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International Journal of Surgery... May 2024Following an initiative published by Lancet in 2002 and an IDEAL-D framework, the value of preclinical animal studies has garnered increasing attention in recent... (Meta-Analysis)
Meta-Analysis Comparative Study
Assessing the application of barbed sutures in comparison to conventional sutures for surgical applications: a global systematic review and meta-analysis of preclinical animal studies.
BACKGROUND
Following an initiative published by Lancet in 2002 and an IDEAL-D framework, the value of preclinical animal studies has garnered increasing attention in recent research. Numerous preclinical animal experiments tried to generate evidence to guide the development of barbed sutures. However, discernible drawbacks and incongruities in outcomes have emerged between clinical and preclinical animal studies. Therefore, this meta-analysis aimed to review the preclinical animal experiments comparing barbed sutures with conventional sutures. The authors hope to facilitate clinical translation of barbed sutures by evaluating effectiveness, safety, and physical properties/reliability.
MATERIALS AND METHODS
A systematic search of PubMed, EMBASE, Cochrane Library, and ClinicalTrials.gov was conducted to identify controlled preclinical animal experiments comparing barbed sutures with conventional sutures. The risk of bias was assessed using SYRCLE. GRADE approach was used to evaluate evidence quality. Revman was applied to analyze all the data. Subgroup, sensitivity, and meta-regression analyses were also performed.
RESULTS
A total of 62 articles were eligible with low to moderate quality, including 2158 samples from 10 different animal species across 27 surgical procedures. Barbed suture exhibited a significant reduction in suture time, limited change in Cross-Sectional Area (CSA), and decreased instances of tissue disruption (all P <0.05). Subgroup analyses, considering both clinical and research significance, indicated that barbed sutures might cause more specific adverse events and demonstrate suboptimal performance of physical properties/reliability. Meta-regression suggested that heterogeneity resulted from variations in studies and animal models.
CONCLUSION
Although barbed suture demonstrated superiority in numerous surgeries for time efficiency, its safety and physical properties/reliability might be influenced by diverse preclinical models, sutures' brand, surgeries, and anatomical sites. Further evaluation, based on standardized and well-designed animal experiments, is essential for medical device development and applications in human beings.
Topics: Sutures; Animals; Suture Techniques
PubMed: 38445518
DOI: 10.1097/JS9.0000000000001230 -
World Journal of Pediatric Surgery 2024Polyglactin (PG) and polydioxanone (PDS) sutures are extensively used based on the surgeon's preference. The development of post-reconstruction urethrocutaneous fistula...
BACKGROUND
Polyglactin (PG) and polydioxanone (PDS) sutures are extensively used based on the surgeon's preference. The development of post-reconstruction urethrocutaneous fistula (UCF) is variably attributed to the choice of suture material for urethroplasty. This meta-analysis compares complications of hypospadias repair using PG and PDS sutures.
METHODS
The systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The authors conducted thorough searches in databases including MEDLINE, EMBASE, CENTRAL, Scopus, Google Scholar, and clinical trial registries. Outcome measures included UCF, meatal stenosis, wound infection, urethral stricture, glans dehiscence, and overall complications. Quantitative analysis was used with fixed or random-effect models to find the pooled risk ratio and I heterogeneity.
RESULTS
The criteria for inclusion were met by five comparative studies with the inclusion of 1244 children altogether. Pooled analysis failed to show a statistically significant difference in the incidence of meatal stenosis, urethral stricture, wound infection, and total complications using PG and PDS sutures. However, it showed a reduction in the incidence of UCF with PDS suture hypospadias repairs (risk ratio=0.66, 95% CI 0.48 to 0.92).
CONCLUSIONS
PDS sutures are associated with decreased incidence of UCF than PG after hypospadias repair. The incidence of meatal stenosis, urethral stricture, wound infection, and total complications was not affected by the type of suture material used for repair.
CLINICAL IMPLICATIONS
This meta-analysis suggests decreased incidence of UCF when PDS sutures are used for hypospadias repair which may impact the choice of suture material for repair.
PROSPERO REGISTRATION NUMBER
CRD42023409710.
