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World Journal of Surgery Aug 2017To investigate the outcome of laparoscopic repair of duodenal atresia (LRDA) in relation to different approaches with regard to suture material and anastomosis... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To investigate the outcome of laparoscopic repair of duodenal atresia (LRDA) in relation to different approaches with regard to suture material and anastomosis technique. To identify evidence for the safety and efficacy of LRDA compared with the conventional open repair.
METHODS
Systematic search was performed for all studies on LRDA, excluding case reports, and all comparative studies between LRDA and open repair. Chi-square was used to assess associations between complications or conversions rates and different LRDA approaches (suture material, suturing technique). Meta-analysis was employed to compare LRDA and open repair.
RESULTS
The complications and conversions rates of LRDA were not affected by the different suture materials (Silk, Vicryl, PDS; p = 0.51) or suturing technique (interrupted, continuous; p = 0.46). The meta-analysis did not show significant differences between LRDA and open repair in overall complications rate (p = 0.88), time to feeds (p = 0.12) and hospitalization time (p = 0.28), although it revealed longer operative time with LRDA (p < 0.0001).
CONCLUSIONS
LRDA shows comparable safety and efficacy with the open repair, although it is associated with significantly longer operative time. There is no evidence that the type of the suture material or anastomotic technique affects the outcome of LRDA.
Topics: Anastomosis, Surgical; Conversion to Open Surgery; Duodenal Obstruction; Duodenum; Female; Humans; Intestinal Atresia; Laparoscopy; Operative Time; Suture Techniques; Sutures
PubMed: 28258456
DOI: 10.1007/s00268-017-3937-3 -
Arthroplasty (London, England) Mar 2020The aim of this systematic review and meta-analysis was to evaluate the efficacy of barbed versus conventional sutures in total knee arthroplasty. (Review)
Review
OBJECTIVE
The aim of this systematic review and meta-analysis was to evaluate the efficacy of barbed versus conventional sutures in total knee arthroplasty.
METHODS
Two investigators independently performed data extraction and assessed study quality using the keywords "barbed suture, wound suture, total knee arthroplasty" in two search trials, individual trials, and trials from Systematic Reviews or Meta-analyses in PubMed, Cochrane Library, Web of Science, and EMBASE databases.
RESULT
A total of 11 articles (involving 1546 total knee arthroplasties) were included in this study. Comparison was made between barbed and conventional sutures in terms of various measures. No significant differences were identified in superficial infection and deep infection (p > 0.51; odds ratio 0.84 [95% confidence interval, 0.50, 1.4] and p > 0.28; odds ratio 0.50 [95% confidence interval, 0.14, 1.75], respectively). There was no significant difference in time for capsular suture (p < 0.05; odds ratio - 4.05 [95% confidence interval, - 4.39, - 3.71]). There existed no significant differences in Hospital for Special Surgery Knee Score and Knee Society Score (p > 0.05; odds ratio - 1.20 [95% confidence interval, - 2.98, 0.58] and p > 0.05; odds ratio - 1.62 [95% confidence interval, - 4.06, 0.18], respectively). No significant differences were revealed in suture breakage and needle stick injury (p < 0.05; odds ratio 36.51 [95% confidence interval, 7.06, 188.72] and p < 0.05; odds ratio 0.16 [95% confidence interval, 0.04, 0.72], respectively). No significant difference was exhibited in dehiscence (p = 0.99; odds ratio 0.99 [95% confidence interval, 0.41, 2.38]).
CONCLUSION
In total knee arthroplasty, both barbed and conventional sutures yielded similar results in terms of superficial and deep infection, Hospital for Special Surgery Knee Score, Knee Society Score, and wound dehiscence. Barbed suture was associated with higher incidence of suture breakage, shorter suture time, and less needle stick injury.
