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Annals of Palliative Medicine Nov 2021In recent years, pelvic restoration surgery is widely used in the diagnosis and treatment of stress urinary incontinence (SUI) as people pay more attention to postpartum... (Meta-Analysis)
Meta-Analysis
BACKGROUND
In recent years, pelvic restoration surgery is widely used in the diagnosis and treatment of stress urinary incontinence (SUI) as people pay more attention to postpartum pelvic floor dysfunction (PFD). The therapeutic effect of pelvic restoration combined with anti-SUI surgery remains undetermined. The evaluation indicators of the therapeutic effects include the incidence of postoperative obstruction, the incidence of postoperative defecation difficulties, and the quality of life score.
METHODS
PubMed, Cochrane Library, and EMBASE were searched from the establishment of the database to April 2021 for randomized control trials (RCTs) of pelvic restoration and anti-SUI surgery, and the RevMan5.3 software provided by the Cochrane Collaboration was used for meta-analysis.
RESULTS
A total of 6 documents (a total of 1,944 patients) were included, including 1,021 patients in the experimental group and 923 patients in the control group. The incidence of obstruction after pelvic restoration combined with anti-SUI surgery was statistically significant (OR =1.35, 95% CI, 0.95-1.92, P=0.10); there was a statistically significant difference in the incidence of postoperative dyspareunia (OR =1.58, 95% CI, 0.91-2.74, P=0.10).
DISCUSSION
A total of 8 documents included in this meta-analysis confirmed that pelvic restoration combined with anti-SUI surgery for PFD can improve the prognosis and quality of life of patients.
Topics: Female; Humans; Incidence; Pelvic Floor; Quality of Life; Urinary Incontinence, Stress
PubMed: 34872292
DOI: 10.21037/apm-21-2737 -
Annals of Palliative Medicine May 2020Several enhanced recovery after surgery (ERAS) protocols for radical prostatectomy (RP) have been reported in recent years. Nonetheless, there is no sufficient evidence... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Several enhanced recovery after surgery (ERAS) protocols for radical prostatectomy (RP) have been reported in recent years. Nonetheless, there is no sufficient evidence to support the implementation of ERAS as a standard of care modality.
METHODS
A search was done in the PubMed, Embase, Clinical Trials.gov, Cochrane Library, CNKI Library databases and reference lists to identify relevant studies from inception until May 2019 to be included in the study. A systematic review of five randomized controlled trials (RCTs), one prospective cohort study and four retrospective studies covering 3,803 patients, comparing ERAS with conventional care was performed. Outcomes of interest for the study were intraoperative outcomes (operation time and blood loss), postoperative outcomes (hospital stay, catheter stay, first defecation and first anal exhaust) and postoperative complications. Random events meta-analyses were performed. Sensitivity analysis was also performed to determine whether the results of the meta-analysis were robust.
RESULTS
Notably, ERAS group had significantly shorter hospital stay [overall standardized mean difference (SMD) =-1.65, 95% confidence interval (CI): -2.53, -0.76, P<0.001], shorter time to first defecation (overall SMD =-1.56, 95% CI: -2.71, -0.42, P=0.008), shorter time to first anal exhaust (overall SMD =-1.23, 95% CI: -1.97, -0.50, P=0.001) and lower incidence of nausea [overall risk ratio (RR) =0.62, 95% CI: 0.40, 0.94, P=0.024] compared to the conventional group. There was no statistical difference in intraoperative outcomes, catheter stay and other postoperative complications between the two groups (P>0.05).
CONCLUSIONS
The data presented so far consistently show that ERAS may be utilized as a standard of care in RP treatment.
Topics: Enhanced Recovery After Surgery; Humans; Length of Stay; Male; Postoperative Complications; Prospective Studies; Prostatectomy; Prostatic Neoplasms; Recovery of Function; Reference Standards; Retrospective Studies
PubMed: 32389010
DOI: 10.21037/apm.2020.04.03 -
Journal of Gastroenterology and... Feb 2020Standardizing evaluative outcomes and their assessment facilitates comparisons between clinical studies and provides a basis for comparing direct effects of different...
