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Visceral Medicine Oct 2022Spontaneous or postoperative gastrointestinal defects are still life-threatening complications with elevated morbidity and mortality. Recently, endoscopic treatment...
BACKGROUND
Spontaneous or postoperative gastrointestinal defects are still life-threatening complications with elevated morbidity and mortality. Recently, endoscopic treatment options - up and foremost endoscopic vacuum therapy (EVT) - have become increasingly popular and have shown promising results in these patients.
METHODS
We performed an electronic systematic search of the MEDLINE databases (PubMed, EMBASE, and Cochrane) and searched for studies evaluating endoscopic options for the treatment of esophageal and colorectal leakages and/or perforations until March 2022.
RESULTS
The closure rate of both esophageal and colorectal defects by EVT is high and even exceeds the results of surgical revision in parts. Out of all endoscopic treatment options, EVT shows most evidence and appears to have the highest therapeutic success rates. Furthermore, EVT for both indications had a low rate of serious complications without relevant in-hospital mortality. In selected patients, EVT can be applied without fecal diversion and transferred to an outpatient setting.
CONCLUSION
Despite multiple endoscopic treatment options, EVT is increasingly becoming the new gold standard in endoscopic treatment of extraperitoneal defects of the upper and lower GI tract with localized peritonitis or mediastinitis and without close proximity to major blood vessels. However, further prospective, comparative studies are needed to strengthen the current evidence.
PubMed: 37970585
DOI: 10.1159/000526759 -
Endoscopy International Open Sep 2021Esophageal defects (leaks, fistulas, and perforations) are associated with significant morbidity and mortality. Endoluminal vacuum-assisted closure (EVAC) is a novel... (Review)
Review
Esophageal defects (leaks, fistulas, and perforations) are associated with significant morbidity and mortality. Endoluminal vacuum-assisted closure (EVAC) is a novel intervention that entails the use of sponges in the defect along with negative pressure to achieve granulation tissue formation and healing and has been gaining popularity. We performed a systematic review and pooled analysis of available literature to assess the safety and effectiveness of EVAC for esophageal defects. We queried PubMed/Medline, Embase, Cochrane, and Web of Science through September 25, 2020 to include all pertinent articles highlighting the safety and effectiveness profile of EVAC for esophageal defects. Pooled rates, 95 % confidence intervals (CIs), and heterogeneity ( ) were assessed for each outcome. A total of 18 studies with 423 patients were included (mean age 64.3 years and males 74.4 %). The technical success for EVAC was 97.1 % (CI: 95.4 %-98.7 %, = 0 %). The clinical success was 89.4 % (CI: 85.6 %-93.1 %, = 36.8 %). The overall all-cause mortality and adverse events (AEs) noted were 7.1 % (CI: 4.7 %-9.5 %, = 0 %) and 13.6 % (CI: 8.0 %-19.1 %, = 68.9 %), respectively. The pooled need for adjuvant therapy was 15.7 % (CI: 9.8 %-21.6 %, = 71.1 %). This systematic review and meta-analysis showed high rates of technical success, clinical success, and low all-cause mortality and AEs using EVAC. Although the technique is a promising alternative, the lack of comparative studies poses a challenge in making definite conclusions regarding use of EVAC compared to other endoscopic modalities, such as clips and stents.
PubMed: 34466361
DOI: 10.1055/a-1508-5947 -
AJNR. American Journal of Neuroradiology Nov 2022Arterial perforation is a potentially serious complication during endovascular thrombectomy.
BACKGROUND
Arterial perforation is a potentially serious complication during endovascular thrombectomy.
PURPOSE
Our aim was to describe interventional approaches after arterial perforation during endovascular thrombectomy and to determine whether reperfusion remains associated with favorable outcome despite this complication.
DATA SOURCES
Data from consecutive patients with acute stroke undergoing endovascular thrombectomy were retrospectively collected between 2015 to 2020 from a single-center cohort, and a systematic review was performed using PubMed, EMBASE, and Ovid MEDLINE up to June 2020.
STUDY SELECTION
Articles reporting functional outcome after arterial perforation during endovascular thrombectomy were selected.
DATA ANALYSIS
Functional outcomes of patients achieving successful reperfusion (TICI 2b/3) were compared with outcomes of those with unsuccessful reperfusion in our single-center cohort. We then summarized the literature review to describe interventional approaches and outcomes after arterial perforation during endovascular thrombectomy.
DATA SYNTHESIS
In our single-center cohort, 1419 patients underwent endovascular thrombectomy, among whom 32 (2.3%) had vessel perforation and were included in the analysis. The most common hemostatic strategy was watchful waiting (71% of cases). Patients with successful reperfusion had a higher proportion of favorable 90-day mRS scores (60% versus 12.5%; = .006) and a lower mortality rate (13.3% versus 56.3%, = .01) than patients without successful reperfusion. Thirteen articles were included in the systematic review. Successful reperfusion also appeared to be associated with better outcomes.