PubMed: 35236431
DOI: 10.1186/s42836-020-00028-6 -
Langenbeck's Archives of Surgery Jul 2023Incisional hernia (IH) is the main complication after laparotomy. In an attempt to reduce this complication, mesh techniques and studies in which the closure technique... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Incisional hernia (IH) is the main complication after laparotomy. In an attempt to reduce this complication, mesh techniques and studies in which the closure technique is modified have been proposed. Both types are characterized by comparison with the closure described as standard or conventional: 1 × 1, mass, and continuous closure. For this study, modified closure techniques (MCTs) were considered as those techniques in which an extra suture is placed (reinforced tension line (RTL), retention), the closure point is modified in distance (small bites) or shape (CLDC, Smead Jones, interrupted, Cardiff point) and which aim to reduce these complications. The objective of this network meta-analysis (NMA) was to evaluate the effectiveness of MCTs for reducing the incidence of IH and abdominal wound dehiscence (AWD) to provide objective support for their recommendation.
METHODS
An NMA was performed according to the PRISMA-NMA guidelines. The primary objective was to determine the incidence of IH and AWD, and the secondary objective was to determine the incidence of postoperative complications. Only published clinical trials were included. The risk of bias was analyzed, and the random-effects model was used to determine statistical significance.
RESULTS
Twelve studies comparing 3540 patients were included. The incidence of HI was lower in RTL, retention suture, and small bites, these techniques showed statistical differences with pooled ORs (95% CI) of 0.28 (0.09-0.83), 0.28 (0.13-0.62), and 0.44 (0.31-0.62), respectively. Associated complications, including hematoma, seroma, and postoperative pain, could not be analyzed; however, MCTs did not increase the risk of surgical site infection.
CONCLUSION
Small bites, RTL, and retention sutures decreased the prevalence of IH. RTL and retention suture decreased the prevalence of AWD. RTL was the best technique as it reduced both complications (IH and AWD) and had the best SUCRA and P-scores, and the number needed to treat (NNT) for net effect was 3.
REGISTRATION
This study was prospectively registered in the PROSPERO database under registration number CRD42021231107.
Topics: Humans; Incisional Hernia; Laparotomy; Network Meta-Analysis; Suture Techniques; Abdomen; Abdominal Injuries; Sutures; Abdominal Wound Closure Techniques; Surgical Wound Dehiscence
PubMed: 37418033
DOI: 10.1007/s00423-023-02954-w -
BMJ Clinical Evidence Apr 2011Over 85% of women having a vaginal birth suffer some perineal trauma. Spontaneous tears requiring suturing are estimated to occur in at least a third of women in the UK... (Review)
Review
INTRODUCTION
Over 85% of women having a vaginal birth suffer some perineal trauma. Spontaneous tears requiring suturing are estimated to occur in at least a third of women in the UK and US, with anal sphincter tears in 0.5% to 7% of women. Perineal trauma can lead to long-term physical and psychological problems.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of intrapartum surgical and non-surgical interventions on rates of perineal trauma? What are the effects of different methods and materials for primary repair of first- and second-degree tears and episiotomies? What are the effects of different methods and materials for primary repair of obstetric anal sphincter injuries (third- and fourth-degree tears)? We searched: Medline, Embase, The Cochrane Library, and other important databases up to March 2010 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 38 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: active pushing, spontaneous pushing, and sustained breath-holding (Valsalva) method of pushing; continuous support during labour; conventional suturing; different methods and materials for primary repair of obstetric anal sphincter injuries; episiotomies (midline and mediolateral incisions); epidural analgesia; forceps; methods of delivery ("hands-on" method, "hands poised"); water births; non-suturing of muscle and skin (or perineal skin alone); passive descent in the second stage of labour; positions (supine or lithotomy positions, upright position during delivery); restrictive or routine use of episiotomy; sutures (absorbable synthetic sutures, catgut sutures, continuous sutures, interrupted sutures); and vacuum extraction.
Topics: Analgesia, Epidural; Humans; Labor, Obstetric; Parturition; Perineum; Suture Techniques; Sutures; Vacuum Extraction, Obstetrical; Wound Healing
PubMed: 21481287
DOI: No ID Found -
World Journal of Surgery Apr 2016Today, ventral hernia repair is predominantly performed with meshes. There is no meta-analysis of high quality evidence that compares the results of suture to mesh... (Comparative Study)
Comparative Study Meta-Analysis Review
BACKGROUND
Today, ventral hernia repair is predominantly performed with meshes. There is no meta-analysis of high quality evidence that compares the results of suture to mesh repair. The objective of this systematic review with meta-analysis is to compare patient centred outcomes of suture versus mesh repair.
