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Journal of Minimally Invasive Gynecology Jun 2024Despite various surgical and non-surgical strategies for abdominal wall endometriosis, the lack of definitive guidance on optimal treatment choice leads to clinical... (Review)
Review
OBJECTIVE
Despite various surgical and non-surgical strategies for abdominal wall endometriosis, the lack of definitive guidance on optimal treatment choice leads to clinical uncertainty. This review scrutinizes the safety and efficacy of abdominal wall endometriosis treatments to aid in decision-making.
DATA SOURCES
We performed a systematic literature review of PubMed, Embase and Cochrane Library databases from 1947 until December 2023.
METHODS OF STUDY SELECTION
A comprehensive literature search identified studies that assessed both surgical and nonsurgical interventions, including high-intensity focused ultrasound (HIFU), cryoablation, radiofrequency ablation (RFA), and microwave ablation (MWA). This review is registered in NIHR-PROSPERO (CRD 42023494969). Local tumor control (LTC), local pain relief (LPR) and adverse events (AE) were recorded.
TABULATION, INTEGRATION, AND RESULTS
This review included 51 articles among 831 identified. All study designs were considered eligible for inclusion. A total of 2,674 patients are included: 2,219 patients (83%) undergoing surgery, and 455 (17%) undergoing percutaneous interventions (342 HIFU, 103 cryoablation, 1 RFA, 9 MWA). Follow-up length was 18 months in median, ranging from 1 to 235 months. Overall LTC rates ranged from 86% to 100%. Surgical interventions consistently demonstrated the highest rate of LTC with a median rate of 100%, and LPR with a median rate of 98.2% (95% confidence interval [CI]: 93.9-97.7). HIFU showed median LTC and LPR rates, respectively of 95.65% (95% CI, 87.7-99.9) and 76.1% (95% CI, 61.8-90.4); and cryoablation of 85.7% (95% CI, 66.0-99.9) and 79.2% (95% CI, 67.4-91.03). Minor AE were reported after surgery in 17.5% of patients (225/1284) including 15.9% (199/1284) of mesh implantation; 76.4% (239/313) after HIFU; and 8.7 % (9/103) after cryoablation. Severe AE were reported in 25 patients in the surgery group and 1 in the percutaneous group.
CONCLUSION
The safety profile and efficacy of nonsurgical interventions support their clinical utility for management of abdominal wall endometriosis.
PubMed: 38901689
DOI: 10.1016/j.jmig.2024.06.007 -
Medicina (Kaunas, Lithuania) Jul 2023: Robotic surgery has been widely adopted in general surgery worldwide but access to this technology is still limited to a few hospitals. With the recent introduction of... (Review)
Review
: Robotic surgery has been widely adopted in general surgery worldwide but access to this technology is still limited to a few hospitals. With the recent introduction of new robotic platforms, several studies reported the feasibility of different surgical procedures. The aim of this systematic review is to highlight the current clinical practice with the new robotic platforms in general surgery. : A grey literature search was performed on the Internet to identify the available robotic systems. A PRISMA compliant systematic review was conducted for all English articles up to 10 February 2023 searching the following databases: MEDLINE, EMBASE, and Cochrane Library. Clinical outcomes, training process, operating surgeon background, cost-analysis, and specific registries were evaluated. : A total of 103 studies were included for qualitative synthesis after the full-text screening. Of the fifteen robotic platforms identified, only seven were adopted in a clinical environment. Out of 4053 patients, 2819 were operated on with a new robotic device. Hepatopancreatobiliary surgery specialty performed the majority of procedures, and the most performed procedure was cholecystectomy. Globally, 109 emergency surgeries were reported. Concerning the training process, only 45 papers reported the background of the operating surgeon, and only 28 papers described the training process on the surgical platform. Only one cost-analysis compared a new robot to the existing reference. Two manufacturers promoted a specific registry to collect clinical outcomes. : This systematic review highlights the feasibility of most surgical procedures in general surgery using the new robotic platforms. Adoption of these new devices in general surgery is constantly growing with the extension of regulatory approvals. Standardization of the training process and the assessment of skills' transferability is still lacking. Further studies are required to better understand the real clinical and economical benefit.
