P-BN33 Should a three-port technique be the gold standard for laparoscopic cholecystectomy?

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Lawrence Nip ◽  
Kin Seng Tong ◽  
Cynthia-Michelle Borg
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gold Standard ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Standard Technique ◽  
Mean Difference ◽  
Benign Diseases ◽  
Analgesia Requirement ◽  
Electronic Database Search

Abstract Background The four-port technique is currently considered the gold standard technique for laparoscopic cholecystectomy. A three-port technique has been described but there is no consensus over the safety profile and efficacy of this technique compared to the four-port technique.  Methods A comprehensive systematic review and meta-analysis comparing the three-port technique to the standard four-port technique in laparoscopic cholecystectomy for benign diseases of the gallbladder was performed. Two authors independently conducted an electronic database search of CENTRAL, MEDLINE, EMBASE, CINAHL, WHO ICTRP and ClinicalTrials.gov. For each outcome, we calculated the risk ratio (RR), mean difference (MD) or standardised mean difference (SMD) with 95% confidence intervals.  Results Eighteen trials were included which randomised 2085 participants. Length of hospital stay and postoperative analgesia requirement favoured the three-port group [(MD -0.29, 95% CI -0.43 – -0.16, p < 0.0001) and (SMD -0.68, 95% CI -1.03 – -0.33, p = 0.0001) respectively]. There were no differences in length of procedure and success rate between the two groups [(MD 0.90, 95% CI -3.78 – 5.58, p = 0.71) and (RR 0.99, 95% CI 0.97 – 1.01, p = 0.17) respectively]. There were no differences in the rate of any measured adverse events. There were no mortalities in either group. The GRADE quality of evidence was low. Conclusions The three-port technique for laparoscopic cholecystectomy can be chosen by experienced surgeons who perform it regularly. However, the decision to use three ports should not be at the expense of safe dissection.

scholarly journals The Comparison of Short-Term Postoperative Pain in Single- versus Multiple-Visit Root Canal Treatment: A Systematic Review and Meta-Analysis Study

2021 ◽  
Vol 2021 ◽  
pp. 1-12
Author(s):  
Armin Izadpanah ◽  
Ailar Javaheripour ◽  
Azam Maleki ◽  
Mahdieh Alipour ◽  
Hossein Hosseinifard ◽  
...  
Keyword(s):  
Systematic Review ◽  
Postoperative Pain ◽  
Root Canal ◽  
Meta Analysis ◽  
Mean Difference ◽  
Single Visit ◽  
Multiple Visit ◽  
Statistical Heterogeneity ◽  
The Times

Postoperative pain after root canal therapy (RoCT) is an unpleasant experience for patients, and it could be affected by different factors. The times of visits could be one of these factors that were evaluated in various studies. However, there is inconsistent evidence on the relation between postoperative pain and the times of visits. Therefore, the current systematic review aimed to summarize the results of these studies and meta-analyze them. For this purpose, a comprehensive search was conducted in four main databases (Cochrane Database of Systematic Reviews, Web of Science, PubMed, and Scopus databases) for related English articles from 1978 to August 2020. The quality of studies was evaluated using the Delphi checklist. The heterogeneity of studies was determined by I2 statistic, and publication bias was assessed using the funnel plot and the Begg test. The results were presented by using relative ratio (RR) estimates and standard mean difference (SMD) with its 95% confidence intervals (CI) using a random-effects model. Initial searches from mentioned databases identified 1480 papers; of which only 27 of them met the inclusion criteria. In quality assessment, thirteen studies had quality scores of more than 7, two studies had 4 scores, and the rest had 5 scores. Overall, based on the available evidence, the meta-analysis showed that the risk of postoperative pain in single-visit was 1.02 times (CI 95% (0.99, 1.19), I2 = 60.7%, p = 0.001 ) higher than that of the multiple-visit treatment. The mean difference of postoperative pain in single-visit was −0.30 (CI 95% (−0.36, −0.25), I2 = 0.94.4, p = 0.001 ) compared with the multiple-visit treatment. Based on the results of this meta-analysis, the risk of postoperative pain in single-visit RoCT was higher than that in multiple-visit RoCT with acceptable statistical heterogeneity and moderate quality of the studies.

