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European Archives of... May 2023Juvenile angiofibroma (JA) is a benign, but locally invasive tumor of the nasopharynx. Surgical resection of JA is performed through endoscopic (EA), endoscopic-assisted... (Review)
Review
PURPOSE
Juvenile angiofibroma (JA) is a benign, but locally invasive tumor of the nasopharynx. Surgical resection of JA is performed through endoscopic (EA), endoscopic-assisted (EAA), or open approaches (OA). The management of these tumors is constantly evolving. We aimed to compare the surgical efficiency and morbidity of EA, EAA, and OA in JA treatment by conducting a systematic review of the literature published over the last 10 years.
METHODS
A systematic review of the English literature on surgical cases of JA published between 2012 and 2022 was performed. Eligible articles were analyzed for individual patient data (IPD) and aggregate patient data (APD). The primary predictor variable was the surgical approach. The primary outcome variable was recurrence rate.
RESULTS
The search retrieved 75 articles reporting 1586 JA surgical cases; 129 in IPD, and 1457 in APD data sets. Within the IPD data set, recurrence rates were significantly lower in cases completed by EA than that by OA (p < 0.05). There was no significant difference in recurrence rates between the EA and EAA groups (p > 0.05). EAA had a lower recurrence rate than that of OA (p < 0.05). For the APD data set, the recurrence rate following EA was significantly lower than that following OA (p < 0.05). There was no significant difference in recurrence between the EA and EAA groups (p > 0.05), and between the EAA and OA groups (p > 0.05).
CONCLUSIONS
EA represents the method of choice for mild and moderately advanced JA. EAA and OA still play important roles in the treatment of advanced-stage JA.
Topics: Endoscopy; Angiofibroma; Nasopharynx; Nasopharyngeal Neoplasms; Treatment Outcome; Humans
PubMed: 36683103
DOI: 10.1007/s00405-023-07824-1 -
Cureus Dec 2022The gold standard treatment for benign gallbladder disease is laparoscopic cholecystectomy (LC). LC is commonly performed using monopolar diathermy with ligation of the... (Review)
Review
The gold standard treatment for benign gallbladder disease is laparoscopic cholecystectomy (LC). LC is commonly performed using monopolar diathermy with ligation of the cystic duct and artery with clips. The aim of the current systematic review was to compare harmonic scalpel (HS) with clips in LC. Eligible studies were identified from PubMed, Cochrane library, Embase and Medline and meta-analysis was conducted using Review Manager 5.4. The primary outcome evaluated was bile leak while secondary outcomes evaluated were overall postoperative complications, operative time, conversion to open surgery and gall bladder perforation. Eight randomized control trials met the eligibility criteria which included a total of 1,205 patients. There was no statistically significant difference between the two groups in terms of bile leak (p = 0.56, I=0%). With respect to the operative time (p = 0.004, I=97%), conversion to open surgery (p = 0.02, I=0%) and gall bladder perforation (p = 0.0001, I=26%) HS was superior to clips. HS is an acceptable alternative to the use of clips when ligating the cystic duct.
PubMed: 36505958
DOI: 10.7759/cureus.32335 -
Journal of Stomatology, Oral and... Dec 2020The aim of this systematic review and meta-analysis was to compare the occurrence of tissue artifacts in punch and scalpel biopsies of oral and maxillofacial lesions. (Meta-Analysis)
Meta-Analysis
AIM
The aim of this systematic review and meta-analysis was to compare the occurrence of tissue artifacts in punch and scalpel biopsies of oral and maxillofacial lesions.
METHODS
Electronic searches were conducted in four databases (PubMed, Scopus, Web of Science and Ovid). Study selection, data extraction, and quality assessment of the included articles were performed independently by two authors. An evaluation of the strength of the evidence (GRADE) and meta-analysis were conducted. Odds ratio and confidence intervals (CI) were provided.
