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International Journal of Colorectal... Apr 2013This manuscript is a review of different surgical techniques to manage perforated colon diverticulitis. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
This manuscript is a review of different surgical techniques to manage perforated colon diverticulitis.
OBJECTIVE
This study was conducted to compare the benefits and disadvantages of different surgical treatments for Hinchey III or IV type of colon diverticulitis.
METHODS
A systematic search was conducted in Medline, Embase, Cochrane Central Register of Controlled Trials, and the Science Citation Index (1990 and 2011). A total of 1,809 publications were identified and 14 studies with 1,041 patients were included in the study. Any surgical treatment was considered in this review. Mortality was considered the primary outcome, whereas hospital stay and reoperation rate were considered secondary outcomes.
RESULTS
Primary resection with anastomosis has a significant advantage in terms of lower mortality rate with respect to Hartmann's procedure (P = 0.02). The postoperative length of hospitalization was significantly shorter in the resection with anastomosis group (P < 0.001). Different findings have emerged from studies of patients with the primary resection with anastomosis vs laparoscopic peritoneal lavage and subsequent resection: overall surgical morbidity and hospital stay were lower in the laparoscopic peritoneal lavage group compared to the primary resection and anastomosis group (P < 0.001).
CONCLUSIONS
Despite numerous published articles on operative treatments for patients with generalized peritonitis from perforated diverticulitis, we found a marked heterogeneity between included studies limiting the possibility to summarize in a metanalytical method the data provided and make difficult to synthesize data in a quantitative fashion. The advantages in the group of colon resection with primary anastomosis in terms of lower mortality rate and postoperative stay should be interpreted with caution because of several limitations. Future randomized controlled trials are needed to further evaluate different surgical treatments for patients with generalized peritonitis from perforated diverticulitis.
Topics: Anastomosis, Surgical; Colon, Sigmoid; Colostomy; Diverticulitis, Colonic; Humans; Intestinal Perforation; Laparoscopy; Peritoneal Lavage; Suture Techniques
PubMed: 23242271
DOI: 10.1007/s00384-012-1622-4 -
American Journal of Kidney Diseases :... Dec 2007Peritonitis frequently complicates peritoneal dialysis. Appropriate treatment is essential to reduce adverse outcomes. Available trial evidence about peritoneal dialysis... (Review)
Review
BACKGROUND
Peritonitis frequently complicates peritoneal dialysis. Appropriate treatment is essential to reduce adverse outcomes. Available trial evidence about peritoneal dialysis peritonitis treatment was evaluated.
SELECTION CRITERIA FOR STUDIES
The Cochrane CENTRAL Registry (2005 issue), MEDLINE (1966 to February 2006), EMBASE (1985 to February 2006), and reference lists were searched to identify randomized trials of treatments for patients with peritoneal dialysis peritonitis.
INTERVENTIONS
Trials of antibiotics (comparisons of routes, agents, and dosing regimens), fibrinolytic agents, peritoneal lavage, and intraperitoneal immunoglobulin.
OUTCOMES
Treatment failure, relapse, catheter removal, microbiological eradication, hospitalization, all-cause mortality, and adverse reactions.
RESULTS
36 eligible trials were identified: 30 trials (1,800 patients) of antibiotics; 4 trials (229 patients) of urokinase; 1 trial of peritoneal lavage (36 patients); and 1 trial of intraperitoneal immunoglobulin (24 patients). No superior antimicrobial class was identified. In particular, glycopeptides and first-generation cephalosporins were equivalent (3 trials, 387 patients; relative risk [RR], 1.84; 95% confidence interval [CI], 0.95 to 3.58). Simultaneous catheter removal/replacement was superior to urokinase at decreasing treatment failures (1 trial, 37 patients; RR, 2.35; 95% CI, 1.13 to 4.91). Continuous and intermittent intraperitoneal antibiotic dosing were equivalent regarding treatment failure (4 trials, 338 patients; RR, 0.69; 95% CI, 0.37 to 1.30) and relapse (4 trials, 324 patients; RR, 0.93; 95% CI, 0.63 to 1.39). One trial showed superiority of intraperitoneal antibiotics over intravenous therapy.
