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Scientific Reports Feb 2021Prophylactic drainage after major liver resection remains controversial. This systematic review and meta-analysis evaluate the value of prophylactic drainage after major... (Meta-Analysis)
Meta-Analysis
Prophylactic drainage after major liver resection remains controversial. This systematic review and meta-analysis evaluate the value of prophylactic drainage after major liver resection. PubMed, Web of Science, and Cochrane Central were searched. Postoperative bile leak, bleeding, interventional drainage, wound infection, total complications, and length of hospital stay were the outcomes of interest. Dichotomous outcomes were presented as odds ratios (OR) and for continuous outcomes, weighted mean differences (MDs) were computed by the inverse variance method. Summary effect measures are presented together with their corresponding 95% confidence intervals (CI). The certainty of evidence was evaluated using the Grades of Research, Assessment, Development and Evaluation (GRADE) approach, which was mostly moderate for evaluated outcomes. Three randomized controlled trials and five non-randomized trials including 5,050 patients were included. Bile leakage rate was higher in the drain group (OR: 2.32; 95% CI 1.18-4.55; p = 0.01) and interventional drains were inserted more frequently in this group (OR: 1.53; 95% CI 1.11-2.10; p = 0.009). Total complications were higher (OR: 1.71; 95% CI 1.45-2.03; p < 0.001) and length of hospital stay was longer (MD: 1.01 days; 95% CI 0.47-1.56 days; p < 0.001) in the drain group. The use of prophylactic drainage showed no beneficial effects after major liver resection; however, the definitions and classifications used to report on postoperative complications and surgical complexity are heterogeneous among the published studies. Further well-designed RCTs with large sample sizes are required to conclusively determine the effects of drainage after major liver resection.
Topics: Abdomen; Drainage; Hepatectomy; Humans; Length of Stay; Liver; Pancreas; Postoperative Complications; Time Factors
PubMed: 33542274
DOI: 10.1038/s41598-021-82333-x -
Annals of Medicine Dec 2023Patients with walled-off necrosis (WON) are still challenging to treat safely and effectively. Recently, double-pigtail plastic stents (DPS), bi-flanged metallic stents... (Meta-Analysis)
Meta-Analysis
Safety and efficacy of lumen-apposing metal stents and double-pigtail plastic stents for endoscopic ultrasound-guided drainage of walled-off necrosis; a systematic review and meta-analysis.
BACKGROUND
Patients with walled-off necrosis (WON) are still challenging to treat safely and effectively. Recently, double-pigtail plastic stents (DPS), bi-flanged metallic stents (BFMS), and lumen-apposing metal stents (LAMS) have been employed with endoscopic ultrasound-guided (EUS-guided) drainage. However, there is little solid evidence to support the effectiveness and safety of using stents. This study aims to compare the outcomes of the LAMS and the PS.
METHOD
Till July 2022, a thorough database search was done, and studies that met the criteria were chosen. By using the RevMan software, the technical and clinical success and other secondary outcomes were calculated. Subgroup analysis was performed between the LAMS and the BFMS.
RESULTS
Fifteen studies (two randomized controlled trials and thirteen observational) with 687 patients receiving metal stents and 771 patients receiving plastic stents were selected for final analysis. There was no significant risk of bias or publication bias. The odds ratios (OR) for technical and clinical success were 0.36 (95% confidence interval (95% CI) 0.08, 1.52) and 2.26 (95%CI 1.62, 3.15), respectively. The OR for overall adverse events was 0.74 (95% CI 0.41, 1.34). In subgroup analysis, the LAMS and the BFMS showed the same outcomes.
CONCLUSION
Compared to DPS, LAMS had better clinical outcomes and fewer side effects when treating patients with WON.
Topics: Humans; Plastics; Treatment Outcome; Stents; Drainage; Necrosis; Ultrasonography, Interventional; Retrospective Studies
PubMed: 36779694
DOI: 10.1080/07853890.2022.2164048 -
International Journal of Surgery... Nov 2015To assess the effectiveness of intra-abdominal drainage (IAD) post laparoscopic cholecystectomy (LC). (Meta-Analysis)
Meta-Analysis Review
AIM
To assess the effectiveness of intra-abdominal drainage (IAD) post laparoscopic cholecystectomy (LC).
METHODS
Main electronic databases [MEDLINE via Pubmed, EMBASE, Scopus, Web of Knowledge, Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Library, and clinical trial registry (ClinicalTrial.gov)] were searched for randomised controlled trial (RCT) reporting outcomes of IAD. The systematic review was conducted in accordance with the PRISMA guidelines and meta-analysis was analysed using fixed and random-effects models.
