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Journal of Craniovertebral Junction &... 2024Anterior cervical discectomy and fusion (ACDF) is one of the most frequently performed cervical surgeries in the world, yet there have been several reported... (Review)
Review
BACKGROUND
Anterior cervical discectomy and fusion (ACDF) is one of the most frequently performed cervical surgeries in the world, yet there have been several reported complications.
OBJECTIVE
To determine the actual incidence of complications related to ACDF as well as any risk variables that may have been identified in earlier research.
METHODS
To evaluate the origin, presentation, natural history, and management of the risks and the complications, we conducted a thorough assessment of the pertinent literature. An evaluation of clinical trials and case studies of patients who experienced one or more complications following ACDF surgery was done using a PubMed, Cochrane Library, and Google Scholar search. Studies involving adult human subjects that were written in the English language and published between 2012 and 2022 were included in the search. The search yielded 79 studies meeting our criteria.
RESULTS
The overall rates of complications were as follows: Dysphagia 7.9%, psudarthrosis 5.8%, adjacent segment disease (ASD) 8.8%, esophageal perforations (EPs) 0.5%, graft or hardware failure 2.2%, infection 0.3%, recurrent laryngeal nerve palsy 1.7%, cerebrospinal fluid leak 0.8%, Horner syndrome 0.5%, hematoma 0.8%, and C5 palsy 1.9%.
CONCLUSION
Results showed that dysphagia was a common postoperative sequelae with bone morphogenetic protein use and a higher number of surgical levels being the major risk factors. Pseudarthrosis rates varied depending on the factors such as asymptomatic radiographic graft sinking, neck pain, or radiculopathy necessitating revision surgery. The incidence of ASD indicated no data to support anterior cervical plating as more effective than standalone ACDF. EP was rare but frequently fatal, with no correlation found between patient age, sex, body mass index, operation time, or number of levels.
PubMed: 38957769
DOI: 10.4103/jcvjs.jcvjs_168_23 -
Pediatric Surgery International Jul 2024To report our experience with laparoscopic repair of anterior congenital diaphragmatic hernia (CDH) using extracorporeal subcutaneous knot tying and to define recurrence...
PURPOSE
To report our experience with laparoscopic repair of anterior congenital diaphragmatic hernia (CDH) using extracorporeal subcutaneous knot tying and to define recurrence risk factors.
METHODS
This retrospective unicentric study included children who underwent laparoscopic repair of anterior CDH without patch, using extracorporeal knot tying of sutures passed through the full thickness of the abdominal wall (2013-2020). A systematic review of the literature with meta-analysis was performed using the MEDLINE database since 2000.
RESULTS
Eight children were included (12 months [1-183]; 10.6 kg [3.6-65]). Among the two patients with Down syndrome, one with previous cardiac surgery had a recurrence at 17 months postoperatively. In our systematic review (26 articles), among the 156 patients included, 10 had a recurrence (none with patch). Recurrence was statistically more frequent in patients with Down syndrome (19.4%) than without (2.5%) (p < 0.0001), and when absorbable sutures were used (50%) instead of non-absorbable sutures (5.3%) (p < 0.0001).
CONCLUSION
Laparoscopic repair of anterior CDH without patch was a safe and efficient surgical approach in our patients. The use of a non-absorbable prosthetic patch should be specifically discussed in anterior CDH associated with Down syndrome and/or in case of previous cardiac surgery to perform a diaphragmatic tension-free closure.