PubMed: 38440224
DOI: 10.1136/wjps-2023-000659 -
Cancers Feb 2024: Robot-assisted partial nephrectomy (RAPN) is increasingly being employed in the management of renal cell carcinoma (RCC) and it is expanding in the field of complex... (Review)
Review
: Robot-assisted partial nephrectomy (RAPN) is increasingly being employed in the management of renal cell carcinoma (RCC) and it is expanding in the field of complex renal tumors. The aim of this systematic review was to consolidate and assess the results of RAPN when dealing with entirely central hilar masses and to examine the various methods used to address the surgical difficulties associated with them. : A thorough literature search in September 2023 across various databases focused on RAPN for renal hilar masses, adhering to PRISMA guidelines. The primary goal was to evaluate RAPN's surgical and functional outcomes, with a secondary aim of examining different surgical techniques. Out of 1250 records, 13 full-text manuscripts were reviewed. : Evidence is growing in favor of RAPN for renal hilar masses. Despite a predominance of retrospective studies and a lack of long-term data, RAPN shows positive surgical outcomes and preserves renal function without compromising cancer treatment effectiveness. Innovative suturing and clamping methods are emerging in surgical management. : RAPN is a promising technique for managing renal hilar masses in RCC, offering effective surgical outcomes and renal function preservation. The study highlights the need for more long-term data and prospective studies to further validate these findings.
PubMed: 38398084
DOI: 10.3390/cancers16040693 -
The Journal of Craniofacial Surgery Feb 2024To study the prevalence of complications in patients who have undergone cartilage sparing otoplasty.
OBJECTIVE
To study the prevalence of complications in patients who have undergone cartilage sparing otoplasty.
METHODS
On December 26, 2021, the authors searched 8 databases using the search term "(otoplasty) AND (cartilage sparing OR cartilage sparing)" for collecting the most appropriate studies. The authors used R software version 4.1.2 for conducting the meta-analysis.
RESULTS
Of the 414 records screened, the authors included 14 studies. Recurrence/reoperation was the most common reported complication with a prevalence of 4.27% (95% CI: 2.93-6.22), followed by suture erosion 2.46% (95% CI: 0.86-7.07) and hematoma/hemorrhage 1.34% (95% CI: 0.79-2.27). The authors did not find any significant difference between cartilage sparing and cartilage scoring in terms of recurrence/reoperation [odds ratio (OR): 0.92; 95% CI: 0.53-1.60; P = 0.766], hematoma/hemorrhage (OR: 1.39; 95% CI: 0.28-7.01; P = 0.688), and wound infection (OR: 0.37; 95% CI: 0.06-2.24; P = 0.279).
CONCLUSION
Various complications have been reported, including recurrence and reoperation, hematoma, wound infections, suture erosions, keloid formation, and skin necrosis. However, the prevalence of these events is not high, although significant heterogeneity was reported for some outcomes. Therefore, it can be concluded that cartilage sparing otoplasty is a safe and reproducible technique.
PubMed: 38363310
DOI: 10.1097/SCS.0000000000009976 -
Journal of Cardiothoracic Surgery Feb 2024Negative pressure wound therapy (NPWT) is traditionally used to treat postoperative wound infections. However, its use in closed wound sternotomy post cardiac surgery in... (Meta-Analysis)
Meta-Analysis Review
The negative pressure wound therapy for prevention of sternal wound infection: Can we reduce infection rate after the use of bilateral internal thoracic arteries? A systematic literature review and meta-analysis.
BACKGROUND
Negative pressure wound therapy (NPWT) is traditionally used to treat postoperative wound infections. However, its use in closed wound sternotomy post cardiac surgery in high-risk patients has become increasingly popular. The potential preventive benefit of reducing sternal wound infections has been recently acknowledged. Bilateral internal mammary artery (BIMA) grafts are used in coronary artery bypass grafting but have been associated with an increased risk of sternal wound infections (SWIs).
OBJECTIVES
This systematic analysis examines whether NPWT can reduce the incidence of SWI following BIMA grafts, leading to more patients benefiting from the better survival outcome associated with BIMA grafting.
METHOD
A comprehensive systematic search and meta-analysis were performed to identify studies on the use of NPWT in closed wound sternotomy. Ovid MEDLINE (in-process and other nonindexed citations and Ovid MEDLINE 1990 to present), Ovid EMBASE (1990 to present), and The Cochrane Library (Wiley), PubMed, and Google Scholar databases were searched from their inception to May 2022 using keywords and MeSH terms. Thirty-four articles from 1991 to May 2022 were selected.
RESULT
Three studies reported on the outcome of NPWT following BIMA grafting. The pooled analysis did not show any significant difference in the incidence of sternal wound infection between NPWT and standard dressing (RR 0.48 95% CI 0.17-1.37; P = 0.17) with substantial heterogeneity (I 65%). Another seven studies were found comparing the outcome of SWI incidence of negative pressure closed wound therapy with conventional wound therapy in patients undergoing adult cardiac surgery. The pooled analysis showed that NPWT was associated with a low risk of SWIs compared to conventional dressing (RR 0.47 95% CI 0.36-0.59; P < 0.00001), with low heterogeneity (I 1%).
CONCLUSION
The literature identified that NPWT significantly decreased the incidence of sternal wound complications when applied to sutured sternotomy incisions in high-risk patients, and in some cases, it eliminated the risk. However, the inadequate number of randomized controlled trials assessing the effectiveness of NPWT in BIMA grafting emphasizes the need for further, robust studies.