Topics: Humans; Robotics; Robotic Surgical Procedures; Hospitals; Surgeons; Cholecystectomy
PubMed: 37512075
DOI: 10.3390/medicina59071264 -
SAGE Open Medicine 2022To systematically summarize the burden of gastroschisis and omphalocele in Sub-Saharan Africa. (Review)
Review
OBJECTIVE
To systematically summarize the burden of gastroschisis and omphalocele in Sub-Saharan Africa.
METHODS
Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, systematically reviewed and meta-analyzed literatures from Medline (PubMed), Cochrane Library, HINARI, and Google Scholar that investigated at the prevalence of major congenital abdominal wall malformation. The pooled prevalence of major abdominal wall defects was estimated using a weighted inverse variance random-effects model. The Q statistic and the I statistics were used to examine for heterogeneity among the included studies. The funnel plot and Egger's regression test were used to check for publication bias.
RESULTS
A total of 1951 studies were identified; 897 from PubMed, 26 from Cochrane Library, 960 from Google Scholar, and 68 from other sources. Fourteen articles that met the eligibility criteria were selected for this meta-analysis with 242,462 total enrolled participants and 4693 births with congenital anomaly. The pooled prevalence of ompahalocele among congenital defect patients in Sub-Saharan Africa was found to be 4.47% (95% confidence interval: 3.04-5.90; I = 88.3%; p < 0.001). The pooled prevalence of omphalocele among births with congenital defect was found to be 4.04% (95% confidence interval: 2.62-5.46) in cross-sectional studies and 4.43% (95% confidence interval: 306-5.81) in cohort studies. The average prevalence of omphalocele among births with congenital defect was found to be 8% (95% confidence interval: 5.53-10.47) in Uganda and 6.65% (95% confidence interval: 4.18-9.13) in Nigeria. The pooled prevalence of gastroschisis among congenital birth defect in Sub-Saharan Africa was found to be 3.22% (95% confidence interval: 1.83-4.61; I = 33.1%; p = 0.175).
CONCLUSION
Based on this review, the pooled prevalence of omphalocele and gastroschisis in sub-Saharan Africa are high. Therefore, a perinatal screening program for congenital anomalies should be implemented. In addition, early referral of suspected cases of congenital anomalies is required for better management until advanced diagnostic centers are established in various locations of Sub-Saharan Africa.
PubMed: 36161211
DOI: 10.1177/20503121221125536 -
ANZ Journal of Surgery Jul 2021This study systematically reviewed the literature regarding perioperative mortality in human adults undergoing elective surgical abdominal wall hernia repair, including... (Meta-Analysis)
Meta-Analysis
BACKGROUND
This study systematically reviewed the literature regarding perioperative mortality in human adults undergoing elective surgical abdominal wall hernia repair, including an audit of the Royal Australasian College of Surgeons (RACS) Australian and New Zealand Audit of Surgical Mortality (ANZASM) database.
METHODS
A systematic review was conducted in accordance with PRISMA guidelines for the reporting of systematic reviews and meta-analysis of observational studies. Cochrane Library, PubMed, MEDLINE and Embase database searches and data extraction were conducted from June 1979 to October 2019. Statistical analysis was undertaken utilising denominator values for elective hernia procedures derived from the Australian Institute of Health and Welfare (AIHW) data. Risk-adjusted perioperative mortality rates for the relevant procedures were also produced, using a binary logistic regression for the risk adjustment.
RESULTS
Through systematic review of the literature, it was established that the overall reported perioperative mortality in human adults undergoing elective surgical abdominal wall hernia repair was low (0.1%-0.5%). Using ANZASM and AIHW data, the calculated risk-adjusted mortality rate for Australian patients was found to be significantly lower (0.04%-0.06%, p < 0.001).
CONCLUSION
The risk-adjusted mortality rate for elective abdominal wall hernia surgery in Australia is very low and compares favourably to international cohorts. Despite low absolute numbers, the factors which were most significantly associated with increased perioperative mortality in patients undergoing elective surgical abdominal wall hernia repair were increased age, cardiorespiratory co-morbidity and incisional hernia repair.