LIMITATIONS
The method quality of trials generally was suboptimal and outcome definitions were inconsistent. Small patient numbers led to inadequate power to show an effect. Interventions, such as optimal duration of antibiotic therapy, were not evaluated.
CONCLUSIONS
Trials did not identify superior antibiotic regimens. Intermittent and continuous antibiotic dosing are equivalent treatment strategies.
Topics: Anti-Bacterial Agents; Fibrinolytic Agents; Humans; Peritoneal Dialysis; Peritoneal Lavage; Peritonitis; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 18037098
DOI: 10.1053/j.ajkd.2007.08.015 -
Gastric Cancer : Official Journal of... Jan 2015Gastric cancer patients with positive peritoneal cytology as the only marker of metastatic disease have poor prognoses. There is no universal consensus on the most... (Meta-Analysis)
Meta-Analysis
Gastric cancer patients with positive peritoneal cytology as the only marker of metastatic disease have poor prognoses. There is no universal consensus on the most appropriate treatment regimen for this particular patient group. We reviewed and analyzed published data to determine the optimal treatment regimen for patients with peritoneal cytology-positive gastric adenocarcinomas. Six electronic databases were explored [PubMed, Cochrane (Systematic Reviews and Controlled Trials), PROSPERO, DARE, and EMBASE]. The primary outcome was overall survival with secondary outcomes including patterns of recurrence and treatment-related morbidity. Six studies were included for data extraction. There was no significant heterogeneity between studies. The use of S1 monotherapy was associated with a significant survival benefit (HR 0.48; 95% CI 0.32-0.70; p = 0.0002). Intraoperative intraperitoneal chemotherapy (IIPC) with adjuvant chemotherapy showed a trend toward improvement in overall survival (HR 0.70; 9 % CI 0.47-1.04; p = 0.08). A recent randomized controlled trial examining extensive intraperitoneal lavage (EIPL) with IIPC showed a significant improvement in overall survival (5-year overall survival, 43.8% for EIPL-IPC group compared with 4.6% for IPC group). However, these promising results need to be validated in larger prospective randomized trials.
Topics: Administration, Oral; Antineoplastic Combined Chemotherapy Protocols; Drug Combinations; Humans; Intraoperative Period; Neoadjuvant Therapy; Neoplasm Recurrence, Local; Oxonic Acid; Peritoneal Lavage; Stomach Neoplasms; Tegafur; Treatment Outcome
PubMed: 24890254
DOI: 10.1007/s10120-014-0388-5 -
Surgical Oncology Jun 2013Free intraperitoneal tumour cells are an independent indicator of poor prognosis, and are encorporated in current staging systems in upper gastrointestinal cancers, but... (Review)
Review
BACKGROUND
Free intraperitoneal tumour cells are an independent indicator of poor prognosis, and are encorporated in current staging systems in upper gastrointestinal cancers, but not colorectal cancer. This systematic review aimed to evaluate the role and prognostic significance of positive peritoneal lavage in colorectal cancer.
METHODS
A search was undertaken of PUBMED/Medline and Cochrane databases for English language articles from 1990 to 2012 using a predefined search strategy. Both detection of free tumour cells and/or detection of tumour-associated antigens in peritoneal lavage fluid were considered a positive lavage. Primary endpoints were rates of positive lavage, recurrence and survival.
RESULTS
Of 3805 articles identified by title, 18 met inclusion criteria (n = 3197 patients, 59.5% colon, 40.5% rectal cancer). There was heterogeneity across studies in method of detection of peritoneal disease with 7 studies using more than one method (conventional cytology (14 studies), immunological techniques (6 studies), molecular techniques (4 studies)). The rate of positive lavage varied from 2.1% to 52% across studies, with a weighted mean rate of positive lavage of 13.17% overall (95% CI 12.74-13.59). In 10 studies (n = 2017) positive peritoneal lavage was associated with worse survival, and with increased recurrence in 12 (n = 2371). Clinicopathological factors frequently associated with positive lavage included macroscopic peritoneal disease, increasing tumour stage and nodal disease.