RESULTS
Twelve RCTs involving 1763 patients (897 drained versus 866 without drain) were included in the final pooled analysis. There was no statistically significant different in the rate of intra-abdominal collections (RR 1.08, 95% CI 0.78 to 1.49; p = 0.65). IAD did not reduce the overall incidence of nausea and vomiting (RR 1.10, 95% CI 0.90 to 1.36; p = 0.36) and shoulder tip pain (RR 0.99, 95% CI 0.69 to 1.40; p = 0.93). Drain group had a significant higher pain scores (measured by visual analogue scale) (MD 10.08, 95% CI 5.24 to 14.92; p < 0.00001). IAD prolonged operative time (MD 4.93 min, 95% CI 3.40 to 6.47; p < 0.00001) but not the length of hospital stay (MD 0.22 day, 95% CI -0.45 to 0.89; p = 0.52). Wound infection was found to be unrelated to the use of a drain (RR 1.86, 95% CI 0.95 to 3.63; p = 0.07).
CONCLUSIONS
There is no significant advantage of IAD placement. The routine use of abdominal drain seems to have unfavourable clinical outcome and the practice should be carefully re-considered.
Topics: Cholecystectomy, Laparoscopic; Drainage; Humans; Length of Stay; Operative Time; Postoperative Care; Randomized Controlled Trials as Topic
PubMed: 26386402
DOI: 10.1016/j.ijsu.2015.09.033 -
Ear, Nose, & Throat Journal Aug 2022We have attempted to characterize the clinical presentations and management of infratemporal fossa abscesses with the goal of improving awareness and promoting earlier... (Review)
Review
OBJECTIVES
We have attempted to characterize the clinical presentations and management of infratemporal fossa abscesses with the goal of improving awareness and promoting earlier diagnosis and treatment for this rare condition.
METHODS
an extensive systematic search was performed through Pubmed/Medline, CINAHL (EBSCOhost), and Web of Science. Two authors screened out studies by abstracts, and a third resolved any conflicts. The remaining studies were assessed by full-text assessment, leaving 43 studies for data extraction.
RESULTS
sixty-seven patients were included from the final 43 studies. The patients were predominantly male (56.7%), and the average age of patients was 44.3 years (standard deviation (SD) 19.8 years). Risk factors most commonly odontogenic, whether the etiology was through tooth extraction (n = 30, 44.8%) or infection (n = 17, 25.4%). Symptoms on presentation included pain (n = 40, 83.3%), swelling (n = 39, 81.3%), and trismus (n = 36, 75.0%). Twenty-two (32.8%) patients were managed with intraoral incision and drainage (I&D), 18 (26.9%) with extraoral I&D. After treatment, 45 of the 48 (93.8%) patients from the case reports and series were deemed to have achieved complete resolution.
CONCLUSIONS
Infratemporal fossa abscesses are rare, but they may be associated with serious neurologic and systemic complications. Although prompt diagnosis paramount in avoiding these sequelae, patients often experienced delays in diagnosis. Surgical drainage and extended antibiotic therapy is recommended.
PubMed: 35961934
DOI: 10.1177/01455613221121040 -
Children (Basel, Switzerland) Jul 2023to systematically review and meta-analyze the impact on morbidity and mortality of peritoneal drainage (PD) compared to laparotomy (LAP) in preterm neonates with... (Review)
Review
Laparotomy versus Peritoneal Drainage as Primary Treatment for Surgical Necrotizing Enterocolitis or Spontaneous Intestinal Perforation in Preterm Neonates: A Systematic Review and Meta-Analysis.
AIM
to systematically review and meta-analyze the impact on morbidity and mortality of peritoneal drainage (PD) compared to laparotomy (LAP) in preterm neonates with surgical NEC (sNEC) or spontaneous intestinal perforation (SIP).
METHODS
Medical databases were searched until June 2022 for studies comparing PD and LAP as primary surgical treatment of preterm neonates with sNEC or SIP. The primary outcome was survival during hospitalization; predefined secondary outcomes included need for parenteral nutrition at 90 days, time to reach full enteral feeds, need for subsequent laparotomy, duration of hospitalization and complications.
RESULTS
Three RCTs (N = 493) and 49 observational studies (N = 19,447) were included. No differences were found in the primary outcome for RCTs, but pooled observational data showed that, compared to LAP, infants with sNEC/SIP who underwent PD had lower survival [48 studies; N = 19,416; RR 0.85; 95% CI 0.79-0.90; GRADE: low]. Observational studies also showed that the subgroup of infants with sNEC had increased survival in the LAP group (30 studies; N = 9370; RR = 0.82; 95% CI 0.72-0.91; GRADE: low).