RESULTS
After the removal of duplicates, 466 references were identified. Four studies evaluating artifacts, such as crush, fragmentation, splits, hemorrhage, curling, and orientation artifacts and also those induced by improper surgical removal, were included. Specimens obtained using scalpel biopsy were 2.98 times more likely (CI=1.53-5.80) to present crushes and 12.36 times more likely (CI=2.64-57.83) to present splits than specimens procured using punch biopsy. Scalpel biopsies were also 2.40 times more likely to present fragmentation than punch biopsies (CI=1.01-5.72). No significant differences between scalpel and punch biopsies were found concerning the presence of hemorrhage, curling, or orientation artifacts and those induced by improper surgical removal. After sensitivity analysis, samples obtained from scalpel biopsy were 6.18 times more likely to present hemorrhage than those from a punch biopsy (CI=2.21-17.28). Based on the GRADE evaluation, the confidence in the effect estimate of the sub-group analysis of crush and fragmentation was moderate. For the other subgroup analysis, the confidence was low or very low.
CONCLUSION
Punch biopsies were less likely to produce artifacts, such as crush, fragmentation, splits, and hemorrhage, than biopsies obtained with a scalpel.
Topics: Artifacts; Biopsy; Humans; Mouth Diseases
PubMed: 32574868
DOI: 10.1016/j.jormas.2020.06.005 -
Indian Journal of Otolaryngology and... Dec 2022Haemostasis during any surgical procedure is fundamental for attaining a positive patient outcome. Safe thyroid surgery requires meticulous attention for careful control...
Haemostasis during any surgical procedure is fundamental for attaining a positive patient outcome. Safe thyroid surgery requires meticulous attention for careful control of bleeding and safe guarding important structures like recurrent laryngeal nerve. Many methods such as ligation and suturing, electro ligation sealing, coagulation, and ultrasonic coagulation have been put to use for achieving haemostasis. The objective of this systemic review was to compare and review the surgical outcomes between harmonic (ultrasonic) scalpel and conventional ligature techniques in performing thyroid surgery. The systematic review was performed in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement and checklist with a total of 11 studies selected for qualitative analysis. The statistical software Review Manager 5.4.1 provided by the Cochrane Collaboration was used for performing the analysis on the two groups. It was concluded that the use of harmonic scalpel for thyroid surgery is useful for reducing operative time, postoperative pain, drainage volume and transient hypocalcemia, hence can be a reliable and a safe tool compared to conventional techniques often used for surgery.
PubMed: 36742765
DOI: 10.1007/s12070-021-03026-5 -
International Journal of Colorectal... Dec 2021Hemorrhoidectomy remains the gold standard treatment for grade III-IV hemorrhoids. However, despite strong recommendations for the suitability of outpatient surgery,... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Hemorrhoidectomy remains the gold standard treatment for grade III-IV hemorrhoids. However, despite strong recommendations for the suitability of outpatient surgery, post-operative pain has been a limitation to the widespread inclusion of this condition in day surgery programs. The aims of the study were to analyze and compare the post-operative pain of conventional open hemorrhoidectomy, considered the reference technique, against other surgical procedures such as closed hemorrhoidectomy, open hemorrhoidectomy using bipolar or ultrasonic sealant, hemorrhoidopexy, or HAL-RAR, when performed exclusively as outpatients.
METHODS
A systematic review and meta-analysis was conducted according to PRISMA methodology. All prospective and randomized studies of patients operated on for hemorrhoids in day surgery and specifying the value of post-operative pain, using a validated scale, were included. Conventional meta-analyses and a random-effects network meta-analysis were carried out.
RESULTS
Twenty-nine studies were included (3309 patients). None of the procedures described severe pain in the post-operative period. Hemorrhoidopexy was the least painful. Conventional open hemorrhoidectomy was the most painful on the first and seventh post-operative days. Pain was reduced after closed hemorrhoidectomy technique and when bipolar or harmonic scalpel was used. Furthermore, transfixive ligation of the hemorrhoidal pedicle was associated with increased post-operative pain.