Topics: Humans; Hernias, Diaphragmatic, Congenital; Laparoscopy; Retrospective Studies; Infant; Recurrence; Herniorrhaphy; Male; Female; Child, Preschool; Child; Suture Techniques; Infant, Newborn; Adolescent; Down Syndrome; Risk Factors
PubMed: 38954216
DOI: 10.1007/s00383-024-05739-4 -
Journal of Neuroscience Research Jul 2024Increasing neuroimaging studies have attempted to identify biomarkers of Huntington's disease (HD) progression. Here, we conducted voxel-based meta-analyses of... (Meta-Analysis)
Meta-Analysis Review
Increasing neuroimaging studies have attempted to identify biomarkers of Huntington's disease (HD) progression. Here, we conducted voxel-based meta-analyses of voxel-based morphometry (VBM) studies on HD to investigate the evolution of gray matter volume (GMV) alterations and explore the effects of genetic and clinical features on GMV changes. A systematic review was performed to identify the relevant studies. Meta-analyses of whole-brain VBM studies were performed to assess the regional GMV changes in all HD mutation carriers, in presymptomatic HD (pre-HD), and in symptomatic HD (sym-HD). A quantitative comparison was performed between pre-HD and sym-HD. Meta-regression analyses were used to explore the effects of genetic and clinical features on GMV changes. Twenty-eight studies were included, comparing a total of 1811 HD mutation carriers [including 1150 pre-HD and 560 sym-HD] and 969 healthy controls (HCs). Pre-HD showed decreased GMV in the bilateral caudate nuclei, putamen, insula, anterior cingulate/paracingulate gyri, middle temporal gyri, and left dorsolateral superior frontal gyrus compared with HCs. Compared with pre-HD, GMV decrease in sym-HD extended to the bilateral median cingulate/paracingulate gyri, Rolandic operculum and middle occipital gyri, left amygdala, and superior temporal gyrus. Meta-regression analyses found that age, mean lengths of CAG repeats, and disease burden were negatively associated with GMV atrophy of the bilateral caudate and right insula in all HD mutation carriers. This meta-analysis revealed the pattern of GMV changes from pre-HD to sym-HD, prompting the understanding of HD progression. The pattern of GMV changes may be biomarkers for disease progression in HD.
Topics: Huntington Disease; Humans; Gray Matter; Neuroimaging; Brain; Magnetic Resonance Imaging
PubMed: 38953592
DOI: 10.1002/jnr.25366 -
Journal of Orthopaedic Surgery and... Jun 2024It remains unclear whether the use of an orthopaedic traction table (TT) in direct anterior approach (DAA) total hip arthroplasty (THA) results in better outcomes. The... (Meta-Analysis)
Meta-Analysis Comparative Study
Indirect comparisons of traction table versus standard table in total hip arthroplasty through direct anterior approach: a systematic review and frequentist network meta-analysis.
BACKGROUND
It remains unclear whether the use of an orthopaedic traction table (TT) in direct anterior approach (DAA) total hip arthroplasty (THA) results in better outcomes. The aim of this systematic review and network meta-analysis was to compare the THA outcomes through DAA on a standard operating table and the THA outcomes through DAA on a TT.
METHODS
PubMed, Epistemonikos, and Google Scholar were searched for relevant randomized controlled trials (RCTs) up to 01 January 2024. An indirect comparison in network meta-analysis was performed to assess treatment effects between DAA on a TT and DAA on a standard table, using fixed-effects and random-effects models estimated with frequentist approach and consistency assumption. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were estimated for continuous variables and odds ratios (ORs) with 95% CIs were estimated for binary variables.
RESULTS
The systematic review of the literature identified 43 RCTs with a total of 2,258 patients. DAA with TT had a 102.3 mL higher intraoperative blood loss and a 0.6 mmol/L lower Hb 3 days postoperatively compared with DAA without TT (SMD = 102.33, 95% CI 47.62 to 157.04; SMD = - 0.60, 95% CI - 1.19 to - 0.00). DAA with TT had a 0.15 lower periprosthetic fracture OR compared with DAA without TT (OR 0.15, 95% CI 0.03 to 0.86). There were no further significant differences in surgical, radiological, functional outcomes and in complication rates.
CONCLUSION
Based on our findings and taking into account the limitations, we recommend that particular attention be paid to the risk of periprosthetic fracture in DAA on a standard operating table and blood loss in DAA with TT. Since numerous other surgical, radiological, functional outcome parameters and other complication rates studied showed no significant difference between DAA on a standard operating table and DAA with TT, no recommendation for a change in surgical technique seems justified.
LEVEL OF EVIDENCE
Level I evidence, because this is a systematic review and meta-analysis of randomized controlled trials.
Topics: Humans; Arthroplasty, Replacement, Hip; Network Meta-Analysis; Traction; Treatment Outcome; Blood Loss, Surgical; Operating Tables; Randomized Controlled Trials as Topic; Postoperative Complications
PubMed: 38951886
DOI: 10.1186/s13018-024-04852-3 -
Techniques in Coloproctology Jul 2024Comparative outcomes of robotic low anterior resection (rTME) and trans-anal total mesorectal excision (TaTME) in patients with low rectal cancer were evaluated. (Meta-Analysis)
Meta-Analysis Comparative Study Review
Peri-operative, oncological and functional outcomes of robotic versus transanal total mesorectal excision in patients with rectal cancer: A systematic review and meta-analysis.