scholarly journals Non-intubated thoracoscopic lobectomies for lung cancer: an exploratory systematic review and meta-analysis

2020 ◽  
Vol 31 (4) ◽  
pp. 499-506 ◽  
Author(s):  
Elena Prisciandaro ◽  
Luca Bertolaccini ◽  
Giulia Sedda ◽  
Lorenzo Spaggiari
Keyword(s):  
Lung Cancer ◽  
Systematic Review ◽  
Risk Ratio ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Mean Difference ◽  
Complication Rates ◽  
Thoracoscopic Lobectomy ◽  
Retrospective Cohort Studies ◽  
The Individual

Abstract Our goal was to assess the safety, feasibility and oncological outcomes of non-intubated thoracoscopic lobectomies for non-small-cell lung cancer (NSCLC). A comprehensive search was performed in EMBASE (via Ovid), MEDLINE (via PubMed) and Cochrane CENTRAL from January 2004 to March 2020. Studies comparing non-intubated anaesthesia with intubated anaesthesia for thoracoscopic lobectomy for NSCLC were included. An exploratory systematic review and a meta-analysis were performed by combining the reported outcomes of the individual studies using a random effects model. For dichotomous outcomes, risk ratios were calculated and for continuous outcomes, the mean difference was used. Three retrospective cohort studies were included, with a total of 204 patients. The comparison between non-intubated and intubated patients undergoing thoracoscopic lobectomy showed no statistically significant differences in postoperative complication rates [risk ratio 0.65, 95% confidence interval (CI) 0.36–1.16; P = 0.30; I2 = 17%], operating times (mean difference −12.40, 95% CI −28.57 to 3.77; P = 0.15; I2 = 48%), length of hospital stay (mean difference −1.13, 95% CI −2.32 to 0.05; P = 0.90; I2 = 0%) and number of dissected lymph nodes (risk ratio 0.92, 95% CI 0.78–1.25; P = 0.46; I2 = 0%). Despite the limitation of only 3 papers included, awake and intubated thoracoscopic lobectomies for resectable NSCLC seem to have comparable perioperative and postoperative outcomes. Nevertheless, the oncological implications of the non-intubated approach should be considered. The long-term benefits for patients with lung cancer need to be carefully assessed.

scholarly journals Minimally invasive versus conventional surgery of the ascending aorta and root: a systematic review and meta-analysis

2019 ◽  
Vol 57 (1) ◽  
pp. 8-17 ◽  
Author(s):  
Tom A Rayner ◽  
Sean Harrison ◽  
Paul Rival ◽  
Dominic E Mahoney ◽  
Massimo Caputo ◽  
...  
Keyword(s):  
Systematic Review ◽  
Renal Impairment ◽  
Minimally Invasive ◽  
Risk Ratio ◽  
Observational Studies ◽  
Meta Analysis ◽  
Ascending Aorta ◽  
Mean Difference ◽  
Standardized Mean Difference

Summary Limited uptake of minimally invasive surgery (MIS) of the aorta hinders assessment of its efficacy compared to median sternotomy (MS). The objective of this systematic review is to compare operative and perioperative outcomes for MIS versus MS. Online databases Medline, EMBASE, Cochrane Library and Web of Science were searched from inception until July 2018. Both randomized and observational studies of patients undergoing aortic root, ascending aorta or aortic arch surgery by MIS versus MS were eligible for inclusion. Primary outcomes were 30-day mortality, reoperation for bleeding, perioperative renal impairment and neurological events. Intraoperative and postoperative timing measures were also evaluated. Thirteen observational studies were included comparing 1101 MIS and 1405 MS patients. The overall quality of evidence was very low for all outcomes. Mortality and the incidence of stroke were similar between the 2 cohorts. Meta-analysis demonstrated increased length of cardiopulmonary bypass (CPB) time for patients undergoing MS [standardized mean difference 0.36, 95% confidence interval (CI) 0.15–0.58; P = 0.001]. Patients receiving MS spent more time in hospital (standardized mean difference 0.30, 95% CI 0.17–0.43; P < 0.001) and intensive care (standardized mean difference 0.17, 95% CI 0.06–0.27; P < 0.001). Reoperation for bleeding (risk ratio 1.51, 95% CI 1.06–2.17; P = 0.024) and renal impairment (risk ratio 1.97, 95% CI 1.12–3.46; P = 0.019) were also greater for MS patients. There was substantial heterogeneity in meta-analyses for CPB and aortic cross-clamp timing outcomes. MIS may be associated with improved early clinical outcomes compared to MS, but the quality of the evidence is very low. Randomized evidence is needed to confirm these findings.