Topics: Adult; Humans; Mammary Arteries; Negative-Pressure Wound Therapy; Wound Healing; Surgical Wound Infection; Surgical Wound Dehiscence
PubMed: 38342923
DOI: 10.1186/s13019-024-02589-y -
Diagnostics (Basel, Switzerland) Jan 2024Obstructive sleep apnea syndrome (OSAS) is a respiratory illness that is associated with recurrent episodes of either partial or full obstruction of the upper airways,... (Review)
Review
Obstructive sleep apnea syndrome (OSAS) is a respiratory illness that is associated with recurrent episodes of either partial or full obstruction of the upper airways, or apnea, among other sleep disorders. This study aims to analyze, through a literature review, whether orthodontic treatment can be a good treatment strategy for this type of disorder. We performed a database search on Scopus, Web of Science, and Pubmed with the keywords OSA(S) and orthodontics to select the papers under evaluation. The criteria for inclusion were articles related to OSA(S) children undergoing an orthodontic treatment and clinical studies or case series, excluding systematic reviews, narrative reviews, meta-analyses, adult studies, animal models, and in vitro studies. The screening phase ended with the selection of 16 publications for this work. RME, or rapid maxillary expansion, turned out to be the preferred orthodontic treatment in cases of pediatric OSAS. The goal of this orthodontic procedure is to increase the hard palate's transverse diameter by reopening the mid-palatal suture. Children with maxillary contraction and dental malocclusion typically undergo such a procedure and have excellent results. However, OSAS is a multifactorial disorder; it does not seem related to the morphology of the oral cavity, and therefore, it is not always possible to cope with this problem exclusively through orthodontic treatment.
PubMed: 38337805
DOI: 10.3390/diagnostics14030289 -
PloS One 2024This study aimed to compare the outcomes of double-armed two-suture longitudinal intussusception microsurgical vasoepididymostomy (LIVE) and single-armed two-suture LIVE... (Meta-Analysis)
Meta-Analysis
Comparative evaluation of double- and single-armed two-suture longitudinal intussusception techniques in microsurgical vasoepididymostomy: An updated systematic review and meta-analysis.
BACKGROUND
This study aimed to compare the outcomes of double-armed two-suture longitudinal intussusception microsurgical vasoepididymostomy (LIVE) and single-armed two-suture LIVE techniques in patients with epididymal obstructive azoospermia (EOA). The main outcomes assessed were patency rates, patency time, semen quality and natural pregnancy rates.
METHODS
Data from patients with EOA who underwent two-suture LIVE were obtained from databases including PubMed, EMBASE, and Web of Science. Weighted data were analyzed using a random-effects model, and weighted mean differences were reported.
RESULTS
A total of 1574 patients with EOA from 24 studies were included. The overall patency rate was approximately 68% (95% confidence interval [CI]: 63-72%), with a patency time of approximately 4.63 months (95% CI: 4.15-5.12). The sperm concentration reached 26.90 million/ml and the sperm motility was 23.74%. The natural pregnancy rate was 38% (95% CI: 31-46%). The different definitions of patency do not seem to have any meaningful impact when comparing patency rates. There was no significant difference in patency rates, patency time, semen quality and natural pregnancy rates between the double-armed and single-armed LIVE techniques.
CONCLUSION
The single-armed LIVE is a potential alternative surgical option when high quality double-needle sutures are not easily accessible.
Topics: Pregnancy; Female; Humans; Male; Semen Analysis; Intussusception; Treatment Outcome; Sperm Motility; Microsurgery; Semen; Epididymis; Azoospermia; Sutures; Vas Deferens
PubMed: 38315686
DOI: 10.1371/journal.pone.0298019 -
Journal of Abdominal Wall Surgery : JAWS 2023Of the more than 20 million patients undergoing groin hernia repair annually worldwide, 6% are scrotal hernias in high resource countries rising to 67% in low resource...
