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Langenbeck's Archives of Surgery Sep 2021The anatomy of the esophageal hiatus is altered during esophagogastric surgery with an increased risk of postoperative hiatus hernia (HH). The purpose of this article... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
The anatomy of the esophageal hiatus is altered during esophagogastric surgery with an increased risk of postoperative hiatus hernia (HH). The purpose of this article was to examine the current evidence on the surgical management and outcomes associated with HH after esophagogastric surgery for cancer.
MATERIALS AND METHODS
Systematic review and meta-analysis. Web of Science, PubMed, and EMBASE data sets were consulted.
RESULTS
Twenty-seven studies were included for a total of 404 patients requiring surgical treatment for HH after esophagogastric surgery. The age of the patients ranged from 35 to 85 years, and the majority were males (82.3%). Abdominal pain, nausea/vomiting, and dyspnea were the commonly reported symptoms. An emergency repair was required in 51.5%, while a minimally invasive repair was performed in 48.5%. Simple suture cruroplasty and mesh reinforced repair were performed in 65% and 35% of patients, respectively. The duration between the index procedure and HH repair ranged from 3 to 144 months, with the majority (67%) occurring within 24 months. The estimated pooled prevalence rates of pulmonary complications, anastomotic leak, overall morbidity, and mortality were 14.1% (95% CI = 8.0-22.0%), 1.4% (95% CI = 0.8-2.2%), 35% (95% CI = 20.0-54.0%), and 5.0% (95% CI = 3.0-8.0%), respectively. The postoperative follow-up ranged from 1 to 110 months (mean = 24) and the pooled prevalence of HH recurrence was 16% (95% CI = 13.0-21.6%).
CONCLUSIONS
Current evidence reporting data for HH after esophagogastric surgery is narrow. The overall postoperative pulmonary complications, overall morbidity, and mortality are 14%, 35%, and 5%, respectively. Additional studies are required to define indications and treatment algorithm and evaluate the best technique for crural repair at the index operation in an attempt to minimize the risk of HH.
Topics: Adult; Aged; Aged, 80 and over; Hernia, Hiatal; Herniorrhaphy; Humans; Laparoscopy; Male; Middle Aged; Postoperative Complications; Sutures; Treatment Outcome
PubMed: 34129106
DOI: 10.1007/s00423-021-02214-9 -
The American Journal of Sports Medicine Jan 2022Various suture materials are available for arthroscopic rotator cuff repair. More recently, suture tapes have become popular as they are perceived to be easier to use... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Various suture materials are available for arthroscopic rotator cuff repair. More recently, suture tapes have become popular as they are perceived to be easier to use with less soft tissue irritation. However, little is known about their biomechanical and clinical properties compared with conventional sutures in rotator cuff repairs.
PURPOSE
To perform a systematic review and meta-analysis on whether suture tapes are biomechanically superior to conventional sutures in arthroscopic rotator cuff repairs and whether this translates to superior functional outcomes and a lower incidence of retears.
STUDY DESIGN
Meta-analysis.
METHODS
The Cochrane Controlled Register of Trials, PubMed, Medline, and Embase were used to perform a systematic review and meta-analysis using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria with the following search terms: (rotator cuff repair OR arthroscopic rotator cuff repair) AND ("tape" OR "wire" OR "cord" OR "suture"). Data pertaining to certain biomechanical properties (contact area, contact pressure, gap formation, load to failure, and stiffness), retears, and patient-reported outcome measures (PROMs) were extracted. The pooled outcome data were analyzed by random- and fixed-effects models.
RESULTS
After abstract and full-text screening, 7 biomechanical and 6 clinical studies were included. All biomechanical studies were on animals, with 91 suture tapes and 91 conventional sutures compared. Suture tapes had higher contact pressure (mean difference [MD], 0.04 MPa; 95% CI, 0.01-0.08; = .02), higher load to failure (MD, 52.62 N; 95% CI, 27.34-77.90; < .0001), greater stiffness (MD, 4.47 N/mm; 95% CI, 0.57-8.38; = .02), and smaller gap formation (MD, -0.30 mm; 95% CI, -0.45 to -0.15; < .0001) compared with conventional sutures. From the clinical analysis of the 681 rotator cuff repairs treated with a suture tape (n = 380) or conventional suture (n = 301), there were no differences in retear rates between the groups (16% vs 20% suture tape and wire, respectively; = .26) at a mean of 11.2 months. Qualitatively, there were no differences in PROMs between the groups at a mean of 36.8 months.
