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SAGE Open Medicine 2022This systematic review was aimed to address the prevalence and causes of intestinal obstruction in Ethiopia.
OBJECTIVE
This systematic review was aimed to address the prevalence and causes of intestinal obstruction in Ethiopia.
METHODS
Systematic searches were conducted on PubMed, EMBASE, CINAHL, Scopus, African Journals Online, HINARI, and other supplementary sources, including Google Scholar. We conducted methodological quality assessments for the articles by employing a critical appraisal checklist of Joanna Briggs Institute.
RESULTS
The reported prevalence of intestinal obstruction in Ethiopia ranges from 18.6% to 50.7% among patients with acute abdomen. However, the prevalence varies from 4.3% to 34.6% among total surgical admissions. The leading causes of small intestinal obstruction were small bowel volvulus, intussusception, and adhesion. Sigmoid volvulus was the most commonly reported cause of large intestine obstruction, followed by colonic cancer.
CONCLUSION
The highest reported prevalence of intestinal obstruction in Ethiopia was 50.7% among patients with acute abdomen and 34.6% among surgical admissions. Small intestine volvulus and sigmoid volvulus were the common causes of small and large bowel obstructions, respectively. Therefore, clinicians have to consider the common causes during the diagnosis and management of intestinal obstruction.
PubMed: 35371487
DOI: 10.1177/20503121221083207 -
World Journal of Surgery Aug 2022Rectus diastasis (RD) is defined as widening of the linea alba and laxity of the abdominal muscles. It can be treated via a wide array of both conservative and surgical... (Review)
Review
BACKGROUND
Rectus diastasis (RD) is defined as widening of the linea alba and laxity of the abdominal muscles. It can be treated via a wide array of both conservative and surgical modalities. Due to the quickly evolving nature of this field coupled with the multiple novel surgical modalities described recently, there is a need for an updated review of surgical techniques and a quantitative analysis of complications and recurrence rates.
METHODS
A systematic review of PUBMED and EMBASE databases was preformed to retrieve all clinical studies describing surgical management of RD. Pooled analyses were preformed to assess recurrence and complication rates after both open and laparoscopic RD repairs (after controlling for herniorrhaphy).
RESULTS
A total of 56 papers were included in this review. In patients who underwent both an RD and a herniorrhaphy, there was no significant difference in recurrence rates between open (0.86%) and laparoscopic repairs (1.6%) (p > 0.05). Similarly, in patients who underwent RD repair without a herniorrhaphy, there was no significant difference in recurrence rates between open (0.89%) and laparoscopic repairs (0%) (p > 0.05). The most common complications reported were seroma, skin dehiscence, hematoma/post-operative bleeding, and infection. After controlling for a herniorrhaphy, there were no significant difference in total complication rates between open and laparoscopic RD repair. The total complication rates in patients who underwent an open RD repair with a herniorrhaphy were 13.3% compared to 14.5% in patients who underwent laparoscopic repairs (p > 0.05). Similarly, the total complication rates in patients who underwent RD repair without a herniorrhaphy were 11.8% in patients who underwent open repairs compared to 16.2% in their counterparts who underwent laparoscopic repairs (p > 0.05).
CONCLUSION
Both open and laparoscopic approaches are safe and effective in repairing RD in patients with and without concurrent herniorrhaphy. Future research should report patient reported outcomes to better differentiate between different surgical approaches.
Topics: Abdominal Wall; Herniorrhaphy; Humans; Laparoscopy; Recurrence; Retrospective Studies; Seroma; Surgical Mesh
PubMed: 35430646
DOI: 10.1007/s00268-022-06550-9 -
Expert Review of Respiratory Medicine Feb 2020: Acute pancreatitis is an inflammatory condition of the pancreas, which runs a severe course in 20% of patients, wherein it is associated with high mortality. It is...