BACKGROUND AND AIM
Standardizing evaluative outcomes and their assessment facilitates comparisons between clinical studies and provides a basis for comparing direct effects of different treatment options. The aim of this study was to systematically review types of outcomes and measurement instruments used in studies regarding treatment options for slow-transit constipation (STC) in adults.
METHODS
In this systematic review of the literature, we searched MEDLINE, Embase, and PsycINFO from inception through February 2018, for papers assessing any STC treatment in adult patients. Outcomes were systematically extracted and categorized in domains using the conceptual framework of the Outcome Measures in Rheumatology filter 2.0. Outcome reporting was stratified by decade of publication, intervention, and study type.
RESULTS
Forty-seven studies were included in this systematic review. Fifty-nine different types of outcomes were identified. The outcomes were structured in three core areas and 18 domains. The most commonly reported domains were defecation functions (94%), gastrointestinal transit (53%), and health-care service use (51%). The most frequently reported outcomes were defecation frequency (83%), health-related quality of life (43%), and adverse events and complications (43%). In 62% of the studies, no primary outcome was defined, whereas in two studies, more than one primary outcomes were selected. A wide diversity of measurement instruments was used to assess the reported outcomes.
CONCLUSION
Outcomes reported in studies on STC in adults are heterogeneous. A lack of standardization complicates comparisons between studies. Developing a core outcome set for STC in adults could contribute to standardization of outcome reporting in (future) studies.
Topics: Adult; Constipation; Defecation; Female; Gastrointestinal Motility; Humans; Male; Outcome Assessment, Health Care; Quality of Life
PubMed: 31376175
DOI: 10.1111/jgh.14818 -
World Journal of Surgical Oncology Apr 2021The application of side-to-end anastomosis (SEA) in sphincter-preserving resection (SPR) is controversial. We performed a meta-analysis to compare the safety and... (Comparative Study)
Comparative Study Meta-Analysis
Safety and efficacy of side-to-end anastomosis versus colonic J-pouch anastomosis in sphincter-preserving resections: an updated meta-analysis of randomized controlled trials.
BACKGROUND
The application of side-to-end anastomosis (SEA) in sphincter-preserving resection (SPR) is controversial. We performed a meta-analysis to compare the safety and efficacy of SEA with colonic J-pouch (CJP) anastomosis, which had been proven effective in improving postoperative bowel function.
METHODS
The protocol was registered in PROSPERO under number CRD42020206764. PubMed, Embase, Web of Science, and the Cochrane Register of Controlled Trials databases were searched. The inclusion criteria were randomized controlled trials (RCTs) that evaluated the safety or efficacy of SEA in comparison with CJP anastomosis. The outcomes included the pooled risk ratio (RR) for dichotomous variables and weighted mean differences (WMDs) for continuous variables. All outcomes were calculated with 95% confidence intervals (CI) by STATA software (Stata 14, Stata Corporation, TX, USA).
RESULTS
A total of 864 patients from 10 RCTs were included in the meta-analysis. Patients undergoing SEA had a higher defecation frequency at 12 months after SPR (WMD = 0.20; 95% CI, 0.14-0.26; P < 0.01) than those undergoing CJP anastomosis with low heterogeneity (I = 0%, P = 0.54) and a lower incidence of incomplete defecation at 3 months after surgery (RR = 0.28; 95% CI, 0.09-0.86; P = 0.03). A shorter operating time (WMD = - 17.65; 95% CI, - 23.28 to - 12.02; P < 0.01) was also observed in the SEA group without significant heterogeneity (I = 0%, P = 0.54). A higher anorectal resting pressure (WMD = 6.25; 95% CI, 0.17-12.32; P = 0.04) was found in the SEA group but the heterogeneity was high (I = 84.5%, P = 0.84). No significant differences were observed between the groups in terms of efficacy outcomes including defecation frequency, the incidence of urgency, incomplete defecation, the use of pads, enema, medications, anorectal squeeze pressure and maximum rectal volume, or safety outcomes including operating time, blood loss, the use of protective stoma, postoperative complications, clinical outcomes, and oncological outcomes.
