scholarly journals Comparison of emergency cholecystectomy and delayed cholecystectomy after percutaneous transhepatic gallbladder drainage in patients with acute cholecystitis: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Shao-Zhuo Huang ◽  
Hao-Qi Chen ◽  
Wei-Xin Liao ◽  
Wen-Ying Zhou ◽  
Jie-Huan Chen ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Blood Loss ◽  
Acute Cholecystitis ◽  
Conversion Rate ◽  
Operative Time ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Intraoperative Blood Loss ◽  
Gallbladder Drainage ◽  
Percutaneous Transhepatic Gallbladder Drainage

Abstract Laparoscopic cholecystectomy and percutaneous transhepatic gallbladder drainage (PTGBD) are common treatments for patients with acute cholecystitis. However, the safety and efficacy of emergency laparoscopic cholecystectomy (ELC) and delayed laparoscopic cholecystectomy (DLC) after PTGBD in patients with acute cholecystitis remain unclear. The PubMed, EMBASE, and Cochrane Library databases were searched through October 2019. The quality of the included nonrandomized studies was assessed using the Methodological Index for Nonrandomized Studies (MINORS). The meta-analysis was performed using STATA version 14.2. A random-effects model was used to calculate the outcomes. A total of fifteen studies involving 1780 patients with acute cholecystitis were included in the meta-analysis. DLC after PTGBD was associated with a shorter operative time (SMD − 0.51; 95% CI − 0.89 to − 0.13; P = 0.008), a lower conversion rate (RR 0.43; 95% CI 0.26 to 0.69; P = 0.001), less intraoperative blood loss (SMD − 0.59; 95% CI − 0.96 to − 0.22; P = 0.002) and longer time of total hospital stay compared to ELC (SMD 0.91; 95% CI 0.57–1.24; P < 0.001). There was no difference in the postoperative complications (RR 0.68; 95% CI 0.48–0.97; P = 0.035), biliary leakage (RR 0.65; 95% CI 0.34–1.22; P = 0.175) or mortality (RR 1.04; 95% CI 0.39–2.80; P = 0.933). Compared to ELC, DLC after PTGBD had the advantages of a shorter operative time, a lower conversion rate and less intraoperative blood loss.

scholarly journals Total Hip Arthroplasty After Failed Less Invasive Hip Preservation Surgery for Osteonecrosis of the Femoral Head: A Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
liang mo ◽  
Jianxiong Li ◽  
Zhangzheng Wang ◽  
Fayi Huang ◽  
Pengfei Xin ◽  
...  
Keyword(s):  
Femoral Head ◽  
Total Hip Arthroplasty ◽  
Blood Loss ◽  
Hip Arthroplasty ◽  
Operative Time ◽  
Meta Analysis ◽  
Harris Hip Score ◽  
Cochrane Library ◽  
Intraoperative Blood Loss ◽  
Total Hip

Abstract BackgroundLess invasive hip-preserving surgery (LIHP) is an effective treatment in delaying total hip arthroplasty (THA) for young patients with osteonecrosis of the femoral head (ONFH). But the success rate of it was not as effective as expected and were significantly reduced with the advancement of the diseases stages. Therefore, it is essential to analysis the impact of LIHP on subsequent THA.MethodsThe search language was restricted to Chinese and English, and the references of included studies were also searched. Chinese databases including CNKI, Wan-Fang databases and VIP, and English databases including PubMed, Embase and Cochrane library were searched by the computer from the inception of each database to 23rd May 2021. The outcome indicators were extracted from the included literature and analyzed by Cochrane Collaboration Review Manager software (RevMan version 5.4). The quality of the studies was scored using the Newcastle-Ottawa scale (NOS).ResultsA total of nine articles met the inclusion and were included in this meta-analysis, two of them were published in Chinese and the remaining studies were published in English. Results showed that the LIHP group has longer operative time (SMD=17.31, 95%CI=6.29 to 28.32, p=0.002), more intraoperative blood loss (SMD=79.90, 95%CI=13.92 to 145.87, p=0.02) and higher rate of varus or valgus femoral stem (OR=4.17, 95%CI=1.18 to 14.71, p=0.03) compared to primary THA group. The risk of intraoperative fracture was higher in the prior LIHP THA group compared with primary THA group but the difference was not statistically significant (OR=5.88, 95%CI=0.93 to 37.05, p=0.06). While there was no significant difference in cup anteversion angle (SMD=-0.10, 95%CI=-0.61 to 0.41, p=0.70), cup inclination angle (SMD=0.58, 95%CI=-0.05 to 1.22, p=0.07), postoperative Harris Hip Score (HHS) (SMD=-0.01, 95%CI=-0.43 to 0.46, p=0.96) and survivorship (OR=1.38, 95%CI=0.34 to 5.55, p=0.65) between THA groups with and without prior LIHP.ConclusionAlthough the prior LIHP increased the difficulty of the conversion to THA with longer operative time, more intraoperative blood loss, and higher rate of intraoperative fracture, it does not detrimentally affect the clinical results of subsequent THA in the mid-term following-up.

scholarly journals Surgical outcome of percutaneous transhepatic gallbladder drainage in acute cholecystitis: Ten years’ experience at a tertiary care centre

2021 ◽  
Author(s):  
Szabolcs Ábrahám ◽  
Illés Tóth ◽  
Ria Benkő ◽  
Mária Matuz ◽  
Gabriella Kovács ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Acute Cholecystitis ◽  
Conversion Rate ◽  
Clinical Success ◽  
Definitive Treatment ◽  
Success Rates ◽  
Female Ratio ◽  
Gallbladder Drainage ◽  
Percutaneous Transhepatic Gallbladder Drainage ◽  
Grade Iii