METHODS
A systematic literature search was performed in EMBASE, MEDLINE and CENTRAL (inception to 06/2014). Furthermore a hand search was performed. RCTs comparing suture versus mesh repair in primary and incisional ventral hernia repair were included. Data on patient characteristics, interventions and results were extracted in standardized tables. Risk of bias was assessed with the cochrane risk of bias tool. Results of studies were pooled with a meta-analysis. All steps were performed by two reviewers. Discrepancies were discussed until a consensus.
RESULTS
The search in the databases resulted in 1560 hits. After screening, 10 randomized controlled trials including 1215 patients satisfied all inclusion criteria. Risk of bias was moderate to high. The relative risk for recurrence was 0.36 [95% CI (0.27, 0.49); I (2) = 0; heterogeneity p = 0.70]. Other complications did not differ significantly. Results for chronic pain were heterogeneous across studies.
CONCLUSION
Mesh repair reduces the number of recurrences significantly. In patients without recurrence mesh repairs seem to be associated with a risk of chronic pain especially if the mesh is fixed sublay.
Topics: Chronic Pain; Hernia, Ventral; Herniorrhaphy; Humans; Incisional Hernia; Pain, Postoperative; Patient Outcome Assessment; Postoperative Complications; Recurrence; Surgical Mesh; Sutures
PubMed: 26563217
DOI: 10.1007/s00268-015-3311-2 -
Acta Obstetricia Et Gynecologica... Dec 2023Iatrogenic bladder injury is a rare complication following obstetric and gynecologic surgery and only sparse information is available regarding length of transurethral... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Iatrogenic bladder injury is a rare complication following obstetric and gynecologic surgery and only sparse information is available regarding length of transurethral catheterization following injuries, suturing techniques including choice of suture, and complications. The primary aim of this systematic review was to evaluate length of transurethral catheterization in relation to complications following iatrogenic bladder injury. Second, we aimed to evaluate the number of complications following repair of iatrogenic bladder injuries and to describe suture technique and best choice of suture.
MATERIAL AND METHODS
A systematic review and meta-analysis was conducted, and the results were presented in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Embase, and Medline electronic databases were searched, and followed by screening from two independent reviewers. Studies published between January 2000 and March 2023 describing methods of bladder injury repair following obstetric or gynecologic benign surgery were included. Data extraction was done using Covidence. We performed a meta-analysis on complications after repair and explored this with a meta-regression analysis (Metafor package R) on length of catheterization to determine if length of catheterization influenced the risk of complication. A risk of bias tool from Cochrane was used to assess risk of bias and the study was registered in PROSPERO (CRD42021290586).
RESULTS
Out of 2175 articles, we included 21 retrospective studies, four prospective studies, and one case-control study. In total, 595 bladder injuries were included. Cesarean section was the most prominent surgery type, followed by laparoscopically assisted vaginal hysterectomy. We found no statistically significant association between length of transurethral catheterization and numbers of complications following repair of iatrogenic bladder injuries. More than 90% of injuries were recognized intraoperatively. Approximately 1% had complications following iatrogenic bladder injury repair (0.010, 95% confidence interval 0.0015-0.0189, 26 studies, 595 participants, I = 4%).
CONCLUSIONS
Our review did not identify conclusive evidence on the length of postoperative catheterization following bladder injury warranting further research. However, the rate of complications was low following iatrogenic bladder injury with a wide range of repair approaches.
Topics: Female; Humans; Pregnancy; Urinary Bladder; Cesarean Section; Retrospective Studies; Case-Control Studies; Prospective Studies; Urinary Bladder Diseases; Obstetric Surgical Procedures; Iatrogenic Disease
PubMed: 37552010
DOI: 10.1111/aogs.14641 -
Orthopaedic Journal of Sports Medicine Nov 2022In conventional double-row repair for rotator cuff tears, tying the medial row of anchor sutures can strangulate the tendon. The knotless medial row technique has been... (Review)
Review
BACKGROUND
In conventional double-row repair for rotator cuff tears, tying the medial row of anchor sutures can strangulate the tendon. The knotless medial row technique has been recommended to improve vascularity and reduce retear rates. The researchers divided the retear pattern into 2 categories: type 1 (failure at the tendon-bone interface) and type 2 (failure at the musculotendinous junction with healed footprint).