LIMITATIONS
Given the low number of published reports, we performed only a descriptive analysis.
CONCLUSIONS
Arterial perforation during endovascular thrombectomy is rare but is associated with high mortality rates and poor outcome. However, successful reperfusion remains correlated with favorable outcome in these patients.
Topics: Humans; Retrospective Studies; Endovascular Procedures; Treatment Outcome; Thrombectomy; Reperfusion; Stroke; Brain Ischemia
PubMed: 36175082
DOI: 10.3174/ajnr.A7650 -
Journal of Periodontology Aug 2016Schneiderian membrane thickness (SMT) has been regarded as a key factor for influencing membrane perforation, which may jeopardize the final clinical outcome of sinus... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Schneiderian membrane thickness (SMT) has been regarded as a key factor for influencing membrane perforation, which may jeopardize the final clinical outcome of sinus augmentation. Hence, this systematic review aims at studying the mean SMT and further investigating patient-related factors that may affect SMT. As a secondary goal, the association between SMT and membrane perforation rate was studied.
METHODS
Three independent reviewers in several databases, including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Oral Health Group Trials Register databases, conducted electronic and manual literature searches. This review was written and conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and MECIR (Methodological Expectations of Cochrane Intervention Reviews) guidelines. Quantitative assessment was performed for articles that met the inclusion criteria to investigate the mean SMT, its contributing factors, and the influence on membrane damage and surgical complications.
RESULTS
Thirty-one studies that reported maxillary SMT were considered for qualitative analysis. Nineteen were further meta-analyzed. Overall mean ± SE SMT was 1.17 ± 0.1 mm (95% confidence interval [CI] = 0.89 to 1.44). Although mean SMT for the three-dimensional radiography (3DR) group was 1.33 mm (95% CI = 1.06 to 1.60), for the histology group, it was 0.48 mm (95% CI = 0.12 to 1.1). Random-effects model showed that, although there is a trend for thicker SMT as determined using 3DR compared with histologic analysis, such difference did not reach statistical significance (P = 0.15). Also, regression analyses demonstrated that the variables periodontitis (P = 0.13) and smoking (P = 0.11) showed thicker SMT. Inconclusive data were obtained when correlating SMT and perforation rate, although it seems that thicker SMT might be more prone to perforation (P = 0.14).
CONCLUSIONS
SMT is, on average, 1 mm in patients seeking sinus augmentation. Three-dimensional technologies overestimate approximately 2.5 times SMT when compared with histologic analysis. Periodontitis and smoking may result in thickening of the sinus membrane. However, current data were inconclusive to link SMT to the rate of membrane damage.
Topics: Alveolar Bone Loss; Bone Regeneration; Bone Transplantation; Dental Prosthesis Design; Humans; Maxilla; Maxillary Sinus; Nasal Mucosa; Regression Analysis
PubMed: 27086614
DOI: 10.1902/jop.2016.160041 -
Frontiers in Pediatrics 2018Neonatal gastric perforation (NGP) is a rare entity. Our aim was to report our experience and review the recent literature to characterize NGP, describe associated...
INTRODUCTION
Neonatal gastric perforation (NGP) is a rare entity. Our aim was to report our experience and review the recent literature to characterize NGP, describe associated factors, and define prognostic factors.
MATERIALS AND METHODS
Retrospective review of all consecutive patients with NGP treated between June 2009 and December 2017 in a third level pediatric hospital. In addition, a systematic review of Medline and Scopus database was performed using a defined strategy. All articles referring to NGP published between 2005 and 2017 were retrieved. Variables considered: prematurity (<37 weeks gestation), birth weight (BW), Apgar score, prenatal complications, age at diagnosis, bag ventilation, pathogenetic events, site of perforation, treatment of perforation, sepsis, and outcome. Mann-Whitney or Fisher's test were used as appropriate. Results are median (range) or prevalence.
RESULTS
Between 2009 and 2016 we treated 8 consecutive patients for NGP and 199 further cases were retrieved from the systematic review (total of 207 patients). Overall survival was 73%. Most frequently reported pathogenesis: iatrogenic (20 patients), hypoxic/ischemic or infection stress (13 patients), duodenal/jejunal obstruction (11 patients), drugs (11 patients), esophageal atresia (10 patients). 60% patients had only primary repair of the perforation as gastric surgery. Sepsis developed in 56 patients (34%).
CONCLUSION
Although the pathogenesis of NGP is pleomorphic, prematurity and low BWs are frequent in these patients. Reviewing our experience and the available literature, none of the variables considered, but sepsis was associated with mortality.