CONCLUSIONS
Compared to LAP, PD as primary surgical treatment for sNEC or SIP has similar survival rates when analyzing data from RCTs. PD was associated with lower survival rates in observational studies.
PubMed: 37508667
DOI: 10.3390/children10071170 -
Digestion 2023At present, endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangial drainage (PTCD) are frequently used for reducing malignant... (Meta-Analysis)
Meta-Analysis
Comparison of Efficacy and Safety between Endoscopic Retrograde Cholangiopancreatography and Percutaneous Transhepatic Cholangial Drainage for the Treatment of Malignant Obstructive Jaundice: A Systematic Review and Meta-Analysis.
BACKGROUND
At present, endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangial drainage (PTCD) are frequently used for reducing malignant obstructive jaundice (MOJ). However, it is controversial as to which method is superior in terms of efficacy and safety.
OBJECTIVES
The aim of this study was to compare the safety, feasibility, and clinical benefits of ERCP and PTCD in matched cases of MOJ.
METHODS
The Web of Science, Cochrane, PubMed, and CNKI databases were searched systematically to identify studies published between January 2000 and December 2019, without language restrictions, that compared ERCP and PTCD in patients with MOJ. The primary outcome was the success rate for each procedure. The secondary outcomes were the technical success rate, serum total bilirubin level, length of hospital stay, hospital expense, complication rate, and survival. This meta-analysis was performed using Review Manager 5.3.
RESULTS
Sixteen studies met the inclusion criteria, including 1,143 cases of ERCP and 854 cases of PTCD. The analysis demonstrated that jaundice remission in PTCD was equal to that in ERCP (mean difference [MD], 1.19; 95% confidence interval [CI]: -0.56 to -2.93; p = 0.18). However, the length of hospital stay in the ERCP group was 3.03 days shorter than that in the PTCD group (MD, -2.41; 95% CI: -4.61 to -0.22; p = 0.03). ERCP had a lower rate of postoperative complications (odds ratio, 0.66; 95% CI: 0.42-1.05); however, the difference was not significant (p = 0.08). ERCP was also more cost-efficient (MD, -5.42; 95% CI: -5.52 to -5.32; p < 0.01). Further, we calculated the absolute mean of hospital stay (ERCP:PTCD = 8.73:12.95 days), hospital expenses (ERCP:PTCD = 5,104.13:5,866.75 RMB), and postoperative complications (ERCP:PTCD = 11.2%:9.1%) in both groups.
CONCLUSION
For remission of MOJ, PTCD and ERCP had similar clinical efficacy. Each method has its own strengths and weaknesses. Considering that ERCP had a lower rate of postoperative complications, shorter hospital stay, and higher cost efficiency, ERCP may be a superior initial treatment choice for MOJ.
Topics: Humans; Cholangiopancreatography, Endoscopic Retrograde; Jaundice, Obstructive; Drainage; Treatment Outcome; Postoperative Complications
PubMed: 36617409
DOI: 10.1159/000528020 -
Journal of Clinical Medicine May 2024Psoas muscle abscess (PMA) is an uncommon yet severe condition characterized by diagnostic and therapeutic challenges due to its varied etiology and nonspecific... (Review)
Review
Psoas muscle abscess (PMA) is an uncommon yet severe condition characterized by diagnostic and therapeutic challenges due to its varied etiology and nonspecific symptoms. This study aimed to evaluate the effectiveness and accuracy of various imaging techniques used in the image-guided percutaneous drainage (PD) of PMA. A systematic review was conducted following the PRISMA guidelines. We searched PubMed, Google Scholar, and Science Direct for studies published in English from 1998 onwards that reported on the use of PD in treating PMA, detailing outcomes and complications. Imaging modalities guiding PD were also examined. We identified 1570 articles, selecting 39 for full review. Of these, 23 met the inclusion criteria; 19 were excluded due to unspecified PMA, absence of imaging guidance for PD, or inconclusive results. Eleven studies utilized computed tomography (CT) for PD, with six also using magnetic resonance imaging (MRI). Ten studies implemented ultrasound (US)-guided PD; variations in diagnostic imaging included combinations of US, CT, and MRI. A mixed approach using both CT and US was reported in two articles. Most studies using CT-guided PD showed complete success, while outcomes varied among those using US-guided PD. No studies employed MRI-guided PD. This review supports a multimodal approach for psoas abscess management, using MRI for diagnosis and CT for drainage guidance. We advocate for Cone Beam CT (CBCT)-MRI fusion techniques with navigation systems to enhance treatment precision and outcomes, particularly in complex cases with challenging abscess characteristics.