PURPOSE
To compare studies on knot-tying versus knotless double-row repair for rotator cuff tears according to retear type and clinical and radiological outcomes.
STUDY DESIGN
Systematic review; Level of evidence, 3.
METHODS
A search of the PubMed, Embase, Scopus, and Cochrane databases was performed following the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included were studies that directly compared the knot-tying and knotless double-row techniques and provided postoperative patient-reported outcomes and retear rates. The Methodology Index for Non-Randomized Studies (MINORS) criteria were used for methodological quality assessment of the included studies. Odds ratios (ORs) were calculated for dichotomous outcomes, and mean differences (MDs) were calculated for continuous outcomes.
RESULTS
Included were 12 studies (n = 1411 shoulders); 1 study had level 1 evidence, 3 studies had level 2 evidence, and 8 studies had level 3 evidence. The MINORS score ranged from 15 to 19, indicating that the methodology was fair to good. There was no statistically significant difference in retear rate between techniques (OR, 0.99; 95% CI, 0.67-1.47; = .96); however, more type 1 retears were seen in the knotless technique (OR, 0.42; 95% CI, 0.23-0.77; = .005), and more type 2 retears were seen in the knot-tying technique (OR, 3.15; 95% CI, 1.70-5.83; = .0003). Higher postoperative Constant scores were seen in the knot-tying technique (MD, 1.28; 95% CI, 0.03-2.53; = .04); however, there were no significant differences between techniques regarding other postoperative outcomes.
CONCLUSION
There was no significant difference in overall retear rates between the knotless and knot-tying techniques, and both techniques demonstrated similar clinical outcomes. However, type 2 retear rates were significantly greater after knot-tying repair, and type 1 retear rates were significantly greater after knotless repair.
PubMed: 36452341
DOI: 10.1177/23259671221135604 -
Journal of Traditional Chinese Medicine... Dec 2022To systematically review and analyze the effect of acupuncture and acupoint catgut embedding in treatment of abdominal obesity to provide a more reasonable clinical... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To systematically review and analyze the effect of acupuncture and acupoint catgut embedding in treatment of abdominal obesity to provide a more reasonable clinical treatment regimen.
METHODS
Ten databases were searched as of August 2022: the English databases PubMed, Embase, Cochrane Library, Web of Science, Wiley, and Scopus and the Chinese databases China National Knowledge Infrastructure Database, China Science and Technology Journal Database, Wanfang, and SinoMed/Chinese Biomedical Literature Database. Randomized controlled trials (RCTs) of acupuncture and acupoint catgut embedding as the main interventions to treat abdominal obesity were extracted. The investigators imported the citations into EndNote version X9.1 for deduplication, screening, extraction, and integration. The risk of bias in the included RCTs was assessed according to the Cochrane Handbook. RevMan 5.4 software was used to conduct a Meta-analysis of RCTs that met the inclusion criteria.
RESULTS
Thirteen RCTs (1069 patients) were included in this study, and the data of eleven RCTs (966 patients) were include in the Meta-analysis. The results showed that acupoint catgut embedding can significantly change the weight and waist circumference of patients with abdominal obesity when compared to sham acupuncture or no treatment [mean difference () = 2.32, 95% confidence interval () (1.88, 2.76), < 0.000 01], [ = 3.47, 95% (1.99, 4.94), < 0.000 01]. The change in hip circumference after acupuncture was also significant [ = 0.89, 95% (0.12, 1.66), = 0.02].
CONCLUSION
This study found that acupuncture and acupoint catgut embedding can effectively treat abdominal obesity, therefore, these interventions can be used as clinical supplements and alternative therapies. The diagnostic criteria of the existing studies and the intervention measures of the control group are not unified. It will be necessary to improve the clinical study protocols and expand the sample size to further validate the reliability of the results obtained of this study.