: Acute pancreatitis is an inflammatory condition of the pancreas, which runs a severe course in 20% of patients, wherein it is associated with high mortality. It is associated with several pleuro-pulmonary complications with variable severity that may occur either in isolation but are frequently present in combination. Clinicians need to be aware of these complications for early and appropriate management.: We performed a systematic search of the PUBMED database (1970-2019) to identify relevant articles focusing on pleuro-pulmonary complications that may occur in patients with acute pancreatitis. We also retrieved articles describing the pathophysiological mechanisms and treatment approach of the various complications.: Acute pancreatitis is usually a self-limiting disease, but the development of organ failure during the course worsens the clinical outcome. Pulmonary complications usually occur early in the course of acute pancreatitis. Clinicians need to recognize the various pulmonary complications of acute pancreatitis, early during the disease, and manage them appropriately and aggressively to improve outcomes.
Topics: Humans; Lung Diseases; Pancreatitis; Pleural Effusion; Respiration, Artificial
PubMed: 31779502
DOI: 10.1080/17476348.2020.1698951 -
European Journal of Surgical Oncology :... Apr 2022The hepatic flexure and transverse colon have a complex intermingled lymphovascular anatomy crossing between mesocolon and mesogastrium. Few studies have investigated... (Review)
Review
INTRODUCTION
The hepatic flexure and transverse colon have a complex intermingled lymphovascular anatomy crossing between mesocolon and mesogastrium. Few studies have investigated the oncological relevance of metastatic infrapyloric and gastroepiploic lymph nodes (IGLN) from hepatic flexure and transverse colon tumors. This study aimed to evaluate the incidence and risk factors for IGLN metastases, and the indications, surgical morbidities, and oncological outcome following extended lymphadenectomy.
MATERIALS AND METHODS
According to the PRISMA statement, a systematic review on IGLN lymphadenectomy for colon cancer was conducted into PubMed, Embase, and Cochrane databases. A critical appraisal of study was performed according to the Joanna Briggs Institute Tools.
RESULTS
Nine studies were included. IGLN metastases incidence ranged 0.7-22%. IGLN positivity for patients with metastatic mesocolic lymph nodes ranged 1.7-33.3%. Postoperative complication rate ranged 8.5-36.9%, mostly low grade according to Clavien-Dindo's classification. Postoperative mortality rate ranged 0-5.4% at 30-days. IGLN metastases were associated with advanced disease with a 5-year progression-free survival rate up to 33.9%. Two authors reported perineural invasion and N stage as risk factors, while another reported endoscopic obstruction, signet ring adenocarcinoma, CEA level ≥17 ng/ml, and M1 stage to be risk factors for IGLN involvement. Apart from one study, all other studies were of moderate/high quality.
CONCLUSIONS
Metastatic IGLNs are not uncommon and should be highly considered. IGLN metastases could be potentially associated with an aggressive disease. IGLN dissection is not associated with higher morbidity and mortality than standard CME. Preoperative risk factors of IGLN involvement could guide surgical indication for extended lymphadenectomy.
Topics: Colectomy; Colon, Ascending; Colon, Transverse; Colonic Neoplasms; Humans; Laparoscopy; Lymph Node Excision; Lymph Nodes; Mesocolon
PubMed: 34893366
DOI: 10.1016/j.ejso.2021.12.005 -
The Cochrane Database of Systematic... Feb 2024Oral submucous fibrosis (OSF) is a chronic disease of the oral cavity that causes progressive constriction of the cheeks and mouth accompanied by severe pain and reduced... (Review)
Review
BACKGROUND
Oral submucous fibrosis (OSF) is a chronic disease of the oral cavity that causes progressive constriction of the cheeks and mouth accompanied by severe pain and reduced mouth opening. OSF has a significant impact on eating and swallowing, affecting quality of life. There is an increased risk of oral malignancy in people with OSF. The main risk factor for OSF is areca nut chewing, and the mainstay of treatment has been behavioural interventions to support habit cessation. This review is an update of a version last published in 2008.
OBJECTIVES
To evaluate the benefits and harms of interventions for the management of oral submucous fibrosis.