CONCLUSIONS
The present evidence suggests that SEA is an effective anastomotic strategy to achieve similar postoperative bowel function without increasing the risk of complications compared with CJP anastomosis. The advantages of SEA include a shorter operating time, a lower incidence of incomplete defecation at 3 months after surgery, and better sphincter function. However, close attention should be paid to the long-term defecation frequency after SPR.
Topics: Anal Canal; Anastomosis, Surgical; Colonic Pouches; Humans; Prognosis; Randomized Controlled Trials as Topic; Recovery of Function; Rectal Neoplasms; Treatment Outcome
PubMed: 33882952
DOI: 10.1186/s12957-021-02243-0 -
International Journal of Colorectal... Feb 2022The ileoanal pouch (IPAA) provides patients with ulcerative colitis (UC) that have not responded to medical therapy an option to retain bowel continuity and defecate... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND AIMS
The ileoanal pouch (IPAA) provides patients with ulcerative colitis (UC) that have not responded to medical therapy an option to retain bowel continuity and defecate without the need for a long-term stoma. Despite good functional outcomes, some pouches fail, requiring permanent diversion, pouchectomy, or a redo pouch. The incidence of pouch failure ranges between 2 and 15% in the literature. We conducted a systematic review and meta-analysis aiming to define the prevalence of pouch failure in patients with UC who have undergone IPAA using population-based studies.
METHODS
We searched Embase, Embase classic and PubMed from 1978 to 31st of May 2021 to identify cross-sectional studies that reported the prevalence of pouch failure in adults (≥ 18 years of age) who underwent IPAA for UC.
RESULTS
Twenty-six studies comprising 23,389 patients were analysed. With < 5 years of follow-up, the prevalence of pouch failure was 5% (95%CI 3-10%). With ≥ 5 but < 10 years of follow-up, the prevalence was 5% (95%CI 4-7%). This increased to 9% (95%CI 7-16%) with ≥ 10 years of follow-up. The overall prevalence of pouch failure was 6% (95%CI 5-8%).
CONCLUSIONS
The overall prevalence of pouch failure in patients over the age of 18 who have undergone restorative proctocolectomy in UC is 6%. These data are important for counselling patients considering this operation. Importantly, for those patients with UC being considered for a pouch, their disease course has often resulted in both physical and psychological morbidity and hence providing accurate expectations for these patients is vital.
Topics: Adult; Colitis, Ulcerative; Colonic Pouches; Cross-Sectional Studies; Humans; Middle Aged; Postoperative Complications; Prevalence; Proctocolectomy, Restorative; Retrospective Studies; Treatment Outcome
PubMed: 34825957
DOI: 10.1007/s00384-021-04067-6 -
Frontiers in Surgery 2022Post-hemorrhoidectomy pain (PHP) remains one of the complications of hemorrhoidectomy and can delay patient's recovery. Current clinical guideline on PHP remains...
BACKGROUND
Post-hemorrhoidectomy pain (PHP) remains one of the complications of hemorrhoidectomy and can delay patient's recovery. Current clinical guideline on PHP remains skeptical on the effectiveness of acupuncture, which has been applied for PHP in practice with inconsistent evidence.
OBJECTIVES
This systematic review aimed to evaluate the effectiveness of acupuncture on PHP by reviewing existing evidence.
METHODS
Nine databases such as PubMed and Embase were searched for randomized controlled trials (RCTs) from inception to 30th September 2021. The outcome measures on pain level after hemorrhoidectomy, dose of rescue analgesic drug used, quality of life, adverse events, etc., were extracted and analyzed in a narrative approach.
