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Techniques in Coloproctology Aug 2022Theoretical advantages of Turnbull-Cutait pull-through delayed coloanal anastomosis (DCAA) are a reduced risk of anastomotic leak and therefore avoidance of stoma.... (Meta-Analysis)
Meta-Analysis Review
Surgical outcomes of Turnbull-Cutait delayed coloanal anastomosis with pull-through versus immediate coloanal anastomosis with diverting stoma after total mesorectal excision for low rectal cancer: a systematic review and meta-analysis.
BACKGROUND
Theoretical advantages of Turnbull-Cutait pull-through delayed coloanal anastomosis (DCAA) are a reduced risk of anastomotic leak and therefore avoidance of stoma. Gradually abandoned in favor of immediate coloanal anastomosis (ICAA) with diverting stoma, DCAA has regained popularity in recent years in reconstructive surgery for low RC, especially when combined with minimally invasive surgery (MIS). The aim of this study was to perform the first meta-analysis, exploring the safety and outcomes of DCAA compared to ICAA with protective stoma.
METHODS
A systematic search of MEDLINE, EMBASE, and CENTRAL and Google Scholar databases was performed for studies published from January 2000 until December 2020. The systematic review and meta-analysis were performed according to the Cochrane Handbook for Systematic Review on Interventions recommendations and Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines.
RESULTS
Out of 2626 studies screened, 9 were included in the systematic review and 4 studies in the meta-analysis. Outcomes included were postoperative complications, pelvic sepsis and risk of definitive stoma. Considering postoperative complications classified as Clavien-Dindo III, no significant difference existed in the rate of postoperative morbidity between DCAA and ICAA (13% versus 21%; OR 1.17; 95% CI 0.38-3.62; p = 0.78; I = 20%). Patients in the DCAA group experienced a lower rate of postoperative pelvic sepsis compared with patients undergoing ICAA with diverting stoma (7% versus 14%; OR 0.37; 95% CI 0.16-0.85; p = 0.02; I = 0%). The risk of definitive stoma was comparable between the two groups (2% versus 2% OR 0.77; 95% CI 0.15-3.85; p = 0.75; I = 0%).
CONCLUSIONS
According to the limited current evidence, DCAA is associated with a significant decrease in pelvic sepsis. Further prospective trials focusing on oncologic and functional outcomes are needed.
Topics: Anal Canal; Anastomosis, Surgical; Anastomotic Leak; Colon; Humans; Postoperative Complications; Rectal Neoplasms; Retrospective Studies; Sepsis; Treatment Outcome
PubMed: 35344150
DOI: 10.1007/s10151-022-02601-4 -
BJOG : An International Journal of... Nov 2022There is increased focus on obstetric anal sphincter injury (OASI) and there are several well-established risk factors such as birthweight, instrumental delivery and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
There is increased focus on obstetric anal sphincter injury (OASI) and there are several well-established risk factors such as birthweight, instrumental delivery and median episiotomy. Some studies have found increased risk of OASI in women delivering vaginally after a previous caesarean section (VBAC).
OBJECTIVE
To evaluate whether there is increased prevalence of OASI in VBAC compared with primiparous women.
SEARCH STRATEGY
Literature search using PubMed, Embase and Cochrane databases.
SELECTION CRITERIA
All studies with data on both primiparous women and women undergoing VBAC were included. All included studies were evaluated using the "SIGN - methodology checklist" to verify if the quality was acceptable.
DATA COLLECTION AND ANALYSIS
This systematic review included 23 articles conducted in 11 countries over 19 years. Included studies were analysed using RevMan version 5.4.
MAIN RESULTS
We found increased prevalence of OASI in the VBAC group; 8.18% (95% confidence interval [CI] 8.07-8.29) compared with 6.59% (95% CI 6.56-6.62) in primiparous women. Correspondingly, the meta-analysis revealed increased prevalence for OASI in the VBAC group (odds ratio 1.27, 95% CI 1.10-1.47). We found a high level of heterogeneity (I = 98%).