CONCLUSION
Although biomechanically superior, suture tapes showed similar retear rates and postoperative function to conventional sutures. However, higher-quality clinical studies are required to investigate whether there are no true differences.
Topics: Animals; Arthroscopy; Humans; Rotator Cuff; Rotator Cuff Injuries; Suture Techniques; Sutures
PubMed: 33740395
DOI: 10.1177/0363546521998318 -
Annals of the Royal College of Surgeons... Feb 2020Anastomosis formation constitutes a critical aspect of many gastrointestinal procedures. Barbed suture materials have been adopted by some surgeons to assist in this... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Anastomosis formation constitutes a critical aspect of many gastrointestinal procedures. Barbed suture materials have been adopted by some surgeons to assist in this task. This systematic review and meta-analysis compares the safety and efficacy of barbed suture material for anastomosis formation compared with standard suture materials.
METHODS
An electronic search of Embase, Medline, Web of Science and Cochrane databases was performed. Weighted mean differences were calculated for effect size of barbed suture material compared with standard material on continuous variables and pooled odds ratios were calculated for discrete variables.
FINDINGS
There were nine studies included. Barbed suture material was associated with a significant reduction in overall operative time (WMD: -12.87 (95% CI = -20.16 to -5.58) ( = 0.0005)) and anastomosis time (WMD: -4.28 (95% CI = -6.80 to -1.75) ( = 0.0009)). There was no difference in rates of anastomotic leak (POR: 1.24 (95% CI = 0.89 to 1.71) ( = 0.19)), anastomotic bleeding (POR: 0.80 (95% CI = 0.29 to 2.16) ( = 0.41)), or anastomotic stricture (POR: 0.72 (95% CI = 0.21 to 2.41) ( = 0.59)).
CONCLUSIONS
Use of barbed sutures for gastrointestinal anastomosis appears to be associated with shorter overall operative times. There was no difference in rates of complications (including anastomotic leak, bleeding or stricture) compared with standard suture materials.
Topics: Anastomosis, Surgical; Anastomotic Leak; Constriction, Pathologic; Digestive System Surgical Procedures; Equipment Design; Humans; Operative Time; Postoperative Complications; Postoperative Hemorrhage; Suture Techniques; Sutures
PubMed: 31508982
DOI: 10.1308/rcsann.2019.0106 -
Aesthetic Plastic Surgery Jun 2015Despite popular use of fibrin sealants and quilting sutures for prevention of seroma formation at the donor site of the latissimus dorsi (LD) muscle flap, there is still... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Despite popular use of fibrin sealants and quilting sutures for prevention of seroma formation at the donor site of the latissimus dorsi (LD) muscle flap, there is still no consensus regarding their efficacy. The present review estimates the potential benefits of fibrin and quilting suture for reducing seroma-related morbidity following LD muscle harvest.
METHODS
Using Medline, Ovid, and Cochrane databases, two-arm studies evaluating the efficacy of fibrin sealants, quilting suture, or their combination for prevention of seroma formation following LD muscle transfer were searched. The outcome measure was the incidence of seroma, total drainage volume from the back, periods of drainage in situ, volume of seroma, and frequency of aspiration for treatment of seroma. The efficacy on reducing the seroma-related morbidity for each procedure was estimated by meta-analytic methodology.
RESULTS
Fourteen studies were analyzed. Fibrin alone failed to reduce seroma-related morbidities compared with no intervention, while fibrin instillation combined with quilting suture halved the risk of seroma formation (relative risk (RR): 0.51, 95 % CI 0.12-2.16) and significantly reduced total drainage volume (mean difference (MD); -320.80, 95 % CI -389.92 to -251.68) and drain indwelling periods (MD -1.62, 95 % CI -2.91 to -0.33) compared with quilting suture alone. Quilting suture had significant protective effects on reducing the risk of seroma formation (RR 0.38, 95 % CI 0.19-0.75), total drainage volume (MD -284.10, 95 % CI -474.61 to -93.60), and drain indwelling periods (MD -3.65, 95 % CI -5.43 to -1.87), and its efficacy was enhanced by combining with fibrin.