RESULTS
Four RCTs involving 275 patients were included in the analysis. One study showed that the visual analog scale (VAS) score was significantly lower in the electro-acupuncture (EA) group compared to that in the sham acupuncture (SA) group at 6, 24 h after surgery and during the first defecation ( < 0.05). Similar trends were found in the verbal rating scale (VRS) and Wong-Baker Faces scale (WBS) score but at different time points. Another study also found EA was effective on relieving pain during defecation up to 7 days after surgery when compared with local anesthetics ( < 0.05). However, two studies evaluating manual acupuncture (MA) compared with active medications for PHP showed inconsistent results on effectiveness. Variability was found in the quality of included studies.
CONCLUSIONS
Although benefit of acupuncture on PHP, especially EA on defecation after surgery, was observed at some time points, evidence on effectiveness of acupuncture on PHP was not conclusive.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/, PROSPERO, identifier: CRD42018099961.
PubMed: 35419404
DOI: 10.3389/fsurg.2022.815618 -
Frontiers in Pediatrics 2021Non-pharmacologic auxiliary treatments have been considered crucial therapies for treating chronic idiopathic constipation (CIC) during the past decades worldwide....
Efficacy of Non-pharmacologic Auxiliary Treatments in Improving Defecation Function in Children With Chronic Idiopathic Constipation: A Systematic Review and Network Meta-analysis.
Non-pharmacologic auxiliary treatments have been considered crucial therapies for treating chronic idiopathic constipation (CIC) during the past decades worldwide. Several treatment patterns are available, but their relative efficacy is obscure because there are no head-to-head randomized controlled trials, especially in children. We conducted this network meta-analysis to evalute the effectiveness of these therapies in improving defecation function based on their direct comparisons with standard medical care. Medline, Embase, and Cochrane Central were searched for randomized controlled trials (RCTs) published in English from inception to October 2020, assessing the efficacy of auxiliary therapies (behavior therapy, physiotherapy, biofeedback, or anorectal manometry) in children with CIC. We extracted data for endpoints, risk of bias, and evidence quality. Eligible studies in the meta-analysis reported the data of a dichotomous assessment of overall response to treatment (response or not) or defecation frequency per week after treatment. The hierarchical Bayesian network meta-analysis was used in the study. We chose a conservative methodology, random effects model, to pool data which could handle the heterogeneity well. The relative risk (RR) with 95% confidence intervals (CIs) was calculated for dichotomous outcomes. For continuous results, weighted mean difference (WMD) with related CIs was calculated. The included treatments were ranked to define the probability of being the best treatment. Seven RCTs (838 patients) met inclusion and endpoint criteria. Based on an endpoint of the absence of constipation (Rome criteria) with laxatives allowed, physiotherapy plus standard medical care (SMC) had the highest probability (84%) to bethe most effective therapy. When the treatment response was defined as an absence of constipation with not laxatives allowed, biofeedback plus SMC ranked first (probability 52%). Physiotherapy plus SMC ranked first when the endpoint was based on defecation frequency per week with laxatives allowed (probability 86%). Almost all auxiliary therapies are effective complementary therapies for treating CIC, but they needed to be used simultaneously with SMC. Nevertheless, because of the small number of eligible studies and their small sample sizes, the differences in treatment duration and the endpoints, large sample RCTs with long-term follow-up are required for further investigation.
PubMed: 33987155
DOI: 10.3389/fped.2021.667225 -
Nutrients Dec 2021Previous systematic reviews have not clarified the effect of postoperative coffee consumption on the incidence of postoperative ileus (POI) and the length of hospital... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Previous systematic reviews have not clarified the effect of postoperative coffee consumption on the incidence of postoperative ileus (POI) and the length of hospital stay (LOS). We aimed to assess its effect on these postoperative outcomes.
METHODS
Studies evaluating postoperative coffee consumption were searched using electronic databases until September 2021 to perform random-effect meta-analysis. The quality of evidence was assessed using the Cochrane risk-of-bias tool. Caffeinated and decaffeinated coffee were also compared.