Of the more than 20 million patients undergoing groin hernia repair annually worldwide, 6% are scrotal hernias in high resource countries rising to 67% in low resource countries which represents a heavy disease burden on relatively young men during their most productive period of life. There are many open questions concerning management of scrotal hernia. These guidelines aim to improve the care for scrotal hernia patients by reducing recurrence rates, chronic pain and infection. After developing 19 key questions a systematic literature review was performed till 31 March 2021 for all relevant publications with search terms related to Scrotal Hernia. The articles were scored by all co-authors according to Oxford, SIGN and Grade methodologies. Statements and recommendations were formulated. Online Consensus meetings with 25 HerniaSurge members were organised with voting and grading Recommendations as "strong" (recommendations) or "weak" (suggestions) and by consensus, in some cases upgraded. Only 23 articles (two level 2 registry and 21 level 3-5) were selected. It is proposed to define scrotal hernia as an inguinal hernia which has descended into and causes any scrotal distortion. A new classification for scrotal hernias was proposed based on hernia size, SI for upper third thigh, SII for middle thigh and SIII for lower third thigh or below. Irreducibility is denoted with IR. Despite weak evidence antibiotic prophylaxis is recommended. Urinary catheterization is recommended (upgraded) in complex cases (S2-3) due to prolonged operative time. Scrotal hernia repairs have higher associated morbidity and mortality compared to non-complex groin hernia repairs irrespective of surgical experience. Open anterior (mesh) approach is commonest technique and suture techniques in low resource countries. For minimally invasive approaches, TAPP resulted in less conversion to open approach compared to TEP. Although the evidence is scarce and often low quality scrotal hernia management guidelines aim to lead to better surgical outcomes irrespective of where patients live. This necessarily means a more tailored approach based on available resources and appropriate skills. The guidelines provide an impetus for future research where adoption of proposed classification will enable more meaningful comparison of different techniques for different hernia sizes.
PubMed: 38312421
DOI: 10.3389/jaws.2023.11195 -
Cureus Jan 2024Abdominal wall reconstruction (AWR) is a surgical procedure performed to address various conditions such as hernias, incisional hernias, and complex abdominal wall... (Review)
Review
Abdominal wall reconstruction (AWR) is a surgical procedure performed to address various conditions such as hernias, incisional hernias, and complex abdominal wall defects. Mesh fixation plays a crucial role in providing mechanical reinforcement to the weakened abdominal wall during AWR. Traditionally, suturing has been the preferred method for mesh fixation; however, adhesion techniques using tissue adhesives or glues have gained attention as an alternative approach. This systematic review aims to compare suturing and adhesion techniques for mesh fixation in AWR and assess their effectiveness in preventing hernia recurrence. A comprehensive literature search was conducted across relevant databases, including PubMed, MEDLINE, Embase, and the Cochrane Library. Studies that fulfilled the predetermined eligibility criteria were included. The primary outcome measure of interest was hernia recurrence rates. Secondary outcomes included mesh-related complications, surgical site infections, patient-reported outcomes, and functional outcomes. A risk of bias assessment was performed for the included studies, and data were synthesized qualitatively. Overall, the results of the included studies suggest that atraumatic mesh fixation with glue may have the potential to reduce chronic groin pain (CGP). However, there were significant variations in patient selection criteria, glue administration techniques, and hernia repair methods among the trials, which limited the ability to draw definitive conclusions. Additionally, the definitions of CGP and measurement scales for postoperative pain varied across studies, making it challenging to compare outcomes. The limitations of the review include the small sample sizes in some trials, relatively short follow-up durations, and the lack of standardized criteria for assessing variables such as foreign body sensation and groin compliance. Furthermore, the economic implications of using glue fixation compared to traditional suture fixation need to be considered.
PubMed: 38304671
DOI: 10.7759/cureus.51535 -
Comprehensive systematic review on the self-gripping mesh vs sutured mesh in inguinal hernia repair.Surgery Open Science Jan 2024The objective of this systematic review is to analyse the randomised control trials (RCTs) comparing the self-gripping mesh (SGM) with sutured mesh fixation (SMF) in... (Review)
Review
OBJECTIVE
The objective of this systematic review is to analyse the randomised control trials (RCTs) comparing the self-gripping mesh (SGM) with sutured mesh fixation (SMF) in open inguinal hernia repair.
MATERIALS AND METHODS
RCTs comparing SGM with SMF in open inguinal hernia repair were selected from medical electronic databases and analysis was performed using the principles of meta-analysis with RevMan version 5 statistical software.
RESULTS
Seventeen RCTs involving 3863 patients were used for the final analysis. In the random effect model analysis, the operative time [mean difference - 7.72, 95 %, CI (-9.08, -6.35), Z = 11.07, = 0.00001] was shorter for open inguinal hernia repair with SGM. However, there was noteworthy heterogeneity (Tau = 4.24; Chi = 1795.04, df = 12; ( = 0.00001; I = 99 %) among the included studies. The incidence of chronic groin pain [odds ratio 1.17, 95 %, CI (0.88, 1.54), Z = 1.09, = 0.28], postoperative complications [odds ratio 0.92, 95 %, CI (0.73, 1.16), Z = 0.71, = 0.48] and recurrence [odds ratio 1.31, 95 %, CI (0.80, 2.12), Z = 1.08, = 0.28] were statistically similar between both groups, without heterogeneity.
CONCLUSION
SGM failed to demonstrate a clinical advantage over SMF in terms of perioperative outcomes although the duration of surgery was shorter in SGM.
PubMed: 38293004
DOI: 10.1016/j.sopen.2023.12.010