CONCLUSIONS
According to this review, both fibrin and quilting sutures contributed in varying degrees to reducing seroma-related morbidity following LD muscle transfer, and their combination can have a synergistic effect. Although large-scaled, randomized studies are needed, the combination of both procedures may be considered an effective option for minimizing the risk of seroma.
NO LEVEL ASSIGNED
This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Topics: Female; Fibrin Tissue Adhesive; Humans; Mammaplasty; Prospective Studies; Randomized Controlled Trials as Topic; Retrospective Studies; Seroma; Superficial Back Muscles; Suture Techniques; Sutures; Tissue and Organ Harvesting; Treatment Outcome; Wound Healing
PubMed: 25808821
DOI: 10.1007/s00266-015-0476-x -
BJU International Jun 2019To summarize the available evidence on renorrhaphy techniques and to assess their impact on peri-operative outcomes after minimally invasive partial nephrectomy (MIPN). (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To summarize the available evidence on renorrhaphy techniques and to assess their impact on peri-operative outcomes after minimally invasive partial nephrectomy (MIPN).
MATERIALS AND METHODS
A systematic review of the literature was performed in January 2018 without time restrictions, using MEDLINE, Cochrane and Web of Science databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement recommendations. Studies providing sufficient details on renorrhaphy techniques during laparoscopic or robot-assisted partial nephrectomy and comparative studies focused on peri-operative outcomes were included in qualitative and quantitative analyses, respectively.
RESULTS
Overall, 67 and 19 studies were included in the qualitative and quantitative analyses, respectively. The overall quality of evidence was low. Specific tumour features (i.e. size, hilar location, anatomical complexity, nearness to renal sinus and/or urinary collecting system), surgeon's experience, robot-assisted technology, as well as the aim of reducing warm ischaemia time and the amount of devascularized renal parenchyma preserved represented the key factors driving the evolution of the renorrhaphy techniques during MIPN over the past decade. Quantitative synthesis showed that running suture was associated with shorter operating and ischaemia time, and lower postoperative complication and transfusion rates than interrupted suture. Barbed suture had lower operating and ischaemia time and less blood loss than non-barbed suture. The single-layer suture technique was associated with shorter operating and ischaemia time than the double-layer technique. No comparisons were possible concerning renal functional outcomes because of non-homogeneous data reporting.
CONCLUSIONS
Renorrhaphy techniques significantly evolved over the years, improving outcomes. Running suture, particularly using barbed wires, shortened the operating and ischaemia times. A further advantage could derive from avoiding a double-layer suture.
Topics: Humans; Kidney Neoplasms; Laparoscopy; Nephrectomy; Robotic Surgical Procedures; Suture Techniques; Treatment Outcome
PubMed: 30216617
DOI: 10.1111/bju.14537 -
Journal of the American Academy of... May 2022
Topics: Humans; Suture Techniques; Sutures
PubMed: 33892012
DOI: 10.1016/j.jaad.2021.04.035 -
PloS One 2015Unidirectional barbed suture (UBS) has been widely used for surgery in recent years, especially for urethrovesical anastomosis (UVA) during robot-assisted radical... (Meta-Analysis)
Meta-Analysis Review
The Use of Unidirectional Barbed Suture for Urethrovesical Anastomosis during Robot-Assisted Radical Prostatectomy: A Systematic Review and Meta-Analysis of Efficacy and Safety.
BACKGROUND
Unidirectional barbed suture (UBS) has been widely used for surgery in recent years, especially for urethrovesical anastomosis (UVA) during robot-assisted radical prostatectomy (RARP). However, the efficacy and safety comparing it with conventional non-barbed suture (CS) for UVA is still controversial.
AIMS
The objective of this study is to assess the current evidence regarding the efficacy and safety of UBS compared with CS for UVA during RARP.