SEARCH METHODS
We used standard, extensive Cochrane search methods. The latest search date was 5 September 2022.
SELECTION CRITERIA
We considered randomised controlled trials (RCTs) of adults with a biopsy-confirmed diagnosis of OSF treated with systemic, locally delivered or topical drugs at any dosage, duration or delivery method compared against placebo or each other. We considered surgical procedures compared against other treatments or no active intervention. We also considered other interventions such as physiotherapy, ultrasound or alternative therapies.
DATA COLLECTION AND ANALYSIS
We used standard Cochrane methods. Our primary outcomes were 1. participant-reported resumption of normal eating, chewing and speech; 2. change or improvement in maximal mouth opening (interincisal distance); 3. improvement in range of jaw movement; 4. change in severity of oral/mucosal burning pain/sensation; 5.
ADVERSE EFFECTS
Our secondary outcomes were 6. quality of life; 7. postoperative discomfort or pain as a result of the intervention; 8. participant satisfaction; 9. hospital admission; 10. direct costs of medication, hospital bed days and any associated inpatient costs for the surgical interventions. We used GRADE to assess certainty of evidence for each outcome.
MAIN RESULTS
We included 30 RCTs (2176 participants) in this updated review. We assessed one study at low risk of bias, five studies at unclear risk of bias and 24 studies at high risk of bias. We found diverse interventions, which we categorised according to putative mechanism of action. We present below our main findings for the comparison 'any intervention compared with placebo or no active treatment' (though most trials included habit cessation for all participants). Results for head-to-head comparisons of active interventions are presented in full in the main review. Any intervention versus placebo or no active treatment Participant-reported resumption of normal eating, chewing and speech No studies reported this outcome. Interincisal distance Antioxidants may increase mouth opening (indicated by interincisal distance (mm)) when measured at less than three months (mean difference (MD) 3.11 mm, 95% confidence interval (CI) 0.46 to 5.77; 2 studies, 520 participants; low-certainty evidence), and probably increase mouth opening slightly at three to six months (MD 8.83 mm, 95% CI 8.22 to 9.45; 3 studies, 620 participants; moderate-certainty evidence). Antioxidants may make no difference to interincisal distance at six-month follow-up or greater (MD -1.41 mm, 95% CI -5.74 to 2.92; 1 study, 90 participants; low-certainty evidence). Pentoxifylline may increase mouth opening slightly (MD 1.80 mm, 95% CI 1.02 to 2.58; 1 study, 106 participants; low-certainty evidence). However, it should be noted that these results are all less than 10 mm, which could be considered the minimal change that is meaningful to someone with oral submucous fibrosis. The evidence was very uncertain for all other interventions compared to placebo or no active treatment (intralesional dexamethasone injections, pentoxifylline, hydrocortisone plus hyaluronidase, physiotherapy). Burning sensation Antioxidants probably reduce burning sensation visual analogue scale (VAS) scores at less than three months (MD -30.92 mm, 95% CI -31.57 to -30.27; 1 study, 400 participants; moderate-certainty evidence), at three to six months (MD -70.82 mm, 95% CI -94.39 to -47.25; 2 studies, 500 participants; moderate-certainty evidence) and at more than six months (MD -27.60 mm, 95% CI -36.21 to -18.99; 1 study, 90 participants; moderate-certainty evidence). The evidence was very uncertain for the other interventions that were compared to placebo and measured burning sensation (intralesional dexamethasone, vasodilators). Adverse effects Fifteen studies reported adverse effects as an outcome. Six of these studies found no adverse effects. One study evaluating abdominal dermal fat graft reported serious adverse effects resulting in prolonged hospital stay for 3/30 participants. There were mild and transient general adverse effects to systemic drugs, such as dyspepsia, abdominal pain and bloating, gastritis and nausea, in studies evaluating vasodilators and antioxidants in particular.