scholarly journals Is Endoscopic Discectomy the Next Gold Standard in the Management of Lumbar Disc Disease? Systematic Review and Superiority Analysis

2020 ◽  
pp. 219256822094881
Author(s):  
Sathish Muthu ◽  
Eswar Ramakrishnan ◽  
Girinivasan Chellamuthu
Keyword(s):  
Systematic Review ◽  
Hospital Stay ◽  
Gold Standard ◽  
Lumbar Disc ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Disc Disease ◽  
Lumbar Disc Disease ◽  
Endoscopic Discectomy ◽  
Duration Of Surgery

Study Design: Systematic review and meta-analysis. Objectives: We performed this meta-analysis to evaluate whether endoscopic discectomy (ED) shows superiority compared with the current gold standard of microdiscectomy (MD) in management of lumbar disc disease. Materials and Methods: We conducted independent and duplicate electronic database search including PubMed, Embase, and Cochrane Library from 1990 till April 2020 for studies comparing ED and MD in the management of lumbar disc disease. Analysis was performed in R platform using OpenMeta[Analyst] software. Results: We included 27 studies, including 11 randomized controlled trials (RCTs), 7 nonrandomized prospective, and 9 retrospective studies involving 4018 patients in the meta-analysis. We stratified the results based on the study design. Considering the heterogeneity in some results between study designs, we weighed our conclusion essentially based on results of RCTs. On analyzing the RCTs, superiority was established at 95% confidence interval for ED compared with MD in terms of functional outcomes like Oswestry Disability Index (ODI) score ( P = .008), duration of surgery ( P = .023), and length of hospital stay ( P < .001) although significant heterogeneity was noted. Similarly, noninferiority to MD was established by ED in other outcomes like visual analogue scale score for back pain ( P = .860) and leg pain ( P = .495), MacNab classification ( P = .097), recurrences ( P = .993), reoperations ( P = .740), and return-to-work period ( P = .748). Conclusion: Our meta-analysis established the superiority of endoscopic discectomy in outcome measures like ODI score, duration of surgery, overall complications, length of hospital stay and noninferiority in other measures analyzed. With recent advances in the field of ED, the procedure has the potential to take over the place of MD as the gold standard of care in management of lumbar disc disease.

scholarly journals Efficacy of Oral Ginger (Zingiber officinale) for Dysmenorrhea: A Systematic Review and Meta-Analysis

2016 ◽  
Vol 2016 ◽  
pp. 1-10 ◽  
Author(s):  
Chen X. Chen ◽  
Bruce Barrett ◽  
Kristine L. Kwekkeboom
Keyword(s):  
Systematic Review ◽  
Methodological Quality ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Grey Literature ◽  
Zingiber Officinale ◽  
Mean Difference ◽  
Significant Difference ◽  
Meta Analyses

This systematic review examines the efficacy of oral ginger for dysmenorrhea. Key biomedical databases and grey literature were searched. We included randomized controlled trials comparing oral ginger against placebo or active treatment in women with dysmenorrhea. Six trials were identified. Two authors independently reviewed the articles, extracted data, and assessed risk of bias. Discrepancies were resolved by consensus with a third reviewer. We completed a narrative synthesis of all six studies and exploratory meta-analyses of three studies comparing ginger with placebo and two studies comparing ginger with a nonsteroidal anti-inflammatory drug (NSAID). Ginger appeared more effective for reducing pain severity than placebo. The weighted mean difference on a 10 cm visual analogue scale was 1.55 cm (favoring ginger) (95% CI 0.68 to 2.43). No significant difference was found between ginger and mefenamic acid (an NSAID). The standardized mean difference was 0 (95% CI −0.40 to 0.41). Available data suggest that oral ginger could be an effective treatment for menstrual pain in dysmenorrhea. Findings, however, need to be interpreted with caution because of the small number of studies, poor methodological quality of the studies, and high heterogeneity across trials. The review highlights the need for future trials with high methodological quality.