Abstract Background Percutaneous transhepatic gallbladder drainage (PTGBD) plays an important role in the treatment of elderly patients and/or patients in poor health with acute cholecystitis (AC). The primary aim of this study is to determine how these factors influence the clinical outcome of PTGBD. Moreover, we assessed the timing and results of subsequent cholecystectomies. Patients and Methods We retrospectively examined the results of 162 patients undergoing PTGBD between 2010 and 2020 (male–female ratio: 51.23% vs. 48.77%; mean age: 71.43 ± 13.22 years). Patient’s performance status and intervention outcomes were assessed with clinical success rates (CSR) and in-hospital mortality. The conversion rate (CR) of possible urgent or delayed, elective laparoscopic cholecystectomies (LC) after PTGBD were analysed. Results PTGBD was the definitive treatment in 42.18% of patients, while it was a bridging therapy prior to cholecystectomy (CCY) for the other patients. CSR was 87.97%, it was only 64.29% in grade III AC. In 9.87% of the cases, urgent LC was necessary after PTGBD, and its conversion rate was approximately equal to that of elective LC (18.18 vs. 17.46%, respectively, p = 0.2217). Overall, the post-PTGBD in-hospital mortality was 11.72%, while the same figure was 0% for grade I AC, 7.41% for grade II and 40.91% for grade III. Based on logistic regression analyses, in-hospital mortality (OR 6.07; CI 1.79–20.56), clinical progression (OR 7.62; CI 2.64–22.05) and the need for emergency CCY (OR 14.75; CI 3.07–70.81) were mostly determined by AC severity grade. Conclusion PTGBD is an easy-to-perform intervention with promising clinical success rates in the treatment of acute cholecystitis. After PTGBD, the level of gallbladder inflammation played a decisive role in the course of AC. In a severe, grade III inflammation, we have to consider low CSR and high mortality.

Effects of Preoperative Iodine Administration on Thyroidectomy for Hyperthyroidism: A Systematic Review and Meta-analysis

2019 ◽  
Vol 160 (6) ◽  
pp. 993-1002 ◽  
Author(s):  
Chung-Hsin Tsai ◽  
Po-Sheng Yang ◽  
Jie-Jen Lee ◽  
Tsang-Pai Liu ◽  
Chi-Yu Kuo ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Blood Loss ◽  
Operative Time ◽  
Meta Analysis ◽  
Thyroid Volume ◽  
Vocal Cord Palsy ◽  
Significant Heterogeneity ◽  
Intraoperative Blood Loss ◽  
Significant Difference ◽  
And Control

Objective The current guidelines recommend that potassium iodide be given in the immediate preoperative period for patients with Graves’ disease who are undergoing thyroidectomy. Nonetheless, the evidence behind this recommendation is tenuous. The purpose of this study is to clarify the benefits of preoperative iodine administration from published comparative studies. Data Sources We searched PubMed, Embase, Cochrane, and CINAHL from 1980 to June 2018. Review Methods Studies were included that compared preoperative iodine administration and no premedication before thyroidectomy. For the meta-analysis, studies were pooled with the random-effects model. Results A total of 510 patients were divided into the iodine (n = 223) and control (n = 287) groups from 9 selected studies. Preoperative iodine administration was significantly associated with decreased thyroid vascularity and intraoperative blood loss. Significant heterogeneity was present among studies. We found no significant difference in thyroid volume or operative time. Furthermore, the meta-analysis showed no difference in the risk of postoperative complications, including vocal cord palsy, hypoparathyroidism/hypocalcemia, and hemorrhage or hematoma after thyroidectomy. Conclusion Preoperative iodine administration decreases thyroid vascularity and intraoperative blood loss. Nonetheless, it does not translate to more clinically meaningful differences in terms of operative time and postoperative complications.

scholarly journals Drainage versus No Drainage after Laparoscopic Cholecystectomy for Acute Cholecystitis: A Meta-Analysis

2019 ◽  
Vol 85 (1) ◽  
pp. 86-91
Author(s):  
Ming Xu ◽  
You-Liang Tao
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Randomized Clinical Trials ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Wound Infection Rate ◽  
Cochrane Library ◽  
Prophylactic Drainage ◽  
Significant Difference ◽  
The Cochrane Library

To conduct a randomized controlled trial (RCT), meta-analysis to assess the effectiveness of drains in reducing complications after laparoscopic cholecystectomy (LC) for acute cholecystitis needs to be carried out. An electronic search of PubMed, Embase, Science Citation Index, and the Cochrane Library from January 1990 to January 2018 was performed to identify randomized clinical trials that compare prophylactic drainage with no drainage in LC for acute cholecystitis. The outcomes were calculated as odds ratios (ORs) with 95 per cent confidence intervals (CIs) using RevMan 5.2. Four RCTs, which included 796 patients, were identified for analysis in our study. There was no statistically significant difference in the rate of morbidities (OR = 1.23, 95% CI 0.55–2.76, P = 0.61). Abdominal pain was more severe in the drain group 24 hours after surgery (mean difference = 0.80, 95% CI 0.47–1.14; P < 0.00001). No significant difference was present with respect to wound infection rate and hospital stay. The use of abdominal drainage does not appear to be of any benefit in patients having undergone early LC for acute cholecystitis.

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