scholarly journals 413 Posterior Stabilisation Without Formal Debridement for The Treatment of Non-Tuberculous Pyogenic Spinal Infection in A Frail and Debilitated Population – A Systematic Review and Meta-Analysis

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
M Elmajee ◽  
C Munasinghe ◽  
A Aljawadi ◽  
K Elawady ◽  
F Shuweihde ◽  
...  
Keyword(s):  
Posterior Approach ◽  
Meta Analysis ◽  
Spinal Infection ◽  
Spinal Instability ◽  
Surgical Interventions ◽  
Spine Tango ◽  
Neurological Outcomes ◽  
Neurological Improvement ◽  
Posterior Stabilisation ◽  
Successful Infection

Abstract Background Non-tuberculous pyogenic spinal infection (PSI) incorporates a variety of different clinical conditions. Surgical interventions may be necessary for severe cases where there is evidence of spinal instability or neurological compromise. The primary surgical procedure focuses on the anterior approach with aggressive debridement of the infected tissue regions. We aim to evaluate the effectiveness of the posterior approach without debridement. Method Several databases including MEDLINE, NHS evidence and the Cochrane database were searched. The main clinical outcomes evaluated include pain, neurological recovery (Frankel Grading System, FGS) post-operative complications and functional outcomes (Kirkaldy-Willis Criteria and Spine Tango Combined Outcome Measure Index, COMI). Results From the four papers included in the meta-analysis, post-operative pain levels were found to be lower at a statistically significant level when a random effects model was applied, with the effect size found to be at 0.872 (p < 0.001, 95% CI: 0.7137 to 1.0308). Post-surgical neurological improvement was also demonstrated with a mean FGS improvement of 1.12 in 64 patients over the included articles. Conclusions Posterior approach with posterior stabilisation without formal debridement can results in successful infection resolution, improved pain scores and neurological outcomes. However, Larger series with longer follow-up duration are strongly recommended.

Mechanical thrombectomy in pediatric stroke: systematic review, individual patient data meta-analysis, and case series

2019 ◽  
Vol 24 (5) ◽  
pp. 558-571 ◽  
Author(s):  
Kartik Bhatia ◽  
Hans Kortman ◽  
Christopher Blair ◽  
Geoffrey Parker ◽  
David Brunacci ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Case Reports ◽  
Meta Analysis ◽  
Case Series ◽  
Neurological Outcomes

OBJECTIVEThe role of mechanical thrombectomy in pediatric acute ischemic stroke is uncertain, despite extensive evidence of benefit in adults. The existing literature consists of several recent small single-arm cohort studies, as well as multiple prior small case series and case reports. Published reports of pediatric cases have increased markedly since 2015, after the publication of the positive trials in adults. The recent AHA/ASA Scientific Statement on this issue was informed predominantly by pre-2015 case reports and identified several knowledge gaps, including how young a child may undergo thrombectomy. A repeat systematic review and meta-analysis is warranted to help guide therapeutic decisions and address gaps in knowledge.METHODSUsing PRISMA-IPD guidelines, the authors performed a systematic review of the literature from 1999 to April 2019 and individual patient data meta-analysis, with 2 independent reviewers. An additional series of 3 cases in adolescent males from one of the authors’ centers was also included. The primary outcomes were the rate of good long-term (mRS score 0–2 at final follow-up) and short-term (reduction in NIHSS score by ≥ 8 points or NIHSS score 0–1 at up to 24 hours post-thrombectomy) neurological outcomes following mechanical thrombectomy for acute ischemic stroke in patients < 18 years of age. The secondary outcome was the rate of successful angiographic recanalization (mTICI score 2b/3).RESULTSThe authors’ review yielded 113 cases of mechanical thrombectomy in 110 pediatric patients. Although complete follow-up data are not available for all patients, 87 of 96 (90.6%) had good long-term neurological outcomes (mRS score 0–2), 55 of 79 (69.6%) had good short-term neurological outcomes, and 86 of 98 (87.8%) had successful angiographic recanalization (mTICI score 2b/3). Death occurred in 2 patients and symptomatic intracranial hemorrhage in 1 patient. Sixteen published thrombectomy cases were identified in children < 5 years of age.CONCLUSIONSMechanical thrombectomy may be considered for acute ischemic stroke due to large vessel occlusion (ICA terminus, M1, basilar artery) in patients aged 1–18 years (Level C evidence; Class IIb recommendation). The existing evidence base is likely affected by selection and publication bias. A prospective multinational registry is recommended as the next investigative step.