AUTHORS' CONCLUSIONS
We found moderate-certainty evidence that antioxidants administered systemically probably improve mouth opening slightly at three to six months and improve burning sensation VAS scores up to and beyond six months. We found only low/very low-certainty evidence for all other comparisons and outcomes. There was insufficient evidence to make an informed judgement about potential adverse effects associated with any of these treatments. There was insufficient evidence to support or refute the effectiveness of the other interventions tested. High-quality, adequately powered intervention trials with a low risk of bias that compare biologically plausible treatments for OSF are needed. It is important that relevant participant-reported outcomes are evaluated.
Topics: Adult; Humans; Oral Submucous Fibrosis; Pentoxifylline; Drug-Related Side Effects and Adverse Reactions; Vasodilator Agents; Abdominal Pain; Antioxidants; Dexamethasone
PubMed: 38415846
DOI: 10.1002/14651858.CD007156.pub3 -
Scandinavian Journal of Trauma,... Jun 2023Civilian public mass shootings (CPMSs) are a major public health issue and in recent years several events have occurred worldwide. The aim of this systematic review was... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Civilian public mass shootings (CPMSs) are a major public health issue and in recent years several events have occurred worldwide. The aim of this systematic review was to characterize injuries and mortality after CPMSs focusing on in-hospital management of hemorrhage and vascular injuries.
METHOD
A systematic review of all published literature was undertaken in Medline, Embase and Web of Science January 1st, 1968, to February 22nd, 2021, according to the PRISMA guidelines. Literature was eligible for inclusion if the CPMS included three or more people shot, injured or killed, had vascular injuries or hemorrhage.
RESULTS
The search identified 2884 studies; 34 were eligible for inclusion in the analysis. There were 2039 wounded in 45 CPMS events. The dominating anatomic injury location per event was the extremity followed by abdomen and chest. The median number of operations and operated patients per event was 22 (5-101) and 10.5 (4-138), respectively. A total of 899 deaths were reported with a median mortality rate of 36.1% per event (15.9-71.4%) Thirty-eight percent (13/34) of all studies reported on vascular injuries. Vascular injuries ranged from 8 to 29%; extremity vascular injury the most frequent. Specific vascular injuries included thoracic aorta 18% (42/232), carotid arteries 6% (14/232), and abdominal aorta 5% (12/232). Vascular injuries were involved in 8.3%-10% of all deaths.
CONCLUSION
This systematic review showed an overall high mortality after CPMS with injuries mainly located to the extremities, thorax and abdomen. About one quarter of deaths was related to hemorrhage involving central large vessel injuries. Further understanding of these injuries, and structured and uniform reporting of injuries and treatment protocols may help improve evaluation and management in the future. Level of Evidence Systematic review and meta-analysis, level III.
Topics: Humans; Hemorrhage; Retrospective Studies; Vascular System Injuries; Wounds, Gunshot
PubMed: 37337265
DOI: 10.1186/s13049-023-01093-x -
The Cochrane Database of Systematic... Dec 2021The use of surgical drains is a very common practice after pancreatic surgery. The role of prophylactic abdominal drainage to reduce postoperative complications after... (Review)
Review
BACKGROUND
The use of surgical drains is a very common practice after pancreatic surgery. The role of prophylactic abdominal drainage to reduce postoperative complications after pancreatic surgery is controversial. This is the third update of a previously published Cochrane Review to address the uncertain benifits of prophylactic abdominal drainage in pancreatic surgery.
OBJECTIVES
To assess the benefits and harms of routine abdominal drainage after pancreatic surgery, compare the effects of different types of surgical drains, and evaluate the optimal time for drain removal.
SEARCH METHODS
In this updated review, we re-searched CENTRAL, MEDLINE, Embase, Science Citation Index Expanded, and the Chinese Biomedical Literature Database (CBM) on 08 February 2021.
SELECTION CRITERIA
We included all randomised controlled trials (RCTs) that compared abdominal drainage versus no drainage in people undergoing pancreatic surgery. We also included RCTs that compared different types of drains and different schedules for drain removal in people undergoing pancreatic surgery.