CONCLUSION
Women undergoing VBAC had a higher prevalence of OASI compared with primiparous women.
Topics: Anal Canal; Cesarean Section; Delivery, Obstetric; Episiotomy; Female; Humans; Obstetric Labor Complications; Pregnancy; Retrospective Studies; Risk Factors
PubMed: 35596697
DOI: 10.1111/1471-0528.17227 -
International Journal of Colorectal... Sep 2020In most cases, squamous cell carcinoma of the anus (SCCA) is treated with chemo-radiotherapy preserving sphincter function and offering good long-term survival and low... (Review)
Review
PURPOSE
In most cases, squamous cell carcinoma of the anus (SCCA) is treated with chemo-radiotherapy preserving sphincter function and offering good long-term survival and low recurrence rates. However, chemo-radiotherapy has several side effects: dyspareunia, impotence, fecal incontinence, pain, and skin symptoms. Small/T1 tumors, without metastatic disease, can be treated with local excision alone. We aimed to systematically review the literature regarding outcome following local excision of T1 SCCA.
METHODS
PubMed and Embase databases were searched for studies that investigated outcome following local excision of SCCA.
RESULTS
Twenty-three studies were included. Twenty of the studies were retrospective, and three studies included more than 100 patients. Most of the studies were published before the 1980s. Overall there was great heterogeneity and missing data across the included studies when comparing patient demographics, resection margins, definitions on tumor location, and outcome. Overall 5-year survival was 69% (95% CI 66-72) following local excision. Overall 5-year recurrence was 37% (95% CI 30-45) following local excision. No complications were reported following local excision.
CONCLUSION
The current literature on outcome following local excision of T1 anal cancers consists predominantly of smaller, retrospective, and heterogenous studies. Overall 5-year survival is acceptable, but worse than following chemo-radiation therapy. However, local excision seems to have no or only few minor complications. Recurrence rates are high. Therefore, a thorough follow-up program is needed when performing local excision as primary treatment for T1 SCCA. There is an evident need for further studies.
Topics: Anal Canal; Anus Neoplasms; Digestive System Surgical Procedures; Female; Humans; Male; Neoplasm Recurrence, Local; Neoplasm Staging; Rectal Neoplasms; Retrospective Studies; Treatment Outcome
PubMed: 32671458
DOI: 10.1007/s00384-020-03687-8 -
International Urogynecology Journal Mar 2020The National Health Service (NHS) in England has chosen the Episcissors-60™ as one of the products included in the NHS Innovation Accelerator programme. However, the... (Meta-Analysis)
Meta-Analysis
INTRODUCTION AND HYPOTHESIS
The National Health Service (NHS) in England has chosen the Episcissors-60™ as one of the products included in the NHS Innovation Accelerator programme. However, the evidence for its effectiveness is scanty. We therefore set out to systematically review the literature to compare risk of obstetric anal sphincter injury (OASI) in women who had undergone episiotomy with Episcissors-60™ versus those who had an episiotomy with other scissors.
METHODS
Electronic search was performed on the Healthcare Databases Advanced Search (HDAS) platform using the MEDLINE, EMBASE and CINHAL search engines up to September 2018. The search words used were 'Episcissors-60' or 'episcissors 60.' Studies were included if patients who had episiotomies with Episcissors-60™ were compared with parallel or historic patients who had episiotomy with other scissors. The only restriction used was "human" studies.
RESULTS
Of the initial 21 citations, 4 studies had enough information to be included in the meta-analysis. The number of study participants ranged from 63 to 4314. When comparing 797 patients who had episiotomies with Episcissors-60™ to 1122 patients who had episiotomies with other scissors, there was a significant reduction in OASI: risk difference = -0.04 (95% CI = -0.07 to -0.01; p = 0.005, I = 41%). The number needed to treat was 25 (95% CI = 14-100). This was not associated with an increase in episiotomy rate.
CONCLUSIONS
We reported the first systematic review on the effect of Episcissors-60™ on OASI rate. Although the studies are few, and of small size and low quality, the results are promising in terms of possible reduction in OASI.