CONCLUSION
Positive peritoneal lavage is a negative prognostic factor in colorectal cancer. However, its utility in staging colorectal cancer is currently limited by wide variation in rates of positive lavage between studies due to differences in methods of peritoneal lavage fluid analysis.
Topics: Colorectal Neoplasms; Humans; Neoplasm Metastasis; Peritoneal Neoplasms; Prognosis
PubMed: 23481599
DOI: 10.1016/j.suronc.2013.01.001 -
PancreasThe aims of this review were to determine whether positive peritoneal lavage cytology (CY+) precludes radical resection in pancreatic cancer and to propose prospections... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
The aims of this review were to determine whether positive peritoneal lavage cytology (CY+) precludes radical resection in pancreatic cancer and to propose prospections for future studies.
METHODS
MEDLINE, Embase, and Cochrane Central were searched for related articles. Dichotomous variables and survival outcomes were analyzed with the estimation of odds ratio and hazards ratio (HR), respectively.
RESULTS
A total of 4905 patients were included, of which 7.8% were CY+. Positive peritoneal lavage cytology was correlated with poor overall survival (univariate survival analysis [HR, 2.35; P < 0.00001]; multivariate analysis [HR, 1.62; P < 0.00001]), poor recurrence-free survival (univariate survival analysis [HR, 2.50; P < 0.00001]; multivariate analysis [HR, 1.84; P < 0.00001]), and higher initial peritoneal recurrence rate (odds ratio, 5.49; P < 0.00001).
CONCLUSIONS
Although CY+ predicts poor prognosis and a higher risk of peritoneal metastasis after curative resection, it is not sufficient to preclude curative resection based on the current evidence, and high-quality trials should be conducted to assess the prognostic impact of operation among resectable CY+ patients. In addition, more sensitive and accurate methods to detect peritoneal exfoliated tumor cells and more effective comprehensive treatment for resectable CY+ pancreatic cancer patients are clearly warranted.
Topics: Humans; Cytology; Peritoneum; Pancreatic Neoplasms; Peritoneal Lavage; Peritoneal Neoplasms; Prognosis; Retrospective Studies
PubMed: 37099766
DOI: 10.1097/MPA.0000000000002163 -
Injury Jun 2017Traumatic injuries to the lower gastrointestinal tract (rectum and anus) have been largely reported in the military setting with sparse publications from the civilian... (Review)
Review
INTRODUCTION
Traumatic injuries to the lower gastrointestinal tract (rectum and anus) have been largely reported in the military setting with sparse publications from the civilian setting. Additionally, there remains a lack of international consensus regarding definitive treatment pathways. This systematic review aimed to assess the current literature and propose a standardised treatment algorithm to aid management in the civilian setting.
METHODS
A systematic review of available literature from 1999 to 2016 that was performed. Primary endpoints were the assessment and surgical management of reported rectal and anal trauma.
RESULTS
Seven studies were included in this review, reporting on 1255 patients. 96.3% had rectal trauma and 3.7% had anal trauma. Gunshot wounds are the most common mechanism of injury (46.9%). The overwhelming majority of injuries occurred in males (>85%) and were associated with other pelvic injuries. Surgical management has substantially evolved over the last five decades, with no clear consensus on best management strategies.
CONCLUSION
There remains significant international discrepancy regarding the management of penetrating trauma to the rectum. Key management principals include the varying use of the direct primary closure, faecal diversion, pre-sacral drainage and/or distal rectal washout (rarely used). To date, there is sparse evidence regarding the management of penetrating anal trauma.
Topics: Algorithms; Anal Canal; Clinical Protocols; Digestive System Surgical Procedures; Drainage; Emergency Medicine; Fecal Incontinence; Humans; Peritoneal Lavage; Practice Guidelines as Topic; Proctoscopy; Rectum; Wounds, Penetrating
PubMed: 28292518
DOI: 10.1016/j.injury.2017.03.002 -
The British Journal of Surgery May 2017Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a minimally invasive approach under investigation as a novel treatment for patients with peritoneal... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a minimally invasive approach under investigation as a novel treatment for patients with peritoneal carcinomatosis of various origins. The aim was to review the available evidence on mechanisms, clinical effects and risks.