DATA COLLECTION AND ANALYSIS
Two review authors independently identified the studies for inclusion, collected the data, and assessed the risk of bias. We conducted the meta-analyses using Review Manager 5. We calculated the risk ratio (RR) for dichotomous outcomes and the mean difference (MD) or standardized mean difference (SMD) for continuous outcomes with 95% confidence intervals (CI). For all analyses, we used the random-effects model. We used GRADE to assess the certainty of the evidence for important outcomes.
MAIN RESULTS
We identified a total of nine RCTs with 1892 participants. Drain use versus no drain use We included four RCTs with 1110 participants, randomised to the drainage group (N = 560) and the no drainage group (N = 550) after pancreatic surgery. Low-certainty evidence suggests that drain use may reduce 90-day mortality (RR 0.23, 95% CI 0.06 to 0.90; two studies, 478 participants). Compared with no drain use, low-certainty evidence suggests that drain use may result in little to no difference in 30-day mortality (RR 0.78, 95% CI 0.31 to 1.99; four studies, 1055 participants), wound infection rate (RR 0.98, 95% CI 0.68 to 1.41; four studies, 1055 participants), length of hospital stay (MD -0.14 days, 95% CI -0.79 to 0.51; three studies, 876 participants), the need for additional open procedures for postoperative complications (RR 1.33, 95% CI 0.79 to 2.23; four studies, 1055 participants), and quality of life (105 points versus 104 points; measured with the pancreas-specific quality of life questionnaire (scale 0 to 144, higher values indicating a better quality of life); one study, 399 participants). There was one drain-related complication in the drainage group (0.2%). Moderate-certainty evidence suggests that drain use probably resulted in little to no difference in morbidity (RR 1.03, 95% CI 0.94 to 1.13; four studies, 1055 participants). The evidence was very uncertain about the effect of drain use on intra-abdominal infection rate (RR 0.97, 95% CI 0.52 to 1.80; four studies, 1055 participants; very low-certainty evidence), and the need for additional radiological interventions for postoperative complications (RR 0.87, 95% CI 0.40 to 1.87; three studies, 660 participants; very low-certainty evidence). Active versus passive drain We included two RCTs involving 383 participants, randomised to the active drain group (N = 194) and the passive drain group (N = 189) after pancreatic surgery. Compared with a passive drain, the evidence was very uncertain about the effect of an active drain on 30-day mortality (RR 1.23, 95% CI 0.30 to 5.06; two studies, 382 participants; very low-certainty evidence), intra-abdominal infection rate (RR 0.87, 95% CI 0.21 to 3.66; two studies, 321 participants; very low-certainty evidence), wound infection rate (RR 0.92, 95% CI 0.44 to 1.90; two studies, 321 participants; very low-certainty evidence), morbidity (RR 0.97, 95% CI 0.53 to 1.77; two studies, 382 participants; very low-certainty evidence), length of hospital stay (MD -0.79 days, 95% CI -2.63 to 1.04; two studies, 321 participants; very low-certainty evidence), and the need for additional open procedures for postoperative complications (RR 0.44, 95% CI 0.11 to 1.83; two studies, 321 participants; very low-certainty evidence). There was no drain-related complication in either group. Early versus late drain removal We included three RCTs involving 399 participants with a low risk of postoperative pancreatic fistula, randomised to the early drain removal group (N = 200) and the late drain removal group (N = 199) after pancreatic surgery. Compared to late drain removal, the evidence was very uncertain about the effect of early drain removal on 30-day mortality (RR 0.99, 95% CI 0.06 to 15.45; three studies, 399 participants; very low-certainty evidence), wound infection rate (RR 1.32, 95% CI 0.45 to 3.85; two studies, 285 participants; very low-certainty evidence), hospital costs (SMD -0.22, 95% CI -0.59 to 0.14; two studies, 258 participants; very low-certainty evidence), the need for additional open procedures for postoperative complications (RR 0.77, 95% CI 0.28 to 2.10; three studies, 399 participants; very low-certainty evidence), and the need for additional radiological procedures for postoperative complications (RR 1.00, 95% CI 0.21 to 4.79; one study, 144 participants; very low-certainty evidence). We found that early drain removal may reduce intra-abdominal infection rate (RR 0.44, 95% CI 0.22 to 0.89; two studies, 285 participants; very low-certainty evidence), morbidity (RR 0.49, 95% CI 0.30 to 0.81; two studies, 258 participants; very low-certainty evidence), and length of hospital stay (MD -2.20 days, 95% CI -3.52 to -0.87; three studies, 399 participants; very low-certainty evidence), but the evidence was very uncertain. None of the studies reported on drain-related complications.