BACKGROUND
Comparative outcomes of robotic low anterior resection (rTME) and trans-anal total mesorectal excision (TaTME) in patients with low rectal cancer were evaluated.
METHODS
A systematic online search was conducted using the following databases: PubMed, Scopus, Cochrane database, The Virtual Health Library, Clinical trials.gov and Science Direct. Comparative studies of rTME versus TaTME for low rectal cancer were included. Primary outcomes were postoperative complications, including anastomotic leak, surgical site infection, and Clavien-Dindo complication rate. Total operative time, conversion to open surgery, intra-operative blood loss, intensive therapy unit (ITU) and total hospital length of stay (LOS), oncological outcomes and functional outcomes were the other evaluated outcome parameters.
RESULTS
A total of 12 studies with a total number of 3025 patients divided between rTME (n = 1881) and TaTME (n = 1144) groups were included. There was no significant difference between the two groups for total operative time (P = 0.39), conversion to open surgery (P = 0.29) and intra-operative blood loss (P = 0.62). Clavien-Dindo ≥ 3 complication rate (P = 0.47), anastomotic leak (P = 0.89), rates of re-operation (P = 0.62) and re-admission (P = 0.92), R0 resections (P = 0.52), ITU LOS (P = 0.63) and total hospital LOS (P = 0.30) also showed similar results between the two groups. However, the rTME group had higher rates of total harvested lymph nodes (P = 0.04) and complete total mesorectal excision (TME) resections (P = 0.05). Albeit with a limited dataset, the Wexner and low anterior resection syndrome (LARS) scores showed better functional results in the rTME group compared with the TaTME group (P = 0.0009 and P = 0.00001, respectively).
CONCLUSION
Compared with TaTME, rTME seems to provide better functional outcomes, higher lymph node yield and more complete TME resections with a similar post-operative complications profile.
Topics: Humans; Rectal Neoplasms; Robotic Surgical Procedures; Postoperative Complications; Proctectomy; Operative Time; Length of Stay; Treatment Outcome; Transanal Endoscopic Surgery; Female; Male; Middle Aged; Rectum; Aged; Anastomotic Leak; Blood Loss, Surgical; Conversion to Open Surgery; Adult
PubMed: 38951249
DOI: 10.1007/s10151-024-02947-x -
Orthopedic Reviews 2024Hip-knee-ankle angle (HKA) on Full Limb Radiographs (FLRs) is the gold standard for coronal knee alignment assessment. Despite the widespread utilization of the more...
Femorotibial angle on short knee radiographs fails to accurately predict the lower limb mechanical alignment. A systematic review and meta-analysis on different femorotibial angle definitions and short knee radiograph types.
INTRODUCTION
Hip-knee-ankle angle (HKA) on Full Limb Radiographs (FLRs) is the gold standard for coronal knee alignment assessment. Despite the widespread utilization of the more convenient femorotibial angle (FTA) on either antero-posterior (AP) or postero-anterior (PA) short knee radiographs (SKRs), its definition and correlation with HKA remains controversial. This review is the first to systematically investigate FTA-HKA correlation and the effect of different FTA methods and SKRs.
METHODS
Systematic literature search (Pubmed, Scopus, Cochrane Library) followed PRISMA guidelines, to evaluate studies examining the FTA-HKA correlation. Meta-analyses compared the 3 most common FTA methods, knee center determination method and SKR types.
RESULTS
17 studies (2597 patients, 3234 knees) were included. The strongest correlation with HKA (r = 0.78) was found for FTA Method 1 (angle formed by lines drawn from the midpoint of tibial spines to points 10 cm above and below the joint line). No significant differences were observed when grouping the FTA methods by knee center assessment (Group I, r = 0.78; Group II, r = 0.77). AP SKRs showed a trend towards stronger FTA-HKA correlation compared to PA SKRs, in both Method 1 (r = 0.79 vs 0.75) and Method 3 (r = 0.80 vs 0.66).