Topics: Abdominal Wall; Adult; Australia; Elective Surgical Procedures; Hernia, Ventral; Herniorrhaphy; Humans; Peer Review
PubMed: 34125461
DOI: 10.1111/ans.16977 -
ANZ Journal of Surgery Nov 2020A supravesical hernia (SH) is a rare abdominal wall hernia that is defined by the protrusion of abdominal viscera through the supravesical fossa. The objective of this... (Review)
Review
BACKGROUND
A supravesical hernia (SH) is a rare abdominal wall hernia that is defined by the protrusion of abdominal viscera through the supravesical fossa. The objective of this study was to review current literature on SHs and elucidate their clinical manifestations and preferred therapeutic approach.
METHODS
PubMed, Embase and Cochrane bibliographical databases were searched (last search: 30 March 2020) for articles reporting on SHs.
RESULTS
Thirty-four studies met our inclusion criteria and involved collectively 38 patients (94.7% males) with an age of 59.57 ± 14.84 (mean ± standard deviation) years. Abdominal pain (81.6%) and nausea and vomit (71.1%) were the most frequently encountered symptoms. The majority of patients (78.1%) had signs of bowel obstruction. Twenty-nine patients (76.3%) suffered from an internal SH, while nine (23.7%) had an external one. An open hernia repair was conducted at 29 patients (76.3%), while eight (21.1%) had a laparoscopic approach and in one case (2.6%) the laparoscopic operation was converted to an open one. A mesh was applied at 14.3% of included cases. Eight patients (21.1%) underwent a bowel resection and hernia sac was resected at six (15.8%) cases. Four patients (11.8%) experienced postoperative complications and one patient (2.9%) died on first postoperative day.
CONCLUSION
SH is an extremely rare type of hernia occurring through the supravesical fossa between the remnants of urachus and foetal umbilical arteries. All clinicians should be aware of this entity and further studies are necessary in order to clarify their aetiology, true incidence and optimal therapeutic approach.
Topics: Adult; Aged; Female; Hernia, Ventral; Herniorrhaphy; Humans; Internal Hernia; Intestinal Obstruction; Laparoscopy; Male; Middle Aged; Surgical Mesh
PubMed: 32808417
DOI: 10.1111/ans.16252 -
Journal of Vascular Surgery Aug 2022Clostridium septicum bacteremia is often associated with occult malignancies (approximately 80%), especially of the right colon. Furthermore, inflammation of the aortic... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Clostridium septicum bacteremia is often associated with occult malignancies (approximately 80%), especially of the right colon. Furthermore, inflammation of the aortic wall can rapidly lead to aneurysm induction through bacterial seeding into atheromatous lesions with consecutive life-threatening rupture. We summarize all published data on this rare and lethal disease to evaluate therapeutic approaches and give valid treatment recommendations because there are no guidelines.
METHODS
A systematic review of the literature was conducted screening EMBASE and MEDLINE databases following the PRISMA guidelines with search period from first description to August 25, 2021.
RESULTS
There were 72 cases of C septicum aortitis reported in 64 publications. Endovascular aortic repair (EVAR) was performed in a minority of patients (n = 6) unfit for surgery but lacked long-term survivors. Antibiotic treatment was beneficial in a bridge to surgery concept, but up to now harbored a 6-month mortality rate of 100% (median overall survival, 0.5 months) when no additional aortic repair was performed. Open aortic repair was the only potential curative approach but was accompanied with a 90-day-mortality of 26.7% (4/15).
CONCLUSIONS
Open aortic repair combined with perioperative antibiotic treatment should be offered to all patients as the only potentially curative approach. If applicable, resection of a coexisting colonic tumor should be performed after successful aortic repair. Alternatively, long-term antibiotic treatment can be offered to patients unfit for surgery in a palliative setting. Endovascular aortic repair has been performed on a minority of patients with a high risk for stent graft infection and should remain a salvage strategy when therapeutic pressure demands acute intervention in patients unfit for surgery.
