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BMC Surgery Aug 2023Preventive colostomy is required for colorectal surgery, and the incidence of complications associated with ileostomy and colostomy remains controversial. This study... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Preventive colostomy is required for colorectal surgery, and the incidence of complications associated with ileostomy and colostomy remains controversial. This study aimed to compare the incidence of postoperative complications between ileostomy and colostomy procedures.
METHODS
Data analysis was conducted on 30 studies, and meta-analysis and trial sequential analysis (TSA) were performed on five studies. The basic indicators, such as stoma prolapse, leak, wound infection, ileus, and a series of other indicators, were compared.
RESULTS
No statistically significant differences were observed with complications other than stoma prolapse. Meta-analysis and TSA showed that the incidence of ileostomy prolapse was lower than that of colostomy prolapse, and the difference was statistically significant. Apart from the four complications listed above, the general data analysis showed differences in incidence between the two groups. The incidence of skin irritation, parastomal hernia, dehydration, pneumonia, and urinary tract infections was higher with ileostomy than with colostomy. In contrast, the incidence of parastomal fistula, stenosis, hemorrhage, and enterocutaneous fistula was higher with colostomy than with ileostomy.
CONCLUSIONS
There were differences in the incidence of ileostomy and colostomy complications in the selected studies, with a low incidence of ileostomy prolapse.
PROSPERO REGISTRATION NUMBER
CRD42022303133.
Topics: Humans; Colostomy; Ileostomy; Anastomosis, Surgical; Postoperative Complications; Prolapse
PubMed: 37568176
DOI: 10.1186/s12893-023-02129-w -
Annals of Medicine and Surgery (2012) Aug 2023Although conventional septoplasty is widely used to treat nasal septum deviation, it increases morbidity due to poor visualization, poor illumination, the need for nasal...
UNLABELLED
Although conventional septoplasty is widely used to treat nasal septum deviation, it increases morbidity due to poor visualization, poor illumination, the need for nasal packing, and difficulty in evaluating of the exact pathology. These drawbacks are also encountered in endoscopic septoplasty. Our study aimed to compare the treatment and complication outcomes of conventional and endoscopic septoplasty.
METHODS
The authors searched five electronic databases for relevant clinical trials. The records were screened for eligibility. Data were extracted from the included studies. Outcomes were pooled as risk ratios (RR) or mean differences with 95% CIs using RevMan ver.5.4.
RESULTS
Our study included 13 randomized clinical trials with 735 patients. Our analysis revealed that endoscopic septoplasty was significantly (<0.05) superior to conventional septoplasty for postoperative nasal obstruction relief, intraoperative and postoperative hemorrhage, and mucosal adhesion and synechiae across both long-term and short-term follow-ups. The following pooled RR values were found in short-term follow-up periods: [RR=1.20, 95% CI:=(1.09,1.32)]; [RR=0.27, 95% CI=(0.14,0.54)]; and [RR=0.16, 95% CI=(0.08,0.32)], respectively. Regarding persistent septal deviation and septal tear, endoscopic septoplasty had the upper hand only in short-term follow-up periods [RR=0.30, 95% CI=(0.17,0.53)] and [RR=0.26, 95% CI=(0.15,0.46)], respectively.
CONCLUSION
Our analysis revealed that endoscopic septoplasty was significantly superior to conventional septoplasty in postoperative nasal obstruction relief rate and reducing the risk of intraoperative and postoperative hemorrhage, mucosal adhesion and synechiae, persistent septal deviation, septal tear, and surgery duration.
PubMed: 37554910
DOI: 10.1097/MS9.0000000000000984 -
Annals of Surgery Feb 2024To provide procedure-specific estimates of symptomatic venous thromboembolism (VTE) and major bleeding after abdominal surgery. (Meta-Analysis)
Meta-Analysis
Systematic Reviews and Meta-analyses of the Procedure-specific Risks of Thrombosis and Bleeding in General Abdominal, Colorectal, Upper Gastrointestinal, and Hepatopancreatobiliary Surgery.