Topics: Anal Canal; Delivery, Obstetric; England; Episiotomy; Female; Humans; Obstetric Labor Complications; Obstetrics; Perineum; Pregnancy; Risk Factors; State Medicine
PubMed: 30826873
DOI: 10.1007/s00192-019-03901-4 -
Musculoskeletal Science & Practice Apr 2022Digital rectal examination (DRE) is a commonly used test to help identify people with cauda equina compression (CEC). (Meta-Analysis)
Meta-Analysis Review
Can digital rectal examination be used to detect cauda equina compression in people presenting with acute cauda equina syndrome? A systematic review and meta-analysis of diagnostic test accuracy studies.
BACKGROUND
Digital rectal examination (DRE) is a commonly used test to help identify people with cauda equina compression (CEC).
OBJECTIVE
To determine the diagnostic accuracy of DRE in assessment of anal tone, squeeze, sensation and reflexes, as predictors of CEC.
DESIGN
A systematic review to investigate the diagnostic accuracy of DRE to detect CEC compared with lumbar Magnetic Resonance Imaging (MRI).
METHOD
Six electronic databases were searched from inception to 6 July 2020 for studies published in English. Two assessors independently performed screening, data extraction and risk of bias assessment (QUADAS-2). Meta-analysis was performed using STATA-16.
RESULTS
Six studies were included (n = 741). The sensitivity of anal tone was low across all studies (range: 0.23 to 0.53) with moderate quality evidence against the use of DRE of anal tone. One study on anal sensation found no correlation with CEC using Kendall's tau test: p = 0.102 and another found sensation had low test accuracy. One study identified sensitivity: 0.29 and specificity: 0.96 for anal squeeze, while another identified sensitivity: 0.38 and specificity: 0.6 for anal reflexes.
CONCLUSION
The diagnostic accuracy of DRE of anal tone to detect CEC is low and carries a high risk of false reassurance. It is therefore not recommended in any clinical setting. More research is needed to determine the diagnostic accuracy of DRE of anal squeeze, sensation and reflexes and if done the results should be interpreted with caution.
Topics: Anal Canal; Cauda Equina; Cauda Equina Syndrome; Diagnostic Tests, Routine; Digital Rectal Examination; Humans
PubMed: 35180641
DOI: 10.1016/j.msksp.2022.102523 -
Langenbeck's Archives of Surgery Dec 2022Primary mucosal anorectal malignant melanoma (AMM) is an invasive malignancy with poor survival. Management options have been variable, due to limited data and lack of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Primary mucosal anorectal malignant melanoma (AMM) is an invasive malignancy with poor survival. Management options have been variable, due to limited data and lack of randomised control trials available on the optimal surgical strategy. The aim of this review was to compare local excision versus radical resection.
METHODS
A systematic search of articles in PubMed, Ovid, Scopus, and the Cochrane Library database was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The outcomes of interest were the impact that surgical strategy had on survival (primary) and recurrence rates (secondary) for the treatment of AMM, comparing sphincter sparing local excision (LE) versus extensive abdominoperineal resection (APR).
RESULTS
Ten studies met the predefined criteria. Overall, there were 303 patients, with a median age of 58.2 years. Sixty-one percent (n = 187/303) had radical surgery (abdominoperineal resection) for the primary treatment of AMM. Overall, 5-year survival for the APR and LE was 23% and 32% respectively. Meta-analysis on the median OS noted no statistical difference between the two groups. However, local recurrence occurred in 20.82% and 47.04% in the APR and LE groups respectively. Meta-analysis observed a statistically significant reduction in recurrence when patients had an APR as primary treatment (OR 0.15, 95% CI = 0.08-0.28, p < 0.00001).
CONCLUSION
Though local recurrence rates are more common with local excision of AMM, this does not confer an inferior OS when comparing LE versus APR. The decision to proceed with LE vs. APR should be made on a case-by-case basis.