CONCLUSION
Irrespective of its definition or type of SKR used, FTA lacks reliable accuracy in predicting the HKA in most knees. FLRs should be used whenever precise estimation of the patient's alignment is necessary. Caution is warranted in interpreting studies investigating knee alignment or knee arthroplasty outcomes based on FTA.
PubMed: 38947178
DOI: 10.52965/001c.120053 -
Journal of ISAKOS : Joint Disorders &... Jun 2024Patients with excessive posterior tibial slope (PTS) may have higher risks of anterior cruciate ligament (ACL) reconstruction (ACL-R) failure, and clinical outcomes... (Review)
Review
IMPORTANCE
Patients with excessive posterior tibial slope (PTS) may have higher risks of anterior cruciate ligament (ACL) reconstruction (ACL-R) failure, and clinical outcomes after revision ACL-R procedures are typically poor.
OBJECTIVE
To perform a systematic review of the literature summarizing the clinical and radiological outcomes of the surgical treatment of ACL insufficiency in the setting of excessive PTS using a tibial deflexion osteotomy combined with ACL-R.
EVIDENCE REVIEW
A systematic review of the literature was performed using PubMed, Cochrane Library, and OVID Medline databases from 1990 to present. Inclusion criteria were: studies of outcomes of isolated tibial deflexion osteotomies performed with primary or revision ACL-R in the English language. Data extracted included study demographic information, type of tibial deflexion osteotomy and concomitant procedures, radiological outcomes, patient reported outcome scores, and postoperative complications FINDINGS: Six studies, with 133 knees were identified. All included studies were retrospective case series, with a weighted mean follow-up of 3.39 years. In 106 of 133 (79.7%) knees, tibial deflexion osteotomy was performed concomitantly with an ACL-R, whereas in 27 of 133 (20.3%) knees the procedures were staged. 22, 45, and 66 of 133 knees (16.5%, 33.8%, and 49.6%) underwent primary, 1 revision, and 2 or greater revision ACL-R, respectively. 3 of 133 (2.25%) knees demonstrated recurrent ACL graft failure at final follow-up. On average, PTS decreased from 15.2 degrees preoperatively to 7.1 degrees postoperatively. Mean International Knee Documentation Committee (IKDC), Lysholm, and Tegner scores increased from 42.5, 46.4, and 4.2 preoperatively to 71.8, 89.0, and 6.7 postoperatively.
CONCLUSIONS
The results of this review suggest that combined ACL-R and tibial deflexion osteotomy may be effective in decreasing PTS and improving knee function and stability.
STUDY DESIGN
Systematic Review; Level of evidence 4.
PubMed: 38945397
DOI: 10.1016/j.jisako.2024.06.010 -
World Neurosurgery Jun 2024The optimal choice for fusion strategy in Anterior Cervical Discectomy and Fusion (ACDF) remains an unresolved issue. This study aims to perform a network meta-analysis... (Review)
Review
OBJECTIVE
The optimal choice for fusion strategy in Anterior Cervical Discectomy and Fusion (ACDF) remains an unresolved issue. This study aims to perform a network meta-analysis and systematic review of fusion rate and complication rate of various fusion strategies used in ACDF.
METHODS
This study followed Prisma guidelines, and we searched PubMed, Embase, Cochrane Library, and Web of Science from inception to November 11, 2022, for RCTs comparing the efficacy and safety of fusion modalities in ACDF. The primary outcome was the fusion rate and complication rate. The PROSPERO number is CRD42022374440.
RESULTS
This meta-analysis identified 26 RCT studies with 1789 patients across 15 fusion methods. The cage with autograft + plating (CATG + P) showed the highest fusion rate, surpassing other methods like iliac crest autograft (ICAG) and artificial bone graft (AFG). The stand-alone cage with autograft (SATG) had the second highest fusion rate. Regarding complication rate, the cage with artificial bone graft (CAFG) had the highest rate, more than other methods. The ICAG had a higher complication rate compared to ICAG + P, AFG, SAFG, SATG, and CALG. The SATG performed well in both fusion and complication rate.
CONCLUSION
In this study, we conducted the first network meta-analysis to compare the efficacy and safety of various fusion methods in ACDF. Our findings suggest that SATG, with superior performance in fusion rate and complication rate, may be the optimal choice for ACDF. However, the results should be interpreted cautiously until additional research provides further evidence.