PubMed: 38892910
DOI: 10.3390/jcm13113199 -
Open Forum Infectious Diseases Feb 2021Increasing rates of antimicrobial-resistant organisms have focused attention on sink drainage systems as reservoirs for hospital-acquired Gammaproteobacteria... (Review)
Review
Increasing rates of antimicrobial-resistant organisms have focused attention on sink drainage systems as reservoirs for hospital-acquired Gammaproteobacteria colonization and infection. We aimed to assess the quality of evidence for transmission from this reservoir. We searched 8 databases and identified 52 studies implicating sink drainage systems in acute care hospitals as a reservoir for Gammaproteobacterial colonization/infection. We used a causality tool to summarize the quality of evidence. Included studies provided evidence of co-occurrence of contaminated sink drainage systems and colonization/infection, temporal sequencing compatible with sink drainage reservoirs, some steps in potential causal pathways, and relatedness between bacteria from sink drainage systems and patients. Some studies provided convincing evidence of reduced risk of organism acquisition following interventions. No single study provided convincing evidence across all causality domains, and the attributable fraction of infections related to sink drainage systems remains unknown. These results may help to guide conduct and reporting in future studies.
PubMed: 33553469
DOI: 10.1093/ofid/ofaa590 -
Medicine Aug 2018To evaluate whether negative pressure drainage has advantage over natural drainage in effectiveness and safety for patients with thyroid disease after thyroid surgery. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
To evaluate whether negative pressure drainage has advantage over natural drainage in effectiveness and safety for patients with thyroid disease after thyroid surgery.
METHOD
We performed intensive literature search and followed the standards described in preferred reporting items for systematic review and meta-analysis (PRISMA) statement to conduct this systematic review. Risk of bias was assessed using the Cochrane Risk of bias tool. We used Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to evaluate the quality of evidence body.
RESULTS
Total 1195 participants with thyroid disease from 13 studies were included. For patients underwent thyroidectomy without neck dissection, negative pressure drainage group has a lower risk of seroma and wound infection. The duration of tube placement was shorter in negative pressure drainage group, which produced more fluid than natural drainage in the first 24-hour period. The effect of negative pressure drainage on reoperative rates, mortality, and length of hospitalization remains unclear.
CONCLUSIONS
For patients underwent thyroidectomy with neck dissection, the difference between negative and natural pressure drainage groups remains uncertain due to sparse data. The quality of evidence for the above findings is low. The risk of bias for the studies is also serious. Therefore, more randomized or non-randomized controlled trials with larger sample sizes are required.
Topics: Drainage; Humans; Length of Stay; Neck Dissection; Postoperative Complications; Surgical Wound Infection; Thyroidectomy
PubMed: 30075525
DOI: 10.1097/MD.0000000000011576 -
Academic Emergency Medicine : Official... Mar 2021Cutaneous abscesses are common presentations to the emergency department. While the primary treatment for most abscesses is conventional incision and drainage (CID),... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Cutaneous abscesses are common presentations to the emergency department. While the primary treatment for most abscesses is conventional incision and drainage (CID), this is painful and can lead to multiple return visits. The loop drainage technique (LDT) has been proposed as an alternate, less-invasive approach to abscess management. The primary outcome of this study was to compare LDT with CID for skin and soft tissue abscesses.
METHODS
PubMed, Scopus, CINAHL, LILACS, Google Scholar, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, and bibliographies of selected articles were assessed for all retrospective, prospective observational, and randomized controlled trials comparing treatment failures between LDT and CID among patients with skin and soft tissue abscesses. Data were dual extracted into a predefined worksheet and quality analysis was performed using the Cochrane Risk of Bias tool or the Newcastle-Ottawa scale. Data were summarized and presented as odds ratios (ORs) with 95% confidence intervals (CIs). Subgroup analyses were performed for adult and pediatric patients.
RESULTS
A total of 1,374 studies were identified with eight studies (n = 910 patients) selected for inclusion. Overall, CID failed in 69 of 487 patients (14.17%), while LDT failed in 35 of 423 patients (8.27%). There was an OR of 2.02 (95% CI = 1.29 to 3.18) in favor of higher failures in the CID group. This finding remained consistent with only randomized controlled trials (OR = 1.75, 95% CI = 1.07 to 2.86), but no difference was identified in the adult or pediatric subgroups.
CONCLUSION
The LDT was associated with reduced treatment failures when compared with CID. Future studies should further assess the impact on pain, cosmetic outcomes, and health care costs.
Topics: Abscess; Adult; Child; Drainage; Humans; Observational Studies as Topic; Retrospective Studies; Skin Diseases; Treatment Failure
PubMed: 33037713
DOI: 10.1111/acem.14151