scholarly journals Safety and effectiveness of surgical fixation versus non-surgical methods for the treatment of flail chest in adult populations: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Ayobobola A. Apampa ◽  
Ayesha Ali ◽  
Bryar Kadir ◽  
Zubair Ahmed
Keyword(s):  
Systematic Review ◽  
Surgical Intervention ◽  
Meta Analysis ◽  
Adult Population ◽  
Flail Chest ◽  
Surgical Interventions ◽  
Surgical Methods ◽  
Surgical Fixation ◽  
Randomised Controlled ◽  
Pulmonary Status

Abstract Purpose The objective of this systematic review is to compare the safety and efficacy of surgical fixation of rib fractures against non-surgical interventions for the treatment of flail chest in the adult population. Methods A search was performed on the 22nd of July 2020 to identify articles comparing surgical fixation versus clinical management for flail chest in adults, with a description of the outcome parameters (resource utility, mortality, adverse effects of the intervention and adverse progression in pulmonary status). Relevant randomised controlled trials were selected, their risk of bias assessed, and the data then extracted and analysed. Results 157 patients were included from four studies in the analyses, with 79 and 78 patients in the surgical and non-surgical groups, respectively. The pooled effects of all outcomes tended towards favouring surgical intervention. Surgical intervention was associated with lower rates of pneumonia (I2 = 46%, Tau2 = 0.16, p = 0.16), significantly lower rates of tracheostomy (I2 = 76%, Tau2 = 0.67, p = 0.02), and a significantly lower duration of mechanical ventilation (I2 = 88%, Tau2 = 33.7, p < 0.01) in comparison to the non-surgical management methods. Conclusion Our results suggest that surgical intervention reduces the need for tracheostomy, reduces the time spent in the intensive care unit following a traumatic flail chest injury and could reduce the risk of acquiring pneumonia after such an event. There is a need for further well-designed studies with sufficient sample sizes to confirm the results of this study and also detect other possible effects of surgical intervention in the treatment of traumatic flail chest in adults.

scholarly journals Endoscopic transmural drainage is associated with improved outcomes in disconnected pancreatic duct syndrome: a systematic review and meta-analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Eric Chong ◽  
Chathura Bathiya Ratnayake ◽  
Samantha Saikia ◽  
Manu Nayar ◽  
Kofi Oppong ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pancreatic Duct ◽  
Meta Analysis ◽  
Fluid Collection ◽  
Significant Heterogeneity ◽  
Success Rates ◽  
Surgical Interventions ◽  
Transmural Drainage ◽  
Transpapillary Drainage ◽  
Duct Syndrome

Abstract Background Disconnected pancreatic duct syndrome (DPDS) is a complication of acute necrotizing pancreatitis in the neck and body of the pancreas often manifesting as persistent pancreatic fluid collection (PFC) or external pancreatic fistula (EPF). This systematic review and pairwise meta-analysis aimed to review the definitions, clinical presentation, intervention, and outcomes for DPDS. Methods The PubMed, EMBASE, MEDLINE, and SCOPUS databases were systematically searched until February 2020 using the PRISMA framework. A meta-analysis was performed to assess the success rates of endoscopic and surgical interventions for the treatment of DPDS. Success of DPDS treatment was defined as long-term resolution of symptoms without recurrence of PFC, EPF, or pancreatic ascites. Results Thirty studies were included in the quantitative analysis comprising 1355 patients. Acute pancreatitis was the most common etiology (95.3%, 936/982), followed by chronic pancreatitis (3.1%, 30/982). DPDS commonly presented with PFC (83.2%, 948/1140) and EPF (13.4%, 153/1140). There was significant heterogeneity in the definition of DPDS in the literature. Weighted success rate of endoscopic transmural drainage (90.6%, 95%-CI 81.0–95.6%) was significantly higher than transpapillary drainage (58.5%, 95%-CI 36.7–77.4). Pairwise meta-analysis showed comparable success rates between endoscopic and surgical intervention, which were 82% (weighted 95%-CI 68.6–90.5) and 87.4% (95%-CI 81.2–91.8), respectively (P = 0.389). Conclusions Endoscopic transmural drainage was superior to transpapillary drainage for the management of DPDS. Endoscopic and surgical interventions had comparable success rates. The significant variability in the definitions and treatment strategies for DPDS warrant standardisation for further research.