AUTHORS' CONCLUSIONS
Compared with no drain use, it is unclear whether routine drain use has any effect on mortality at 30 days or postoperative complications after pancreatic surgery. Compared with no drain use, low-certainty evidence suggests that routine drain use may reduce mortality at 90 days. Compared with a passive drain, the evidence is very uncertain about the effect of an active drain on mortality at 30 days or postoperative complications. Compared with late drain removal, early drain removal may reduce intra-abdominal infection rate, morbidity, and length of hospital stay for people with low risk of postoperative pancreatic fistula, but the evidence is very uncertain.
Topics: Abdomen; Drainage; Humans; Length of Stay; Pancreas; Pancreatic Fistula
PubMed: 34921395
DOI: 10.1002/14651858.CD010583.pub5 -
Techniques in Coloproctology Nov 2023Complete mesocolic excision (CME) has been associated with improved oncological outcomes in treatment of colon cancer. However, widespread adoption is limited partly... (Meta-Analysis)
Meta-Analysis Review
Complete mesocolic excision versus standard resection for colon cancer: a systematic review and meta-analysis of perioperative safety and an evaluation of the use of a robotic approach.
PURPOSE
Complete mesocolic excision (CME) has been associated with improved oncological outcomes in treatment of colon cancer. However, widespread adoption is limited partly because of the technical complexity and perceived risks of the approach. The aim of out study was to evaluate the safety of CME compared to standard resection and to compare robotic versus laparoscopic approaches.
METHODS
Two parallel searches were undertaken in MEDLINE, Embase and Web of Science databases 12 December 2021. The first was to evaluate IDEAL stage 3 evidence to compare complication rates as a surrogate marker of perioperative safety between CME and standard resection. The second independent search compared lymph node yield and survival outcomes between minimally invasive approaches.
RESULTS
There were four randomized control trials (n = 1422) comparing CME to standard resection, and three studies comparing laparoscopic (n = 164) to robotic (n = 161) approaches. Compared to standard resection, CME was associated with a reduction in Clavien-Dindo grade 3 or higher complication rates (3.56% vs. 7.24%, p = 0.002), reduced blood loss (113.1 ml vs. 137.6 ml, p < 0.0001) and greater mean lymph node harvest (25.6 vs. 20.9 nodes, p = 0.001). Between the robotic and laparoscopic groups, there were no significant differences in complication rates, blood loss, lymph node yield, 5-year disease-free survival (OR 1.05, p = 0.87) and overall survival (OR 0.83, p = 0.54).
CONCLUSIONS
Our study demonstrated improved safety with CME. There was no difference in safety or survival outcomes between robotic and laparoscopic CME. The advantage of a robotic approach may lie in the reduced learning curve and an increased penetration of minimally invasive approach to CME. Further studies are required to explore this.
PROSPERO ID
CRD42021287065.
Topics: Humans; Robotic Surgical Procedures; Lymph Node Excision; Colectomy; Colonic Neoplasms; Robotics; Mesocolon; Laparoscopy; Treatment Outcome
PubMed: 37414915
DOI: 10.1007/s10151-023-02838-7 -
Annals of Plastic Surgery Aug 2022Plastic surgeons are often consulted to manage postoperative groin lymphatic leaks that may lead to serious sequelae if not promptly treated. Because there are no... (Meta-Analysis)
Meta-Analysis
PURPOSE
Plastic surgeons are often consulted to manage postoperative groin lymphatic leaks that may lead to serious sequelae if not promptly treated. Because there are no standardized guidelines for best treatment practices, this systematic review and meta-analysis evaluates the outcomes of multiple management modalities to ultimately guide decision making for surgeons.