Topics: Humans; Middle Aged; Anus Neoplasms; Rectal Neoplasms; Anal Canal; Organ Sparing Treatments; Melanoma; Melanoma, Cutaneous Malignant
PubMed: 36331615
DOI: 10.1007/s00423-022-02715-1 -
Techniques in Coloproctology Nov 2023Inguinal lymph nodes are a rare but recognised site of metastasis in rectal adenocarcinoma. No guideline or consensus exists for the management of such cases. This... (Review)
Review
PURPOSE
Inguinal lymph nodes are a rare but recognised site of metastasis in rectal adenocarcinoma. No guideline or consensus exists for the management of such cases. This review aims to provide a contemporary and comprehensive analysis of the published literature to aid clinical decision-making.
METHODS
Systematic searches were performed using the PubMed, Embase, MEDLINE and Scopus and Cochrane CENTRAL Library databases from inception till December 2022. All studies reporting on the presentation, prognosis or management of patients with inguinal lymph node metastases (ILNM) were included. Pooled proportion meta-analyses were completed when possible and descriptive synthesis was utilised for the remaining outcomes. The Joanna Briggs Institute tool for case series was used to assess the risk of bias.
RESULTS
Nineteen studies were eligible for inclusion, encompassing 18 case series and one population-based study using national registry data. A total of 487 patients were included in the primary studies. The prevalence of ILNM in rectal cancer is 0.36%. ILNM are associated with very low rectal tumours with a mean distance from the anal verge of 1.1 cm (95% CI 0.92-1.27). Invasion of the dentate line was found in 76% of cases (95% CI 59-93). In patients with isolated inguinal lymph node metastases, modern chemoradiotherapy regimens in combination with surgical excision of inguinal nodes are associated with 5-year overall survival rates of 53-78%.
CONCLUSION
In specific subsets of patients with ILNM, curative-intent treatment regimens are feasible, with oncological outcomes akin to those demonstrated in locally advanced rectal cancers.
Topics: Humans; Lymphatic Metastasis; Inguinal Canal; Adenocarcinoma; Lymph Nodes; Rectal Neoplasms; Lymph Node Excision; Retrospective Studies
PubMed: 37233960
DOI: 10.1007/s10151-023-02826-x -
AIDS and Behavior Mar 2020HIV is more efficiently acquired during receptive anal intercourse (AI) compared to vaginal intercourse (VI) and may contribute substantially to female sex workers'... (Meta-Analysis)
Meta-Analysis
HIV is more efficiently acquired during receptive anal intercourse (AI) compared to vaginal intercourse (VI) and may contribute substantially to female sex workers' (FSW) high HIV burden. We aim to determine how common and frequent AI is among FSW globally. We searched PubMed, Embase and PsycINFO for studies reporting the proportion of FSW practising AI (prevalence) and/or the number of AI acts (frequency) worldwide from 01/1980 to 10/2018. We assessed the influence of participant and study characteristics on AI prevalence (e.g. continent, study year and interview method) through sub-group analysis. Of 15,830 identified studies, 131 were included. Nearly all (N = 128) reported AI prevalence and few frequency (N = 13), over various recall periods. Most studies used face-to-face interviews (N = 111). Pooled prevalences varied little by recall period (lifetime: 15.7% 95%CI 12.2-19.3%, N = 30, I = 99%; past month: 16.2% 95%CI 10.8-21.6%, N = 18, I = 99%). The pooled proportion of FSW reporting < 100% condom use tended to be non-significantly higher during AI compared to during VI (e.g. any unprotected VI: 19.1% 95%CI 1.7-36.4, N = 5 and any unprotected AI: 46.4% 95%CI 9.1-83.6, N = 5 in the past week). Across all study participants, between 2.4 and 15.9% (N = 6) of all intercourse acts (AI and VI) were anal. Neither AI prevalence nor frequency varied substantially by any participant or study characteristics. Although varied, AI among FSW is generally common, inconsistently protected with condoms and practiced sufficiently frequently to contribute substantially to HIV acquisition in this risk group. Interventions to address barriers to condom use are needed.