CONCLUSION
Hemorrhoidal surgery is feasible in day surgery units and post-operative pain can be adequately managed in an outpatient setting. Hemorrhoidopexy was the least painful; however, data should be carefully evaluated by the high rate of long-term recurrence described in literature. Closed hemorrhoidectomy, performed with bipolar or ultrasonic sealing, avoiding transfixive ligation of the hemorrhoidal pedicle, may improve post-operative pain control.
TRIAL REGISTRATION
CRD42020185160.
Topics: Hemorrhoidectomy; Hemorrhoids; Humans; Network Meta-Analysis; Pain, Postoperative; Prospective Studies; Randomized Controlled Trials as Topic; Surgeons; Treatment Outcome
PubMed: 34417639
DOI: 10.1007/s00384-021-04013-6 -
International Journal of Surgery... Mar 2020To compare outcomes of diathermy and scalpel for skin incision in patients undergoing open inguinal hernia repair. (Comparative Study)
Comparative Study Meta-Analysis
OBJECTIVES
To compare outcomes of diathermy and scalpel for skin incision in patients undergoing open inguinal hernia repair.
METHODS
We performed a systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards. We conducted a search of electronic information sources to identify all randomised controlled trials (RCTs) and observational studies comparing use of diathermy and scalpel for skin incision in patients undergoing inguinal hernia repair. Surgical site infection (SSI) was the primary outcome measure. Secondary outcome measures included haematoma, seroma, visual analogue scale (VAS) pain score at 6 h, 12 h, and 24 h, and incision time. We used Cochrane risk of bias tool and ROBINS-I tool to assess the risk of bias of randomised and non-randomised studies. Fixed-effect model was applied to calculate pooled outcome data.
RESULTS
We identified 9 studies, 4 randomised controlled trials and 5 prospective cohort studies, enrolling a total of 830 patients. Meta-analysis of RCTs showed no difference between the diathermy and scalpel groups in terms of surgical site infection (OR: 0.77, 95% CI 0.34, 1.75, P = 0.53), seroma (OR: 0.86, 95% CI 0.29, 2.55, P = 0.78), VAS pain score at 6 h (MD: -0.10, 95% CI -0.31, 0.11, P = 0.34), 12 h (MD: -0.10, 95% CI -0.13, 0.33, P = 0.40), and 24 h (MD: 0.03, 95% CI -0.16, 0.21, P = 0.79). Use of diathermy for skin incision was associated with shorter incision time (MD: -36.00, 95% CI -47.92, -24.08, P < 0.00001) and lower risk of haematoma (OR: 0.14, 95% CI 0.03, 0.65, P = 0.01). Meta-analysis of observational studies showed no difference between the diathermy and scalpel groups in terms of surgical site infection (OR: 0.87, 95% CI 0.54, 1.39, P = 0.55), haematoma (OR 0.14, 95% CI 0.02-1.23, P = 0.08), seroma (OR: 0.86, 95% CI 0.29, 2.55, P = 0.78), VAS pain score at 6 h (MD: -0.10, 95% CI -0.44, 0.24, P = 0.56), 12 h (MD: -0.10, 95% CI -0.26, 0.46, P = 0.58), and 24 h (MD: 0.10, 95% CI -0.27, 0.47, P = 0.59). Use of diathermy for skin incision was associated with shorter incision time (MD: -39.40, 95% CI -41.02, -37.78, P < 0.00001). The results remained consistent through sensitivity analyses. The between-study heterogeneity was low and the quality of the available evidence was moderate.
CONCLUSIONS
There is no difference between use of diathermy and scalpel for skin incision in patients undergoing open inguinal hernia repair in terms of surgical site infection, seroma and postoperative pain. Use of diathermy for skin incision may be associated with shorter incision time and may reduce the risk of haematoma formation.