Topics: Anti-Bacterial Agents; Aorta; Aortic Aneurysm, Abdominal; Aortitis; Blood Vessel Prosthesis Implantation; Clostridium septicum; Endovascular Procedures; Humans; Stents; Treatment Outcome
PubMed: 35358668
DOI: 10.1016/j.jvs.2022.02.029 -
Aesthetic Plastic Surgery Apr 2022Liposuction is among the most popular esthetic procedures worldwide. With growing demand and popularity, reports of serious complications accumulate. Despite being a... (Review)
Review
BACKGROUND
Liposuction is among the most popular esthetic procedures worldwide. With growing demand and popularity, reports of serious complications accumulate. Despite being a rare complication of the procedure, visceral perforation is associated with morbidity and severe debilitation.
METHODS
The authors conducted a literature search for reported cases of perforation of abdominal viscera following liposuction procedures in the electronic databases of PubMed, Scopus and Cochrane Library databases.
RESULTS
The authors found 22 publications; 19 cases case reports and three studies, reporting a total of 49 cases of visceral perforation following abdominal liposuction procedures. Average age of patients was 50 years (range 24-72). Twenty-seven patients (73%) were female, and 10 were male (27%). Forty (81%) patients underwent isolated liposuction, and nine (19%) had multiple procedures carried out in a single surgery. Twenty patients (42%) had undergone previous abdominal surgery, 13 (27%) suffered abdominal wall weakness or deformities, and 7 (14%) suffered from obesity. 25 (52%) ileal perforations occurred, 6 jejunal (12.5%), 5 colic (10%) and 2 (4%) each of splenic and hepatic. Seven patients (14%) died during their hospitalization, 20 (41%) were discharged with no sequelae complications, and 22 (45%) developed complications after discharge.
CONCLUSIONS
Liposuction is a popular esthetic procedure that underwent numerous changes over the past century since its introduction. Despite its widely accepted reputation of a safe procedure with minimal complications, a growing number of reports on visceral perforation following liposuction have emerged. Scrupulous pre-operative evaluation and high index of suspicion are crucial for avoiding complications and unfavorable outcomes.
LEVEL OF EVIDENCE III
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Topics: Adult; Aged; Esthetics; Female; Humans; Lipectomy; Male; Middle Aged; Obesity; Retrospective Studies; Treatment Outcome; Viscera; Young Adult
PubMed: 34462799
DOI: 10.1007/s00266-021-02532-9 -
Surgical Endoscopy Dec 2021In high-income countries, laparoscopic surgery is the preferred approach for many abdominal conditions. Conventional laparoscopy is a complex intervention that is... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
In high-income countries, laparoscopic surgery is the preferred approach for many abdominal conditions. Conventional laparoscopy is a complex intervention that is challenging to adopt and implement in low resource settings. This systematic review and meta-analysis evaluate the clinical effectiveness of gasless laparoscopy compared to conventional laparoscopy with CO pneumoperitoneum and open surgery for general surgery and gynaecological procedures.
METHODS
A search of the MEDLINE, EMBASE, Global Health, AJOL databases and Cochrane Library was performed from inception to January 2021. All randomised (RCTs) and comparative cohort (non-RCTs) studies comparing gasless laparoscopy with open surgery or conventional laparoscopy were included. The primary outcomes were mortality, conversion rates and intraoperative complications.
SECONDARY OUTCOMES
operative times and length of stay. The inverse variance random-effects model was used to synthesise data.
RESULTS
63 studies were included: 41 RCTs and 22 non-RCTs (3,620 patients). No procedure-related deaths were reported in the studies. For gasless vs conventional laparoscopy there was no difference in intraoperative complications for general RR 1.04 [CI 0.45-2.40] or gynaecological surgery RR 0.66 [0.14-3.13]. In the gasless laparoscopy group, the conversion rates for gynaecological surgery were high RR 11.72 [CI 2.26-60.87] when compared to conventional laparoscopy. For gasless vs open surgery, the operative times were longer for gasless surgery in general surgery RCT group MD (mean difference) 10 [CI 0.64, 19.36], but significantly shorter in the gynaecology RCT group MD - 18.74 [CI - 29.23, - 8.26]. For gasless laparoscopy vs open surgery non-RCT, the length of stay was shorter for gasless laparoscopy in general surgery MD - 3.94 [CI - 5.93, - 1.95] and gynaecology MD - 1.75 [CI - 2.64, - 0.86]. Overall GRADE assessment for RCTs and Non-RCTs was very low.