PubMed: 29670869
DOI: 10.3389/fped.2018.00061 -
Translational Andrology and Urology Sep 2019Flexible ureteroscopy (FURS) is now commonly used for the treatment of paediatric renal stones. We conducted a systematic review of literature looking at the outcomes of... (Review)
Review
Flexible ureteroscopy (FURS) is now commonly used for the treatment of paediatric renal stones. We conducted a systematic review of literature looking at the outcomes of flexible ureteroscopy and laser lithotripsy (FURSL) for paediatric stone disease. A systematic review was conducted in a Cochrane style and in accordance PRISMA checklist using MEDLINE, CINAHL, EMBASE, Scopus, and Cochrane library for all English language articles in patients ≤18 years from 1990-2018 who underwent FURSL. A total of 11 studies reported on 431 patients, with a mean age of 8.5 years (range, 0.25-17 years). The mean stone size was 13 mm (range, 1.5-30 mm). The overall stone free rate (SFR) was 87% (58-100%) with a mean complication rate of 12.6% (n=55) (range, 0-31.3%) and 76% needing a post-operative ureteric stent insertion. Of the complications, Clavien I/II complications included fever and urinary tract infection (UTI) (n=19), haematuria (n=7), stent discomfort/stent symptoms/post-operative pain (n=8), voiding disturbance (n=2) and post-operative nausea and vomiting (n=1). Clavien III complications included ureteral injury which included perforation (n=6), urinoma (n=1), and acute urinary retention secondary to stone fragmentation (n=1). Clavien IV complications were urinoma (n=2) and no Clavien V complications were noted. Our review suggests that ureteroscopy and laser stone fragmentation for paediatric population is a safe and effective treatment with good SFR and a low risk of complications.
PubMed: 31656750
DOI: 10.21037/tau.2019.08.23 -
Archives of Plastic Surgery May 2023The medial sural artery perforator (MSAP) flap is a versatile fasciocutaneous flap, and yet is less commonly utilized than other free flaps in microvascular...
The medial sural artery perforator (MSAP) flap is a versatile fasciocutaneous flap, and yet is less commonly utilized than other free flaps in microvascular reconstructions of the head and neck. The aim is to conduct a high-quality Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA)- and Assessment of Multiple Systematic Reviews 2 (AMSTAR 2)-compliant systematic review comparing the use of the MSAP flap to other microvascular free flaps in the head and neck. Medline, Embase, and Web of Science databases were searched to identify all original comparative studies comparing patients undergoing head and neck reconstruction with an MSAP flap to the radial forearm free flap (RFFF) or anterolateral thigh (ALT) flap from inception to February 2021. Outcome studied were the recipient-site and donor-site morbidities as well as speech and swallow function. A total of 473 articles were identified from title and abstract review. Four studies met the inclusion criteria. Compared with the RFFF and the ALT flaps, the MSAP flap had more recipient-site complications (6.0 vs 10.4%) but less donor-site complications (20.2 vs 7.8%). The MSAP flap demonstrated better overall donor-site appearance and function than the RFFF and ALT flaps ( = 0.0006) but no statistical difference in speech and swallowing function following reconstruction ( = 0.28). Although higher quality studies reviewing the use of the MSAP flap to other free flaps are needed, the MSAP flap provides a viable and effective reconstructive option and should be strongly considered for reconstruction of head and neck defects.
PubMed: 37256040
DOI: 10.1055/a-2059-4009 -
Plastic Surgery (Oakville, Ont.) 2015Even with patent deep inferior epigastric vein anastomoses, venous congestion can occur during free transverse rectus abdominis musculocutaneous (TRAM) or deep inferior... (Review)
Review
Intraoperative venous congestion in free transverse rectus abdominis musculocutaneous and deep inferior epigastric artery perforator flaps during breast reconstruction: A systematic review.
BACKGROUND
Even with patent deep inferior epigastric vein anastomoses, venous congestion can occur during free transverse rectus abdominis musculocutaneous (TRAM) or deep inferior epigastric artery perforator (DIEP) flap surgery and lead to flap compromise if not recognized and managed.
OBJECTIVES
To identify the incidence of intraoperative venous congestion and describe the best available prevention and treatment methods.
METHODS
Systematic electronic searches of the PubMed database including Medline were performed to identify studies published until 2014. The following keywords were used: "DIEP" or "free TRAM" and "venous insufficiency" or "venous congestion". Supplemental searches were conducted to identify referenced studies. Statistical analysis using the χ(2) test was performed.
RESULTS
Nine studies representing 4747 free abdominal flaps cases were included and demonstrated an overall incidence of intraoperative venous congestion of 2.8%. The incidence in DIEP flaps (3.3%) was significantly higher than that in the free TRAM flaps (1.0%). All nine articles reported using the superficial inferior epigastric vein to treat venous insufficiency.