scholarly journals Percutaneous Versus Surgical Interventions for Hepatic Cystic Echinococcosis: A Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
G. L. E. Mönnink ◽  
C. Stijnis ◽  
O. M. van Delden ◽  
R. Spijker ◽  
M. P. Grobusch
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Treatment Options ◽  
Length Of Hospital Stay ◽  
Percutaneous Treatment ◽  
Invasive Treatment ◽  
Surgical Interventions ◽  
Percutaneous Therapy ◽  
Registration Number ◽  
Hepatic Echinococcosis

Abstract Purpose This systematic review and meta-analysis summarises the current literature on invasive treatment options of cystic hepatic echinococcosis (CE), comparing percutaneous radiological interventions to surgery, still the cornerstone of treatment in many countries. Methods A literature search was conducted in Medline and EMBASE databases (PROSPERO registration number: CRD42019126150). The primary outcome was recurrence of cysts after treatment. Secondary outcomes were complications, duration of hospitalisation, mortality and treatment conversion. Results The number of eligible prospective studies, in particular RCTs, was limited. In the four included studies, only conventional surgery is compared directly to percutaneous techniques. From the available data, in terms of recurrence, percutaneous treatment of hydatid cysts is non-inferior to open surgery. With regard to complications and length of hospital stay, outcomes favour percutaneous therapy. Conclusion Although evidence from prospective research is small, percutaneous treatment in CE is an effective, safe and less invasive alternative to surgery.

Surgical treatment of rectovaginal fistulas (systematic literature review)

2021 ◽  
pp. 30-48
Author(s):  
Andrei Anatolevich Mudrov ◽  
Aleksandr Yur’evich Titov ◽  
Mariyam Magomedovna Omarova ◽  
Sergei Alekseevich Frolov ◽  
Ivan Vasilevich Kostarev ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Literature Review ◽  
Systematic Literature Review ◽  
Meta Analysis ◽  
High Recurrence Rate ◽  
Surgical Interventions ◽  
Rectovaginal Fistulas ◽  
Surgical Treatments

Despite the large number of available surgical interventions aimed at the treatment of rectovaginal fistulas, the results of their use remain extremely disappointing, associated with the high recurrence rate of the disease reaching 80 %, as well as the lack of a single tactic to minimize the risk of anal incontinence and the need for colostomy. Objective: to conduct a systematic literature review in order to summarize information related to the rectovaginal fistulas surgery. The systematic review includes the results of an analysis of 97 clinical trials selected from 756 publications found in databases. Inclusion criteria: a full-text article, the presence of at least 5 patients in the study, as well as data on the outcome of surgery. Clinical trials with different surgical treatments were identified and classified into the following categories: elimination of the rectovaginal septal defect with a displaced flap (rectal and vaginal); Martius surgery; gracilis muscle transposition; transperineal procedure; abdominal procedure including endoscopic and laparoscopic methods; use of biological or biocompatible materials. Treatment outcomes vary significantly from 0 % to > 80 %. None of the studies were randomized. Due to the low quality of the identified studies, comparison of results and meta-analysis conduction were not possible. Conclusion: as a result of the systematic review, data for the analysis and development of any strategic and tactical algorithms for the treatment of RVF were not obtained. The most important questions still remain open: what and when surgical method to choose, is it necessary to form a disconnecting stoma?

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