CONCLUSION
Gasless laparoscopy has advantages for selective general and gynaecological procedures and may have a vital role to play in low resource settings.
Topics: Abdomen; Female; Gynecologic Surgical Procedures; Humans; Insufflation; Laparoscopy; Treatment Outcome
PubMed: 34398284
DOI: 10.1007/s00464-021-08677-7 -
Journal of Pediatric Surgery Jul 2022Cryptorchidism associated with gastroschisis has been poorly investigated. We aimed to assess the prevalence of this association, and to address the management and... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Cryptorchidism associated with gastroschisis has been poorly investigated. We aimed to assess the prevalence of this association, and to address the management and outcome of cryptorchidism in this context.
MATERIALS AND METHODS
In this systematic review, we searched electronic databases (PubMed, Web of Science, and Google Scholar), without language restrictions from inception to March 31, 2021, for studies on cryptorchidism and gastroschisis co-occurrence. Random effects meta-analysis was used to calculate pooled prevalence estimates of cryptorchidism in gastroschisis and spontaneous testicular descent in this population.
RESULTS
Twenty-five studies were included for the systematic review. All were retrospective case reports or series for a total of 175 patients. Pooled prevalence estimate for cryptorchidism in gastroschisis was 19% (95% CI 13-26). Complete data sets for management and outcome analysis were available in 94 patients, involving 120 undescended testes [63 (52.5%) nonpalpable, 34 (28.3%) prolapsed outside the abdominal wall defect, and 23 (19.2%) palpable]. Fifty-five descended spontaneously, with a pooled prevalence estimate of 50% (95% CI 31-69). Twelve testes/remnants were primarily removed or absent, while 49 testes underwent orchiopexy (success rate, 63%). Excluding 4 testes still awaiting orchiopexy, 30 of the remaining 116 (25.8%) testes had a dismal outcome, including testicular loss (19), hypoplasia (8) or recurrent cryptorchidism (3).
CONCLUSION
Cryptorchidism in gastroschisis appears to occur more frequently than in the normal population. The overall mediocre testicular outcome seems to reflect the most unfavorable presentation of cryptorchidism in gastroschisis, which is represented by originally intrabdominal or prolapsed testis in the majority of cases.
LEVEL OF EVIDENCE
IV.
Topics: Cryptorchidism; Gastroschisis; Humans; Infant; Male; Orchiopexy; Prevalence; Retrospective Studies; Testis
PubMed: 34344532
DOI: 10.1016/j.jpedsurg.2021.07.006 -
Transplantation Reviews (Orlando, Fla.) Dec 2021Abdominal wall closure after intestinal, multivisceral or liver transplantation can be a major challenge. Different surgical techniques have been described to close... (Review)
Review
BACKGROUND
Abdominal wall closure after intestinal, multivisceral or liver transplantation can be a major challenge. Different surgical techniques have been described to close complex abdominal wall defects, but results remain variable. Two promising transplant techniques have been developed using either non-vascularized or vascularized donor rectus fascia. This systematic review aimed to evaluate the feasibility, safety, and effectiveness of the two techniques.
METHODS
A systematic review was performed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Human studies published between January 2000 and April 2020 were included. Methodological quality appraisal was done using an adapted 10-item standardized checklist.
RESULTS
The search resulted in 9 articles including 74 patients. Both techniques proved to be feasible and had similar results. After non-vascularized rectus fascia allotransplantation, there was a slightly higher rate of surgical site infections in the earlier reports. Overall, there were few complications, no fascial graft related rejections or deaths. The included articles scored low on quality appraisal, mostly due to the small number of cases and scarcely reported outcome parameters.
CONCLUSIONS
This systematic literature review reports two emerging new techniques for complex abdominal wall closure in transplant patients, with promising results. Standardized data collection in a prospective manner could give us more detailed information about short- and long-term outcomes. Preclinical animal studies are necessary for a thorough investigation of the mechanisms of graft integration, the risk of hernia development and the alloimmune response against the graft.
Topics: Abdominal Wall; Fascia; Graft Rejection; Humans; Liver Transplantation; Prospective Studies
PubMed: 34147948
DOI: 10.1016/j.trre.2021.100634