CONCLUSION
The risk for developing intraoperative venous congestion following free abdominal flap breast reconstruction is influenced by inadequate perforator selection and persistent dominance in the superficial venous system. The solution is establishing another venous draining route using the superficial inferior epigastric vein.
PubMed: 26665142
DOI: No ID Found -
Endoscopy Dec 2023Cold snare endoscopic mucosal resection (CS-EMR) can reduce the risks associated with electrocautery during colon polyp resection. Data on efficacy are variable. This... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Cold snare endoscopic mucosal resection (CS-EMR) can reduce the risks associated with electrocautery during colon polyp resection. Data on efficacy are variable. This systematic review and meta-analysis aimed to estimate the pooled efficacy and safety rates of CS-EMR.
METHODS
We conducted a comprehensive literature search of multiple databases, from inception to March 2023, for studies addressing outcomes of CS-EMR for colon polyps. The weighted pooled estimates with 95 %CIs were calculated using the random effects model. statistics were used to evaluate heterogeneity.
RESULTS
4137 articles were reviewed, and 16 studies, including 2592 polyps in 1922 patients (51.4 % female), were included. Overall, 54.4 % of polyps were adenomas, 45 % were sessile serrated lesions (SSLs), and 0.6 % were invasive carcinomas. Polyp recurrence after CS-EMR was 6.7 % (95 %CI 2.4 %-17.4 %, = 94 %). The recurrence rate was 12.3 % (95 %CI 3.4 %-35.7 %, = 94 %) for polyps ≥ 20 mm, 17.1 % (95 %CI 4.6 %-46.7 %, = 93 %) for adenomas, and 5.7 % (95 %CI 3.2 %-9.9 %, = 50 %) for SSLs. The pooled intraprocedural bleeding rate was 2.6 % (95 %CI 1.5 %-4.5 %, = 51 %), the delayed bleeding rate was 1.5 % (95 %CI 0.8 %-2.7 %, = 18 %), and no perforations or post-polypectomy syndromes were reported, with estimated rates of 0.6 % (95 %CI 0.3 %-1.3 %, = 0 %) and 0.6 % (95 %CI 0.3 %-1.4 %, = 0 %), respectively.
CONCLUSION
CS-EMR demonstrated an excellent safety profile for colon polyps, with variable recurrence rates based on polyp size and histology. Large prospective studies are needed to validate these findings.
Topics: Humans; Female; Male; Colonic Polyps; Endoscopic Mucosal Resection; Colonoscopy; Colon; Adenoma; Colorectal Neoplasms
PubMed: 37451284
DOI: 10.1055/a-2129-5752 -
Digestion 2023With the development of endoscopic technology and devices, endoscopic full-thickness resection (EFTR) has been challengingly introduced for gastric subepithelial tumors... (Review)
Review
BACKGROUND
With the development of endoscopic technology and devices, endoscopic full-thickness resection (EFTR) has been challengingly introduced for gastric subepithelial tumors (SETs). The resection and closure strategies are under investigation. This systematic review was performed to assess the current status and limitations of EFTR for gastric SETs.
SUMMARY
MEDLINE was searched using the keywords "endoscopic full-thickness resection" or "gastric endoscopic full-thickness closure" AND "gastric" or "stomach" from January 2001 to July 2022. The outcome variables were the complete resection rate, major adverse event (AE) rate including delayed bleeding and delayed perforation, and closure-associated outcomes. Among 288 studies, 27 eligible studies involving 1,234 patients were included in this review. The complete resection rate was 99.7% (1,231/1,234). The major AE rate was 1.13% (14/1,234), with delayed bleeding in two (0.16%) patients, delayed perforation in one (0.08%), panperitonitis or abdominal abscess in three (0.24%), and other AEs in eight (0.64%). Surgical interventions were required intraoperatively or postoperatively in 7 patients (0.56%). Three patients underwent intraoperative conversion to surgery, due to intraoperative massive bleeding, technical difficulty of closure, and retrieval of falling tumor in the peritoneal cavity. Postoperative surgical rescues for AEs were required in four (0.32%). Subgroup analysis of AE outcomes showed no significant differences among closure techniques consisting of endoclips, purse-string suturing, and over-the-scope clips.
KEY MESSAGES
This systematic review demonstrated acceptable outcomes of EFTR and closure for gastric SETs, indicating that EFTR is a promising forthcoming procedure.
Topics: Humans; Stomach Neoplasms; Endoscopy; Wound Closure Techniques; Gastrectomy; Endoscopic Mucosal Resection; Retrospective Studies; Treatment Outcome; Gastroscopy
PubMed: 37423206
DOI: 10.1159/000530679