METHODS
This was a systematic review of the literature on pressurized intraperitoneal chemotherapy published between January 2000 and October 2016. All types of scientific report were included.
RESULTS
Twenty-nine relevant papers were identified; 16 were preclinical studies and 13 were clinical reports. The overall quality of the clinical studies was modest; five studies were prospective and there was no randomized trial. Preclinical data suggested better distribution and higher tissue concentrations of chemotherapy agents in PIPAC compared with conventional intraperitoneal chemotherapy by lavage. Regarding technical feasibility, laparoscopic access and repeatability rates were 83-100 and 38-82 per cent. Surgery-related complications occurred in up to 12 per cent. Postoperative morbidity was low (Common Terminology Criteria for Adverse Events grade 3-5 events reported in 0-37 per cent), and hospital stay was about 3 days. No negative impact on quality of life was reported. Histological response rates for therapy-resistant carcinomatosis of ovarian, colorectal and gastric origin were 62-88, 71-86 and 70-100 per cent respectively.
CONCLUSION
PIPAC is feasible, safe and well tolerated. Preliminary good response rates call for prospective analysis of oncological efficacy.
Topics: Aerosols; Antineoplastic Agents; Carcinoma; Combined Modality Therapy; Epidemiologic Methods; Feasibility Studies; Humans; Peritoneal Neoplasms; Pressure; Quality of Life; Treatment Outcome
PubMed: 28407227
DOI: 10.1002/bjs.10521 -
Surgical Infections Apr 2013Over the past 20 years, there has been a global increase in the incidence and severity of group A streptococcal diseases. Primary group A streptococcal peritonitis is a... (Review)
Review
BACKGROUND
Over the past 20 years, there has been a global increase in the incidence and severity of group A streptococcal diseases. Primary group A streptococcal peritonitis is a life-threatening disease that may present in previously healthy individuals and progress to shock and severe organ dysfunction within a few hours. Our goal was to develop recommendations regarding the care of this group of patients.
METHODS
A systematic review of all adult cases of primary group A streptococcal peritonitis described in the English-language literature between January 1990 and December 2011.
RESULTS
Thirty-two patients with a median age at diagnosis of 38 years and a male:female ratio of 1:4 are described. Exploratory laparotomy was performed in 25 patients, 17 of whom had undergone abdominal computed tomography (CT). Laparoscopic peritoneal lavage was performed in five patients, and, in two patients, no operative interventions were undertaken.
CONCLUSION
The worrisome increase in invasive group A streptococcal disease means that presentations of primary group A streptococcal peritonitis are likely to become more common. The challenge for the treating surgeon is to consider the possibility of this diagnosis. In the current era of multi-detector CT technology, secondary peritonitis from an intra-abdominal source may be excluded reliably using abdominal CT. Exploratory laparotomy is not mandated, and paracentesis is sufficient to confirm the diagnosis and avoid operative morbidity in patients with localized intra-peritoneal fluid collections. Laparoscopic peritoneal lavage should be reserved for patients with widespread intra-peritoneal free fluid or whose condition deteriorates despite antibiotic therapy.
Topics: Adult; Aged, 80 and over; Female; Humans; Male; Middle Aged; Peritonitis; Streptococcal Infections; Streptococcus pyogenes
PubMed: 23464678
DOI: 10.1089/sur.2012.038 -
Diseases of the Colon and Rectum Mar 2020Acute diverticulitis is a common disease with public health significance. Many studies with a high level of evidence have been published recently on the surgical...
BACKGROUND
Acute diverticulitis is a common disease with public health significance. Many studies with a high level of evidence have been published recently on the surgical management of acute diverticulitis.
OBJECTIVE
The aim of this systematic review was to define the accurate surgical management of acute diverticulitis.