METHODS
We comprehensively searched PubMed, Embase, The Cochrane Library, SinoMed (Chinese) and other databases on Oct. 9, 2014 to conduct a systematic review and meta-analysis of all randomized controlled trials (RCTs) and other comparative studies evaluating these two types of suture. The outcome measures included anastomosis time operative time, posterior reconstruction (PR) time, postoperative leakage (PL) rate and continence rates at different time points (4-6 weeks, 3 months, 6-12 months) after surgery. Secondary outcomes included estimated blood loss (EBL) and length of catheterization (LOC).
RESULTS
Three RCTs and six observational studies including 786 cases were identified. Meta-analysis of extractable data showed that use of UBS could significantly reduce anastomosis time (weighted mean difference [WMD]:-3.98min; 95% confidence interval [CI], -6.02 -1.95; p = 0.0001), operative time (WMD:-10.06min; 95% CI, -15.45--4.67; p = 0.0003) and PR time (WMD:-0.93min; 95% CI, -1.52--0.34; p = 0.002). No significant difference was found in PL rate, EBL, LOC, or continence rates at 4-6 weeks, 3 months and 6-12 months after surgery.
CONCLUSIONS
Our meta-analysis indicates that UBS appears to be safe and efficient as CS for UVA during RARP with not only shorter anastomosis time, operative time, PR time, but also equivalent PL rate, EBL, LOC, and continence rates at 4-6 weeks, 3 months and 6-12 months after surgery. For the inherent limitations of the eligible studies, future more persuasive RCTs are needed to confirm and update our findings.
Topics: Anastomosis, Surgical; Humans; Male; Operative Time; Prostate; Prostatectomy; Prostatic Neoplasms; Robotics; Seminal Vesicles; Suture Techniques; Sutures; Treatment Outcome; Urethra
PubMed: 26135310
DOI: 10.1371/journal.pone.0131167 -
Annals of Plastic Surgery Apr 2023LeFort I osteotomy changes the morphology of the nose. The cinch suture has been proven to prevent the increase in nasal base and alar width. Different types of cinch... (Meta-Analysis)
Meta-Analysis
Comparison of the Effectiveness Between Conventional and Modified Cinch Suture Techniques in LeFort I Osteotomy: A Systematic Review and Meta-Analysis of Randomized Control Trials.
BACKGROUND
LeFort I osteotomy changes the morphology of the nose. The cinch suture has been proven to prevent the increase in nasal base and alar width. Different types of cinch sutures have been proposed. However, their effectiveness is unclear.
AIM AND OBJECTIVES
The aim of this study was to compare the surgical outcomes between conventional and modified cinch techniques through a systematic review and meta-analysis of randomized control trials (RCTs).
MATERIAL AND METHODS
We performed systematic search from Embase, PubMed, and the Cochrane Library according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement up to March 2021. The surgical techniques of different cinch sutures were reviewed, and the outcomes of nasal alar width and alar base width were compared between modified and conventional methods.
RESULTS
A total of 4 eligible RCTs were included in this meta-analysis. Pooled data showed no significant difference in alar base width change between modified and conventional methods (mean difference, -0.37; 95% confidence interval, -1.32 to 0.57; P = 0.44). Pooled data of 3 studies also showed no significant difference in nasal alar width change (mean difference, -0.11; 95% confidence interval, -1.18 to 0.95; P = 0.83).
CONCLUSION
Based on the current data pooled from the available RCTs, no significant difference was found between the conventional cinch technique and the modified technique.
Topics: Humans; Nasal Cartilages; Maxilla; Osteotomy, Le Fort; Nose; Suture Techniques
PubMed: 36752416
DOI: 10.1097/SAP.0000000000003354 -
JAMA Surgery May 2014More than 350,000 ventral hernias are repaired in the United States annually, of which 75% are primary ventral hernias (eg, umbilical or epigastric hernias). Despite the... (Comparative Study)
Comparative Study Meta-Analysis Review
IMPORTANCE
More than 350,000 ventral hernias are repaired in the United States annually, of which 75% are primary ventral hernias (eg, umbilical or epigastric hernias). Despite the volume, there is insufficient evidence to support the use of sutures vs mesh for primary ventral hernia repairs.