Topics: Anal Canal; Coitus; Condoms; Female; HIV Infections; Humans; Prevalence; Risk Factors; Safe Sex; Sex Workers; Sexual Behavior; Vagina
PubMed: 30953304
DOI: 10.1007/s10461-019-02477-w -
Journal of Ultrasound Jun 2023Endoanal ultrasound (3D-EAUS) is the gold standard imaging investigation for evaluating the anal sphincter; unfortunately, it is not universally available in most...
INTRODUCTION
Endoanal ultrasound (3D-EAUS) is the gold standard imaging investigation for evaluating the anal sphincter; unfortunately, it is not universally available in most obstetric units. This study aims to appraise the ability of transperineal ultrasound (TPUS) compared with 3D-EAUS as the gold standard to identify anal sphincter defects after primary repair of OASIS.
METHODS
A systematic search of major databases to identify diagnostic accuracy of 3D-TPUS in evaluating anal sphincter defects. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were designed for this systematic review. The risk of bias and applicability concerns were assessed using the QUADAS-2 tool. Our eligibility criteria are patients with a history of primary repair of anal sphincter injuries (OASIS). They were followed up after the primary repair to detect the anal sphincter defect using 3D-TPUS vs. 3D-EAUS as a gold standard.
RESULTS
Two eligible observational studies were included and assessed for risk of bias using the QUADAS-2 tool and showed a low risk of bias and a low risk of concerns. 3D-TPUS had various sensitivity to detect external anal sphincter defects in two studies; meanwhile, the specificity was around 67-70%. For detecting the internal anal sphincter defects, 3D-TPUS had low sensitivity but high specificity (93-94%).
CONCLUSION
3D-TPUS had various sensitivity to detect external anal sphincter defects and low sensitivity to detect internal anal sphincter defects. On the other hand, 3D-TPUS had low specificity for detecting external anal sphincter defects and high specificity for detecting internal anal sphincter defects.
Topics: Pregnancy; Female; Humans; Anal Canal; Ultrasonography; Abdominal Injuries
PubMed: 36630015
DOI: 10.1007/s40477-022-00763-3 -
International Journal of Colorectal... Apr 2021Two subgroups of fecal incontinence (FI) are described in literature and used in clinical practice. However, the pertinence of this classification of FI is still unknown... (Review)
Review
PURPOSE
Two subgroups of fecal incontinence (FI) are described in literature and used in clinical practice. However, the pertinence of this classification of FI is still unknown as there are no clear established guidelines. To a better understanding, we performed a systematic review to characterize the different types of FI (active, passive, or mixed) on the basis of clinical presentation and complementary explorations.
METHODS
This systematic literature review was performed in reference to recommendations for systematic review using PRISMA guidelines without date restriction, until May 2020. This systematic review was performed without temporal limitation using MEDLINE-PubMed, Cochrane Library, and Google Scholar databases.
RESULTS
Six hundred nine unique citations were identified from all the databases combined. Of those, 21 studies met the inclusion criteria, with 8 retrospective observational studies and 13 prospective observational studies. There was a lack of homogeneity in definitions of passive and urge (active) FI among studies. Prevalence of passive and urge FI was respectively of 4.0-5.0 and 15.0-35.0%. Clinical characteristics, physical examination, and endoanal imaging were not evaluated in most studies. In anorectal manometry, maximal squeeze pressure was higher in passive FI subgroup in most studies and results regarding maximal resting pressure remain discordant. There seemed to be no difference regarding first sensation volume and maximal tolerable volume among subgroups. A few studies evaluated pudendal terminal nerve motor latency with no difference among subgroups.
CONCLUSION
There is a lack of well-conducted prospective studies comparing the different subtypes of FI with validated definitions in both clinical and paraclinical examinations.
Topics: Anal Canal; Fecal Incontinence; Humans; Manometry; Observational Studies as Topic; Prospective Studies; Retrospective Studies
PubMed: 33210162
DOI: 10.1007/s00384-020-03803-8