DATA SOURCES
Medline, Embase, and the Cochrane Library were sources used.
STUDY SELECTION
One reviewer conducted a systematic study with combinations of key words for the disease and the surgical procedure. Additional studies were searched in the reference lists of all included articles. The results of the systematic review were submitted to a working group composed of 13 practitioners. All of the conclusions were obtained by full consensus and validated by an external committee.
INTERVENTIONS
The interventions assessed were laparoscopic peritoneal lavage, primary resection with anastomosis with or without ileostomy, and the Hartmann procedure, with either a laparoscopic or an open approach.
MAIN OUTCOME MEASURES
Morbidity, mortality, long-term stoma rates, and quality of life were measured.
RESULTS
Seventy-one articles were included. Five guidelines were retrieved, along with 4 meta-analyses, 14 systematic reviews, and 5 randomized controlled trials that generated 8 publications, all with a low risk of bias, except for blinding. Laparoscopic peritoneal lavage showed concerning results of deep abscesses and unplanned reoperations. Studies on Hinchey III/IV diverticulitis showed similar morbidity and mortality. A reduced length of stay with Hartmann procedure compared with primary resection with anastomosis was reported in the short term, and in the long term, more definite stoma along with poorer quality of life was reported with Hartmann procedure. No high-quality data were found to support the laparoscopic approach.
LIMITATIONS
Trials specifically assessing Hinchey IV diverticulitis have not yet been completed.
CONCLUSIONS
High-quality studies showed that laparoscopic peritoneal lavage was associated with an increased morbidity and that Hartmann procedure was associated with poorer long-term outcomes than primary resection with anastomosis with ileostomy, but Hartmann procedure is still acceptable, especially in high-risk patients.
Topics: Acute Disease; Anastomosis, Surgical; Digestive System Surgical Procedures; Diverticulitis; Emergencies; Humans; Laparoscopy; Peritoneal Lavage
PubMed: 30694823
DOI: 10.1097/DCR.0000000000001327 -
The Journal of Obstetrics and... Sep 2021To determine whether hysteroscopy (HSC) increases the risk of intraperitoneal dissemination in endometrial cancer patients. (Meta-Analysis)
Meta-Analysis Review
AIM
To determine whether hysteroscopy (HSC) increases the risk of intraperitoneal dissemination in endometrial cancer patients.
METHODS
We conducted a comprehensive review of multiple databases. Quality assessments of eligible studies were performed using the Newcastle-Ottawa and Jadad scales. Positive peritoneal cytology (PPC) as the outcome of interest was compared between endometrial cancer patients with and without HSC. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated as a measure of effects.
RESULTS
Three case-control studies and eight retrospective cohort studies included 3364 patients, of whom 1116 underwent preoperative HSC, which resulted in a significantly higher PPC rate (OR, 1.82; 95% CI, 1.31-2.54; p = 0.0004). I was 11%, and the heterogeneity was acceptable. The difference between the groups with stages I-II was statistically insignificant (OR, 1.50; 95% CI, 0.75-2.99; p = 0.25). When liquid was used as the uterine distension medium during HSC and the intrauterine pressure was controlled under 80 mmHg, the difference between the two groups was also insignificant (OR, 1.18; 95% CI, 0.50-2.79; p = 0.71). However, when the intrauterine pressure exceeded 80 mmHg, the difference between the two groups was statistically significant (OR, 2.18; 95% CI, 1.28-3.73; p = 0.004).
CONCLUSION
This meta-analysis indicates that preoperative HSC in patients with endometrial cancer may increase the risk of intraperitoneal dissemination of malignant cells, which may be associated with intrauterine pressure >80 mmHg but not with stages I-II. There is no reason to avoid HSC for the diagnosis of endometrial cancer, especially in early stages, but intrauterine pressure should possibly be controlled below 80 mmHg.
Topics: Endometrial Neoplasms; Endometrium; Female; Humans; Hysteroscopy; Peritoneum; Pregnancy; Retrospective Studies
PubMed: 34155733
DOI: 10.1111/jog.14897