Topics: Humans; Catgut; Acupuncture Points; Obesity, Abdominal; Acupuncture Therapy; Obesity
PubMed: 36378041
DOI: 10.19852/j.cnki.jtcm.2022.06.002 -
BMC Musculoskeletal Disorders Sep 2023To preserve the meniscus's function, repairing the torn meniscus has become a common understanding. After which, the search for the ideal suture material is continuous.... (Meta-Analysis)
Meta-Analysis
BACKGROUND
To preserve the meniscus's function, repairing the torn meniscus has become a common understanding. After which, the search for the ideal suture material is continuous. However, it is still controversial about the efficacy of suture absorbability on meniscus healing.
METHODS
This review is designed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
INCLUSION CRITERIA
(1) Studies on meniscus repair; (2) Second-look arthroscopy was performed; (3) The meniscus was repaired by absorbable and non-absorbable sutures; (4) The healing condition of repaired meniscus via second-look arthroscopy was described.
EXCLUSION CRITERIA
(1) Animal studies, cadaveric studies, or in vitro research; (2) Meniscus transplantation; (3) Open meniscus repair; (4) Reviews, meta-analysis, case reports, letters, and comments; (5) non-English studies. MEDLINE, Embase, and Cochrane Database were searched up to October 2022. Risk of bias and methodology quality of included literature were assessed according to ROBINS-I and the modified Coleman Methodological Scale (MCMS). Descriptive analysis was performed, and meta-analysis was completed by RevMan5.4.1.
RESULTS
Four studies were included in the systematic review. Among them, three studies were brought into the meta-analysis, including 1 cohort study and 2 case series studies about 130 patients with meniscal tears combined with anterior cruciate ligament injury. Forty-two cases were repaired by absorbable sutures, and 88 were repaired by non-absorbable sutures. Using the fixed effect model, there was a statistical difference in the healing success rate between the absorbable and the non-absorbable groups [RR1.20, 95%CI (1.03, 1.40)].
CONCLUSION
In early and limited studies, insufficient evidence supports that non-absorbable sutures in meniscus repair surgery could improve meniscal healing success rate under second-look arthroscopy compared with absorbable sutures. In contrast, available data suggest that absorbable sutures have an advantage in meniscal healing.
TRIAL REGISTRATION
The review was registered in the PROSPERO System Review International Pre-Registration System (Registration number CRD42021283739).
Topics: Arthroscopy; Cohort Studies; Knee Injuries; Meniscus; Sutures; Humans
PubMed: 37684657
DOI: 10.1186/s12891-023-06602-8 -
Journal of Gynecology Obstetrics and... Oct 2022Cesarean section (CS) in obese women poses many surgical, anesthetic, and logistical challenges. This systematic review and meta-analysis aimed to compare the outcomes... (Meta-Analysis)
Meta-Analysis
AIM
Cesarean section (CS) in obese women poses many surgical, anesthetic, and logistical challenges. This systematic review and meta-analysis aimed to compare the outcomes between staples versus subcuticular suture for cesarean skin closure in obese women undergoing CS.
METHODS
PubMed, EMBASE and CENTRAL databases were searched for relevant articles using the keywords cesarean section, cesarean delivery, staple, suture, closure and obese. Randomized controlled trials (RCTs), prospective and retrospective studies comparing between staples and subcuticular suture for wound closure in obese women (BMI ≧ 30 kg/m2) were eligible for inclusion. Outcomes were composite wound complication, wound separation, infection and wound appearance satisfaction.
RESULTS
Four studies (two RCTs, one retrospective, one post hoc analysis of an RCT) met the inclusion criteria, with a total of 2,038 obese women undergoing CS, of whom 984 had wound closure by staples and 1,054 had wound closure by subcuticular suture. Pooled analysis did not show significant differences on the risk for composite wound complication, infection, wound appearance satisfaction score or wound separation between staples and sutures.
CONCLUSIONS
In obese women receiving CS, it appears there are no significant differences in wound complication, infection, satisfaction scores or wound separation between staples and subcuticular suture. These findings may help optimize risk stratification for obese CS patients. A larger study size meta-analysis is needed to confirm the findings.
Topics: Cesarean Section; Female; Humans; Obesity; Pregnancy; Randomized Controlled Trials as Topic; Surgical Wound Infection; Suture Techniques; Sutures
PubMed: 35688324
DOI: 10.1016/j.jogoh.2022.102420