scholarly journals Acute Laparoscopic Cholecystectomy: Delays in Acute Surgery and Cost Analysis of Aproposed New Service

2011 ◽  
Vol 93 (7) ◽  
pp. 261-265
Author(s):  
AJ Cockbain ◽  
AL Young ◽  
E McGinnes ◽  
GJ Toogood
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Meta Analysis ◽  
Gallstone Disease ◽  
Cochrane Review ◽  
Length Of Hospital Stay ◽  
Biliary Colic ◽  
Complication Rates ◽  
Acute Surgery ◽  
Symptomatic Gallstone Disease

Acute laparoscopic cholecystectomy (ALC) is widely considered the most appropriate management for patients presenting with acute cholecystitis as supported by a recent meta-analysis and Cochrane review. Although the benefit of ALC is less clear in patients with biliary colic, few would disagree that earlier cholecystectomy is preferable for most patients with symptomatic gallstone disease. ALC has similar complication rates to elective laparoscopic cholecystectomy (ELC) and a reduced total length of hospital stay. Recurrent symptoms from untreated gallstone disease are common, with the risk of developing more severe complications such as acute cholecystitis, acute pancreatitis or cholangitis while waiting for an operation. It has been reported that patients awaiting ELC after an acute admission have significantly more general practitioner (GP) attendances than those who receive ALC, that they have an average of one emergency department attendance for symptom recurrence and that one in six requires hospital admission due to the severity of recurrent symptoms.

scholarly journals The Effects of Peanuts and Tree Nuts on Lipid Profile in Type 2 Diabetic Patients: A Systematic Review and Meta-Analysis of Randomized, Controlled-Feeding Clinical Studies

2021 ◽  
Vol 8 ◽  
Author(s):  
Jia-yue Xia ◽  
Jun-hui Yu ◽  
Deng-feng Xu ◽  
Chao Yang ◽  
Hui Xia ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Blood Lipids ◽  
Meta Analysis ◽  
Density Lipoprotein ◽  
Mean Difference ◽  
Tree Nuts ◽  
Randomized Controlled ◽  
Type 2 Diabetics

Background: Type 2 diabetes mellitus was found to be associated with metabolic disorders, particularly abnormal glucose and lipid metabolism. Dietary food choices may have profound effects on blood lipids. The primary objective of this study was to examine the effects of peanuts and tree nuts intake on lipid profile in patients with type 2 diabetes.Methods: According to preferred reporting items for systematic reviews and meta-analysis guidelines, we performed a systematic search of randomized controlled clinical trials and systematic reviews published in PubMed, Web of Science, Embase, Scopus, and Cochrane library, from inception through June 2021. Studies in populations with type 2 diabetes, which compare nuts or peanuts to a controlled-diet group were included. We used the mean difference with 95% CIs to present estimates for continuous outcomes from individual studies. In addition, we used the GRADEpro tool to evaluate the overall quality of evidence.Results: Sixteen studies involving 1,041 participants were eligible for this review. The results showed that peanuts and tree nuts supplementation did not induce significant changes in low-density lipoprotein-cholesterol (LDL-C) (mean difference = −0.11; 95%CI: −0.25 – 0.03, p = 0.117) and high-density lipoprotein-cholesterol (HDL-C) (mean difference = 0.01; 95%CI: −0.01 – 0.04, p = 0.400) in patients with type 2 diabetics. In addition, we found that peanuts and tree nuts intake may cause a significantly reduction in total cholesterol (TC) (mean difference = −0.14; 95%CI: −0.26 – −0.02, p = 0.024) and triglyceride (TG) (mean difference = −0.10; 95%CI: −0.17 – −0.02, p = 0.010). In the subgroup analysis, a significantly greater reduction in TC was observed in studies which duration was &lt;12 weeks (mean difference = −0.22; 95%CI: −0.37 – −0.08, p = 0.002). The quality of the body of evidence was “moderate” for TC and TG, the quality of evidence for LDL-C and HDL-C were “low.”Conclusion: Our findings suggest that consuming peanuts and tree nuts might be beneficial to lower TC concentration and TG concentration in type 2 diabetics subjects. Furthermore, peanuts and tree nuts supplementation could be considered as a part of a healthy lifestyle in the management of blood lipids in patients with type 2 diabetes. Given some limits observed in the current studies, more well-designed trials are still needed.