RESULTS
Thirteen trials (1246 patients) and nine ongoing trials were included. Of the 13 trials, 6 were on colorectal surgery, 5 on caesarean section, and 2 on gynecological surgery. Coffee reduced the time to first defecation (mean difference (MD) -10.1 min; 95% confidence interval (CI) = -14.5 to -5.6), POI (risk ratio 0.42; 95% CI = 0.26 to 0.69); and LOS (MD -1.5; 95% CI = -2.7 to -0.3). This trend was similar in colorectal and gynecological surgeries. Coffee had no adverse effects. There was no difference in POI or LOS between caffeinated and decaffeinated coffee ( > 0.05). The certainty of evidence was low to moderate.
CONCLUSION
This review showed that postoperative coffee consumption, regardless of caffeine content, likely reduces POI and LOS after colorectal and gynecological surgery.
Topics: Coffee; Defecation; Digestive System Surgical Procedures; Female; Gynecologic Surgical Procedures; Humans; Ileus; Length of Stay; Male; Postoperative Complications; Postoperative Period; Time Factors
PubMed: 34959946
DOI: 10.3390/nu13124394 -
Annali Dell'Istituto Superiore Di Sanita 2020To summarize the evidence in the literature about rehabilitative treatments that reduce low anterior resection syndrome (LARS) symptoms in patients who underwent surgery...
OBJECTIVE
To summarize the evidence in the literature about rehabilitative treatments that reduce low anterior resection syndrome (LARS) symptoms in patients who underwent surgery for colorectal cancer.
METHODS
We have search in PubMed, Cochrane Central Register of Controlled Trials, Cumulative Index of Nursing and Allied Health and Scopus databases. Studies selected were limited to those including only patient undergone low rectal resection with sphincter preservation and with pre-post assessment with a LARS score. Five articles fit the criteria.
RESULTS
The percutaneous tibial nerve stimulation demonstrated moderate results and sacral nerve stimulation was found to be the best treatment with greater symptom improvement. Only one study considered sexual and urinary problems in the outcomes assessment.
CONCLUSIONS
In clinical practice patients should evaluate with the LARS and other score for evaluation of urinary and sexual problems. Future research must be implemented with higher quality studies to identify the least invasive and most effective treatment/s.
Topics: Adenocarcinoma; Antineoplastic Agents; Colectomy; Colorectal Neoplasms; Combined Modality Therapy; Defecation; Exercise Therapy; Fecal Incontinence; Female; Follow-Up Studies; Humans; Implantable Neurostimulators; Lumbosacral Plexus; Male; Middle Aged; Postoperative Complications; Prospective Studies; Quality of Life; Rectum; Retrospective Studies; Syndrome; Tibial Nerve; Transcutaneous Electric Nerve Stimulation; Urination Disorders
PubMed: 32242534
DOI: 10.4415/ANN_20_01_07 -
In Vivo (Athens, Greece) 2020The safety and efficacy of laparoscopic total gastrectomy (LTG) for remnant gastric cancer (RGC) remains unclear. The purpose of this study was to compare the clinical...
BACKGROUND/AIM
The safety and efficacy of laparoscopic total gastrectomy (LTG) for remnant gastric cancer (RGC) remains unclear. The purpose of this study was to compare the clinical outcomes of LTG with open total gastrectomy (OTG) for RGC.
PATIENTS AND METHODS
Twenty-two patients who underwent total gastrectomy for RGC were enrolled in this study.
RESULTS
LTG was carried out in seven patients, and OTG was performed in the remaining 15 patients. The mean operation time in the LTG group was longer than that in the OTG group. The estimated blood loss in the LTG group was less than that in the OTG group. No cases in the LTG group required open conversion. Postoperatively, the first meal and defecation were earlier in the LTG group than in the OTG group. The overall survival rates of the two groups were comparable.
CONCLUSION
Laparoscopic total gastrectomy is a feasible surgical option for RGC.
Topics: Gastrectomy; Humans; Laparoscopy; Operative Time; Postoperative Complications; Retrospective Studies; Stomach Neoplasms; Treatment Outcome
PubMed: 32606171
DOI: 10.21873/invivo.11996