508667
DOI: 10.3390/children10071170