scholarly journals Efficacy and safety of colchicine in COVID-19: a meta-analysis of randomised controlled trials

RMD Open ◽  
2021 ◽  
Vol 7 (3) ◽  
pp. e001746
Author(s):  
Kedar Gautambhai Mehta ◽  
Tejas Patel ◽  
Paragkumar D Chavda ◽  
Parvati Patel
Keyword(s):  
Adverse Events ◽  
Supportive Care ◽  
Meta Analysis ◽  
Ventilatory Support ◽  
Length Of Hospital Stay ◽  
Efficacy And Safety ◽  
Serious Adverse Events ◽  
Quality Of Evidence ◽  
Randomised Controlled

BackgroundColchicine, an anti-inflammatory drug is prescribed nowadays for COVID-19. In this meta-analysis, we evaluated efficacy and safety of colchicine in patients with COVID-19.MethodsWe searched databases for randomised controlled studies evaluating efficacy and/or safety of colchicine as compared with supportive care in patients with COVID-19. The efficacy outcomes were mortality, ventilatory support, intensive care unit (ICU) admission and length of hospital stay. The safety outcomes were adverse events, serious adverse events and diarrhoea. A meta-analytical summary was estimated using random effects model through Mantle-Hanzle method. An I2 test was used to assess heterogeneity. The Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach was used to assess quality of evidence for each outcome.ResultsOut of 69 full texts assessed, 6 studies (16148 patients with COVID-19) were included in meta-analysis. Patients receiving colchicine did not show significant reduction in mortality (risk difference, RD −0.00 (95% CI −0.01 to 0.01), I2=15%), ventilatory support (risk ratio, RR 0.67 (95% CI 0.38 to 1.21), I2=47%), ICU admission (RR 0.49 (95% CI 0.19 to 1.25), I2=34%), length of hospital stay (mean difference: −1.17 (95% CI −3.02 to 0.67), I2=77%) and serious adverse events (RD −0.01 (95% CI −0.02 to 0.00), I2=28%) than those who received supportive care only. Patients receiving colchicine had higher rates of adverse events (RR 1.58 (95% CI 1.07 to 2.33), I2=81%) and diarrhoea (RR 1.93 (95% CI 1.62 to 2.29), I2=0%) than supportive care treated patients. The GRADE quality of evidence was moderate for most outcomes.ConclusionThe moderate quality evidence suggests no benefit of addition of colchicine to the standard care regimen in patients with COVID-19.

scholarly journals Effectiveness and safety of cemented and uncemented hemiarthroplasty in the treatment of intracapsular hip fractures

2020 ◽  
Vol 102-B (9) ◽  
pp. 1113-1121
Author(s):  
Nakulan Nantha Kumar ◽  
Setor K. Kunutsor ◽  
Miguel A. Fernandez ◽  
Elizabeth Dominguez ◽  
Nick Parsons ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Hip Fractures ◽  
Meta Analysis ◽  
Operating Time ◽  
Length Of Hospital Stay ◽  
Perioperative Outcomes ◽  
Cochrane Library ◽  
Uncemented Hemiarthroplasty ◽  
Mean Differences