Topics: Diathermy; Hernia, Inguinal; Humans; Pain, Postoperative; Prospective Studies; Seroma; Surgical Instruments; Surgical Wound Infection
PubMed: 31978649
DOI: 10.1016/j.ijsu.2020.01.020 -
HPB : the Official Journal of the... Feb 2020Major liver resection can lead to significant morbidity and mortality. Blood loss is one of the most important factors predicting a good outcome. Although various... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Major liver resection can lead to significant morbidity and mortality. Blood loss is one of the most important factors predicting a good outcome. Although various transection methods have been reported, there is no consensus on the best technique. This systematic review and network meta-analysis aims to characterise and identify the best reported technique for elective parenchymal liver transection based on published randomised controlled trials (RCT's).
METHODS
A systematic review was conducted using MEDLINE, EMBASE, and Cochrane Central to identify RCT's up to 5th June 2019 that examined parenchymal transection for liver resection. Data including study characteristics and outcomes including intraoperative (blood loss, operating time) and postoperative measures (overall and major complications, bile leaks) were extracted. Indirect comparisons of all regimens were simultaneously compared using random-effects network meta-analyses (NMA) which maintains randomisation within trials.
RESULTS
This study identified 22 RCT's involving 2360 patients reporting ten parenchymal transection techniques. Bipolar cautery has lower blood loss and shorter operating time than stapler (mean difference: 85 mL; 22min) and Tissue Link (mean difference: 66 mL; 29min). Bipolar cautery was ranked first for blood loss and operating time followed by stapler and TissueLink. Harmonic scalpel is associated with lower overall complications than Hydrojet (Odds ratio (OR): 0.48), BiClamp forceps (OR: 0.46) and clamp crushing (OR: 0.41).
CONCLUSION
Bipolar cautery techniques appear to best at reducing blood loss and associated with shortest operating time. In contrast, Harmonic scalpel appears best for overall and major complications. Given the paucity of data and selective outcome reporting, it is still hard to identify what is the best technique for liver resection. Therefore, further high-quality large-scale RCT's are still needed.
Topics: Blood Loss, Surgical; Cautery; Hepatectomy; Humans; Operative Time; Postoperative Complications; Randomized Controlled Trials as Topic
PubMed: 31668587
DOI: 10.1016/j.hpb.2019.09.014 -
Iranian Journal of Public Health Jan 2022Surgical smoke is an integral part of surgical operations that the surgical team has been exposed to for so long. This study aimed to investigate the effects of smoke,... (Review)
Review
BACKGROUND
Surgical smoke is an integral part of surgical operations that the surgical team has been exposed to for so long. This study aimed to investigate the effects of smoke, on members of the surgical team.
METHODS
A systematic review was conducted focusing on the complexity of surgical smoke. PubMed, Scopus and web of science databases were searched until May 2020 without any time or language limitation. All documents were reviewed by title or abstract according to the search strategy. The screening process of articles was performed by two independent authors. The articles were selected according to the inclusion and exclusion criteria.
RESULTS
Overall, 37 studies in this systematic study were investigated. The effects of many surgical smokes were found in a nutshell including complications such as carcinogenic, toxicity, mutation, irritant, transmission of tumor cells, virus transmission, headaches, dizziness, sleepiness, headache, the bad odor in head hair, the tearing of the eye on the surgical team and staff.
CONCLUSION
Surgical smoke, produced during surgical operations, is one of the risks and threats to which the surgical team and operating room staff are at risk then can affect the organs of different bodies from the body of all operating room staff and surgical team.