OBJECTIVE
To provide procedure-specific estimates of symptomatic venous thromboembolism (VTE) and major bleeding after abdominal surgery.
BACKGROUND
The use of pharmacological thromboprophylaxis represents a trade-off that depends on VTE and bleeding risks that vary between procedures; their magnitude remains uncertain.
METHODS
We identified observational studies reporting procedure-specific risks of symptomatic VTE or major bleeding after abdominal surgery, adjusted the reported estimates for thromboprophylaxis and length of follow-up, and estimated cumulative incidence at 4 weeks postsurgery, stratified by VTE risk groups, and rated evidence certainty.
RESULTS
After eligibility screening, 285 studies (8,048,635 patients) reporting on 40 general abdominal, 36 colorectal, 15 upper gastrointestinal, and 24 hepatopancreatobiliary surgery procedures proved eligible. Evidence certainty proved generally moderate or low for VTE and low or very low for bleeding requiring reintervention. The risk of VTE varied substantially among procedures: in general abdominal surgery from a median of <0.1% in laparoscopic cholecystectomy to a median of 3.7% in open small bowel resection, in colorectal from 0.3% in minimally invasive sigmoid colectomy to 10.0% in emergency open total proctocolectomy, and in upper gastrointestinal/hepatopancreatobiliary from 0.2% in laparoscopic sleeve gastrectomy to 6.8% in open distal pancreatectomy for cancer.
CONCLUSIONS
VTE thromboprophylaxis provides net benefit through VTE reduction with a small increase in bleeding in some procedures (eg, open colectomy and open pancreaticoduodenectomy), whereas the opposite is true in others (eg, laparoscopic cholecystectomy and elective groin hernia repairs). In many procedures, thromboembolism and bleeding risks are similar, and decisions depend on individual risk prediction and values and preferences regarding VTE and bleeding.
Topics: Humans; Anticoagulants; Colorectal Neoplasms; Hemorrhage; Postoperative Complications; Thrombosis; Venous Thromboembolism
PubMed: 37551583
DOI: 10.1097/SLA.0000000000006059 -
Asian Journal of Surgery Aug 2023This meta-analysis aimed to assess whether administration tranexamic acid (TXA) could reduce blood loss and vascular events in patients undergoing unicompartmental knee... (Meta-Analysis)
Meta-Analysis Review
This meta-analysis aimed to assess whether administration tranexamic acid (TXA) could reduce blood loss and vascular events in patients undergoing unicompartmental knee arthroplasty (UKA). We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and case control trials (CCT) that compared outcomes of patients who did and did not receive TXA during UKA. We searched Cochrane Central Register of including PubMed, EMBASE, Web of Science, the Cochrane Library, Wan Fang data, CBM and CNKI for relevant studies. We assessed the risk of bias of the included studies and calculated pooled risk estimates. The primary outcome was operation time, intraoperative blood loss, postoperative HCT, postoperative HB, transfusion rate, dominant blood loss, postoperative drainage volume, hidden blood loss, total blood loss, postoperative ROM,postoperative VAS score, postoperative complications. Data were using fixed-effects or random-effects models with standard mean differences and risk ratios for continuous and dichotomous variables, respectively. Finally, 9 clinical studies with 744 patients were included in this meta-analysis. Compared with the control group, TXA group could reduced transfusion rate, dominant blood loss, postoperative drainage volume, hidden blood loss, and total blood loss, and increased postoperative HB with statistically significance. The main findings of this meta-analysis are that the transfusion rate, dominant blood loss, postoperative drainage volume, hidden blood loss, total blood loss and postoperative HB in the tranexamic acid group were superior to those in the routine group. Additional high-quality RCTs should be conducted in the future.
Topics: Humans; Tranexamic Acid; Antifibrinolytic Agents; Arthroplasty, Replacement, Knee; Blood Loss, Surgical; Postoperative Hemorrhage
PubMed: 36396576
DOI: 10.1016/j.asjsur.2022.10.078