Aims We conducted a systematic review and meta-analysis to compare the mortality, morbidity, and functional outcomes of cemented versus uncemented hemiarthroplasty in the treatment of intracapsular hip fractures, analyzing contemporary and non-contemporary implants separately. Methods PubMed, Medline, EMBASE, CINAHL, and Cochrane Library were searched to 2 February 2020 for randomized controlled trials (RCTs) comparing the primary outcome, mortality, and secondary outcomes of function, quality of life, reoperation, postoperative complications, perioperative outcomes, pain, and length of hospital stay. Relative risks (RRs) and mean differences (with 95% confidence intervals (CIs)) were used as summary association measures. Results A total of 18 studies corresponding to 16 non-overlapping RCTs with a total of 2,819 intracapsular hip fractures were included. Comparing contemporary cemented versus uncemented hemiarthroplasty, RRs (95% CIs) for mortality were 1.32 (0.44 to 3.99) perioperatively, 1.01 (0.48 to 2.10) at 30 days, and 0.90 (0.71 to 1.15) at one year. The use of contemporary cemented hemiarthroplasty reduced the risk of intra- and postoperative periprosthetic fracture. There were no significant differences in the risk of other complications, function, pain, and quality of life. There were no significant differences in perioperative outcomes except for increases in operating time and overall anaesthesia for contemporary cemented hemiarthroplasty with mean differences (95% CIs) of 6.67 (2.65 to 10.68) and 4.90 (2.02 to 7.78) minutes, respectively. The morbidity and mortality outcomes were not significantly different between non-contemporary cemented and uncemented hemiarthroplasty. Conclusion There are no differences in the risk of mortality when comparing the use of contemporary cemented with uncemented hemiarthroplasty in the management of intracapsular hip fractures. Contemporary cemented hemiarthroplasty is associated with a substantially lower risk of intraoperative and periprosthetic fractures. Cite this article: Bone Joint J 2020;102-B(9):1113–1121.

scholarly journals Efficacy of probiotics in the prevention of VAP in critically ill ICU patients: an updated systematic review and meta-analysis of randomized control trials

2020 ◽  
Vol 8 (1) ◽  
Author(s):  
Priyam Batra ◽  
Kapil Dev Soni ◽  
Purva Mathur
Keyword(s):  
Systematic Review ◽  
Mechanical Ventilation ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Critically Ill ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Mean Difference ◽  
Icu Stay ◽  
Length Of Icu Stay

Abstract Introduction Ventilator-associated pneumonia (VAP) is reported as the second most common nosocomial infection among critically ill patients with the incidence ranging from 2 to 16 episodes per 1000 ventilator days. The use of probiotics has been shown to have a promising effect in many RCTs. Our systematic review and meta-analysis were thus planned to determine the effect of probiotic use in critically ill ventilated adult patients on the incidence of VAP, length of hospital stay, length of ICU stay, duration of mechanical ventilation, the incidence of diarrhea, and the incidence of oropharyngeal colonization and in-hospital mortality. Methodology Systematic search of various databases (such as Embase, Cochrane, and Pubmed), published journals, clinical trials, and abstracts of the various major conferences were made to obtain the RCTs which compare probiotics with placebo for VAP prevention. The results were expressed as risk ratios or mean differences. Data synthesis was done using statistical software - Review Manager (RevMan) Version 5.4 (The Cochrane Collaboration, 2020). Results Nine studies met our inclusion criterion and were included in the meta-analysis. The incidence of VAP (risk ratio: 0.70, CI 0.56, 0.88; P = 0.002; I2 = 37%), duration of mechanical ventilation (mean difference −3.75, CI −6.93, −0.58; P 0.02; I2 = 96%), length of ICU stay (mean difference −4.20, CI −6.73, −1.66; P = 0.001; I2 = 84%) and in-hospital mortality (OR 0.73, CI 0.54, 0.98; P = 0.04; I2 = 0%) in the probiotic group was significantly lower than that in the control group. Probiotic administration was not associated with a statistically significant reduction in length of hospital stay (MD −1.94, CI −7.17, 3.28; P = 0.47; I2 = 88%), incidence of oro-pharyngeal colonization (OR 0.59, CI 0.33, 1.04; P = 0.07; I2 = 69%), and incidence of diarrhea (OR 0.59, CI 0.34, 1.03; P = 0.06; I2 = 38%). Discussion Our meta-analysis shows that probiotic administration has a promising role in lowering the incidence of VAP, the duration of mechanical ventilation, length of ICU stay, and in-hospital mortality.

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