PubMed: 35223623
DOI: 10.18502/ijph.v51i1.8289 -
The British Journal of Radiology Dec 2023Major randomized controlled trials of mechanical thrombectomy (MT) for acute ischemic stroke (AIS) failed to include a substantial number of patients presenting with low... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Major randomized controlled trials of mechanical thrombectomy (MT) for acute ischemic stroke (AIS) failed to include a substantial number of patients presenting with low baseline Alberta Stroke Program Early CT Score (ASPECTS:0-5). Patients experiencing hyperacute strokes (last known well ≤ 6 h) can potentially benefit most from MT. We conducted a systematic review and meta-analysis to report presentation severity and radiographic and clinical outcomes for hyperacute stroke patients presenting with low-ASPECTS.
METHODS
Our comprehensive literature search of PubMed, Embase, and Cochrane databases up to August 31, 2022 included articles reporting patients presenting hyperacutely who underwent MT for anterior circulation large vessel occlusion AIS with an ASPECTS ≤ 5 on baseline imaging. Pooled averages were calculated for age and presenting National Institutes of Health Stroke Scale (NIHSS). Fixed- and random-effects meta-analyses for weighted estimation of overall rates were performed. Forest plots were generated for proportions and estimated overall outcome rates.
RESULTS
18 studies (1958 patients) were included (mean age = 64.1 years; presenting NIHSS = 18.4). Final modified thrombolysis in cerebral infarction 2b-3 grade was achieved in 76.4%, with symptomatic intracranial hemorrhage in 12.1%. Good (modified Rankin Scale [mRS] 0-2) and ambulatory (mRS 0-3) 3-month outcomes were achieved by 27.4 and 46.7%, respectively; 90-day mortality was 26.4%.
CONCLUSION
MT in low-ASPECTS hyperacute stroke patients may result in ambulatory clinical outcomes with acceptable hemorrhage risk. Recanalization rates achieved were similar to those in patients presenting with ASPECTS ≥ 6; this did not fully translate to better clinical outcomes.
ADVANCES IN KNOWLEDGE
MT should be considered for hyperacute strokes with low presenting ASPECTS.
Topics: Humans; Middle Aged; Ischemic Stroke; Alberta; Thrombectomy; Treatment Outcome; Retrospective Studies; Stroke; Tomography, X-Ray Computed; Brain Ischemia
PubMed: 37873928
DOI: 10.1259/bjr.20230084 -
Aesthetic Surgery Journal Jul 2024Various surgical techniques have been devised for the surgical cosmetic enhancement of female outer genitalia. The selection of an optimal method should be based on...
BACKGROUND
Various surgical techniques have been devised for the surgical cosmetic enhancement of female outer genitalia. The selection of an optimal method should be based on satisfaction rates and safety; however, a comprehensive, contemporary systematic assessment of these factors in has been limited in the literature.
OBJECTIVES
Our aim was to conduct a comprehensive systematic review and meta-analysis to evaluate the overall satisfaction rates and risk factors associated with various labiaplasty techniques and tools.
METHODS
The authors performed a systematic literature search in three medical databases: PubMed, Elsevier and Cochrane Library (CENTRAL) with the closing date of October 2023. Original articles with quantitative satisfaction rates and frequencies of most common complications (hematoma, dehiscence, swelling, bleeding and infection) were included.
RESULTS
Systematic search provided a total of 3954 records. After selection and review of the articles, 86 eligible, peer-reviewed studies were identified, of which 53 provided quantitative data. High overall satisfaction rate was found for all methods (Prop: 94%; CI: 93-95%), with highest satisfaction for deepithelization (Prop: 97%; CI: 85%-99%). Complications were generally rare, with elevated incidences for some techniques (wedge resection - dehiscence: Prop: 8%; CI: 5%-13% and composite reduction - swelling: Prop: 13%; CI: 2%-54%). Scalpel has significantly higher incidence of complications than laser, namely for bleeding, swelling and hematoma.
CONCLUSIONS
Labiaplasty can be considered a generally effective approach to outer female genitalia beautification, with low associated risks. Surgeons must tailor their approach to the patients' needs and anatomy to achieve maximal satisfaction, given the differences in the frequency of complications for each method.
PubMed: 38957153
DOI: 10.1093/asj/sjae143