METHODS
Literature surrounding lymphatic leaks in the groin was reviewed from PubMED, MEDLINE, EMBASE, and the Cochrane Library from January 1, 2000, to December 1, 2020 according to Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. The inciting procedure, postoperative lymphatic complication, used management, and days to resolution were recorded. Pairwise comparisons using the Wilcoxon rank sum test with Bonferroni continuity correction were used to determine which treatment modalities differed significantly and accounted for multiple hypothesis testing.
RESULTS
A total of 1468 total studies were initially found, which narrowed to 267 unique articles after duplicates were removed. Twelve articles ultimately met the inclusion criteria and were included in the data analysis. There were 264 groin complications, of which 217 were initially treated with conservative management, 81 with a minimally invasive procedure, and 125 with surgery. More than 95% of all cases had an inciting procedure of a vascular nature.For vascular surgery-induced lymphatic leak treated by minimally invasive and surgical techniques, a significantly higher number of cases resolved compared with those treated conservatively (100% and 96.7% compared with 29.5%, respectively, P < 0.05). However, there were no significant differences in the proportion that resolved between the minimally invasive and surgical cases ( P = 0.11). Vascular cases that were only managed with surgery had significantly shorter days to resolution compared with cases that first attempted conservative management ( P < 0.001).
CONCLUSIONS
Both minimally invasive and surgical options have increased odds of resolution and lower failure rates compared with conservative management alone. The odds of resolution were higher when treated with more invasive procedures compared with conservative-only management, but the mean days to resolution was longer. This meta-analysis depicts successful resolution with procedural management and supports an initial trial of minimally invasive techniques.
Topics: Groin; Humans; Lymphatic Vessels; Minimally Invasive Surgical Procedures; Postoperative Complications; Treatment Outcome; Vascular Surgical Procedures
PubMed: 35703193
DOI: 10.1097/SAP.0000000000003228 -
Annals of Translational Medicine Apr 2021Gender confirmation surgery has a crucial role among transgender individuals. Phalloplasty is a procedure that uses flaps for phallic shaft creation. Flaps can be... (Review)
Review
Gender confirmation surgery has a crucial role among transgender individuals. Phalloplasty is a procedure that uses flaps for phallic shaft creation. Flaps can be classified in free flaps or pedicle flaps and can be obtained from different donor sites such as forearm, thigh, abdomen, groin, and leg, and upper back. We conducted a systematic review about surgical flaps for phallic shaft creation in transgender patients. A systematic review was conducted on PubMed/MEDLINE, Cochrane Clinical Answers, and Cochrane Central Register of Controlled Trials databases without timeframe limitations. Exclusion criteria included articles that reported phalloplasty on patients other than transgender, as well as other surgical techniques such as urethroplasty, vaginectomy, hysterectomy and studies focused on psychosocial outcomes. Two hundred twenty-eight potential articles were identified in the initial search. Forty-one studies fulfilled the inclusion and exclusion criteria. Surgical flaps for phallic shaft creation in transgender patients were reported on 1,391 cases. Microsurgical flaps were the most common (24 of 33). The flap technique most frequently described was radial forearm flap (15 of 33) followed by Anterolateral thigh flap (7 of 33), Latissimus dorsi flap (5 of 33), abdominal flap (4 of 33), fibular flap (3 of 33), and groin flaps (3 of 33). The literature on surgical flaps for phallic shaft creation in transgender patients reflected how challenging the reconstruction of the phallus is. In summary, there is no universal choice of flap that could be applied to every patient. Therefore, the surgical approach must be chosen considering surgeon experience, physical examination, and patient desire. We hope this review supports future studies on surgical flaps for phallic shaft creation in transgender patients.
PubMed: 33987305
DOI: 10.21037/atm-20-3527