PubMed: 38942142
DOI: 10.1016/j.wneu.2024.06.117 -
Arthroscopy : the Journal of... Jun 2024The objective of the current study was to analyze if the arthroscopic Bankart repair using a knotless suture anchor has a better functional outcome than the conventional... (Review)
Review
PURPOSE
The objective of the current study was to analyze if the arthroscopic Bankart repair using a knotless suture anchor has a better functional outcome than the conventional knot-tying Bankart repair.
METHODS
Comprehensive literature search was done in Pubmed, Scopus, Embase, and Cochrane databases in May 2023. Studies comparing the clinical outcome of Bankart repair using knotless and knot-tying techniques were included in the study. In vitro, animal, and level 4 and 5 studies were excluded. The risk of bias of randomized controlled trials (RCT) was calculated according to the RoB 2 tool, and for non-randomized studies, MINORS criteria were used. Statistical analysis was done using RevMan software.
RESULTS
A total of nine studies, including two RCT and seven non-randomized comparative studies involving 720 patients, were included in the systematic review. The ROWE score ranged 81.7 to 94.3 in the knot-tying and 86 to 96.3 in the knotless group. VAS scores at final follow-up ranged between 0.1 to 1.7 in the knot-tying and 0.7 to 2.5 in the knotless group. The rate of redislocation, subluxation, and revision surgery in the knot-tying group ranged from 0 to 14.7%, 16.7 to 29.7%, and 1.6 to 17.6%, respectively, while that in the knotless group ranged from 2.4 to 23.8%, 7.4 to 22.2%, and 2.4 to 19%, respectively. The mean external rotation was 54 to 65 degrees in the knot-tying and 61 to 99 in the knotless group. The mean forward-flexion was 164 to 172 in the knot-tying and 165 to 174 in the knotless group. Our subjective synthesis doesn't reveal any difference in the outcome between the two groups.
CONCLUSION
The available literature does not demonstrate a clear difference in functional outcomes, residual pain, and rate of complications like redislocation, subluxation and revision surgery between Bankart repair performed with knotted and knotless anchors.
PubMed: 38942097
DOI: 10.1016/j.arthro.2024.05.036 -
Alternative Therapies in Health and... Jun 2024Congenital anal atresia poses a significant challenge in pediatric surgery, necessitating precise and effective interventions to ensure optimal outcomes. While...
BACKGROUND
Congenital anal atresia poses a significant challenge in pediatric surgery, necessitating precise and effective interventions to ensure optimal outcomes. While traditional anterior sagittal approach anoplasty has been a standard procedure, emerging evidence suggests potential benefits of anal dimple anorectoplasty.
OBJECTIVE
This study aims to assess the clinical efficacy of anal dimple anorectoplasty in treating congenital anal atresia.
METHODS
We conducted a rigorous systematic review and meta-analysis, extensively searching various databases such as Wanfang, CNKI, VIP, PubMed, Web of Science, and the Cochrane Library. Our aim was to identify randomized controlled trials comparing the efficacy of traditional anterior sagittal approach anoplasty with anal dimple anorectoplasty in treating congenital anal atresia. Search terms included "anal dimple anorectoplasty," "congenital anal atresia," and "RCT." Data regarding operation time, postoperative hospitalization duration, and complication rates were collected.
RESULTS
Anal dimple anorectoplasty exhibited significantly greater clinical efficacy (odds ratio [OR]=4.91, 95% confidence interval [CI]: 2.02-11.94, P < .00001), along with markedly reduced postoperative hospitalization duration (95% CI: -1.27 to -0.57, P < .00001), and a substantially lower incidence of complications (OR=0.1, 95% CI: 0.04-0.25, P < .00001) compared to traditional anterior sagittal approach anoplasty. These findings underscore the clear advantage of anal dimple anorectoplasty over conventional methods, indicating its potential as a preferred surgical approach for congenital anal atresia.
CONCLUSIONS
Anal dimple anorectoplasty emerges as a highly effective intervention for pediatric patients with congenital anal atresia, demonstrating a notable decrease in postoperative complications. These findings highlight its potential as a preferred surgical approach to enhance patient outcomes and minimize adverse events.
PubMed: 38940776
DOI: No ID Found