OBJECTIVE
To compare suture vs mesh repairs for 3 outcomes: hernia recurrence, surgical site infection (SSI), and seromas.
DATA SOURCES
Randomized controlled trials, case-control, and cohort studies were identified from OVID, PubMed, and reference lists from January 1, 1980, through June 1, 2012.
STUDY SELECTION
English-language studies with adult patients were eligible for review if there was mention of both suture and mesh techniques used during elective repair of a primary ventral hernia. Two study authors independently reviewed the 1492 articles originally identified and selected 9 for analysis. The Downs and Black 26-item checklist was used to critically assess the risk of bias.
DATA EXTRACTION
Year of publication, study design, inclusion and exclusion criteria, number of patients, follow-up duration, use of preoperative antibiotics, size of hernias repaired, age, body mass index (calculated as weight in kilograms divided by height in meters squared), American Society of Anesthesiologists grade, repair techniques, incidence of hernia recurrence, seroma, and SSI.
DATA EXTRACTION AND SYNTHESIS
Three separate univariate meta-analyses for each end point followed by a multivariate meta-analysis were performed. Across all 9 studies, there were 637 mesh repairs and 1145 suture repairs. The pooled mesh repairs demonstrated a 2.7% recurrence rate, 7.7% seroma rate, and 7.3% SSI rate The pooled suture repairs demonstrated an 8.2% recurrence rate, 3.8% seroma rate, and 6.6% SSI rate. On the basis of results from the multivariate meta-analysis, recurrences (log odds ratio , −1.04; 95% CI, −1.58 to −0.52) were more common with suture repair, whereas seromas (0.84; 0.27-1.41) and SSIs (0.65; 0.12-1.18) were more common with mesh repair.
CONCLUSIONS AND RELEVANCE
Mesh repair has a small reduction in recurrence rates compared with suture repairs for primary ventral hernias, but an increased risk of seroma and SSI was observed. Further high-quality studies are necessary to determine whether suture or mesh repair leads to improved outcomes for primary ventral hernias.
Topics: Adult; Case-Control Studies; Cohort Studies; Hernia, Ventral; Herniorrhaphy; Humans; Outcome Assessment, Health Care; Postoperative Complications; Randomized Controlled Trials as Topic; Secondary Prevention; Surgical Mesh; Suture Techniques
PubMed: 24554114
DOI: 10.1001/jamasurg.2013.5014 -
General Dentistry 2023The use of cyanoacrylate tissue adhesive for surgical wound closure has become increasingly popular in recent years and has shown efficacy. Therefore, the aim of this...
The use of cyanoacrylate tissue adhesive for surgical wound closure has become increasingly popular in recent years and has shown efficacy. Therefore, the aim of this systematic review was to compare the effectiveness of cyanoacrylate adhesive as a substitute for conventional suture placement after extraction of impacted third molars. The PubMed/MEDLINE, Scopus, Cochrane, and gray literature databases were searched for randomized or controlled prospective clinical trials published up to October 2022 that compared the use of cyanoacrylate adhesive and conventional silk suture in third molar surgeries. The risk of bias of each study was assessed using the RoB 2 tool (revised Cochrane risk of bias tool for randomized trials). Five randomized clinical trials with a total of 236 patients were included. The most commonly evaluated outcomes were pain and bleeding. The type of adhesive used varied and included ethyl-2-cyanoacrylate, isoamyl 2-cyanoacrylate, and a mixture of n-butyl cyanoacrylate and 2-octyl cyanoacrylate. Compared with 3-0 silk suture, cyanoacrylate tissue adhesive resulted in lower levels of postoperative pain in 3 studies and lower rates of bleeding in all 5 studies. Thus, cyanoacrylate can be a good substitute for silk sutures for wound closure in intraoral surgeries.
Topics: Humans; Tissue Adhesives; Molar, Third; Prospective Studies; Cyanoacrylates; Sutures; Silk; Randomized Controlled Trials as Topic
PubMed: 37595079
DOI: No ID Found