Laparoscopic Intervention to Pancreatic Pseudocyst Confers Short-Term Benefits: A Meta-Analysis

Background. Surgical interventions for pancreatic pseudocyst (PP) are traditionally managed by an open surgical approach. With the development of minimally invasive surgical techniques, a laparoscopic surgical approach for PPs has been conducted increasingly with comparable outcomes. The present study was conducted to compare the efficacy and safety of surgical intervention for PPs between the laparoscopic approach and the open approach. Methods. Databases including Cochrane Library, PubMed, and EMBASE were searched to identify studies that compared the safety and efficacy of surgical intervention for PPs between the laparoscopic approach and the open approach (until Aug 1st 2020). Results. A total of 6 studies were eligible in qualitative synthesis. The laparoscopic approach was associated with less intraoperative blood loss (MD = −69.97; 95% CI: −95.14 to −44.70, P < 0.00001 ; P = 0.86 for heterogeneity) and shorter operating time (MD = −33.12; 95% CI: −62.24 to −4.00, P = 0.03 ; P < 0.00001 for heterogeneity). There was no significant difference found between the two approaches regarding the success rate and the recurrence rate. The postoperative complications and mortality rates were comparable between the two approaches. Conclusions. The laparoscopic approach for the surgical intervention of PPs is safe and efficacious with shorter-term benefits.

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Liver Surgery for Hepatocellular Carcinoma: Laparoscopic versus Open Approach

International Journal of Hepatology ◽

10.4061/2011/596792 ◽

2011 ◽

Vol 2011 ◽

pp. 1-6 ◽

Cited By ~ 34

Author(s):

C. G. Ker ◽

J. S. Chen ◽

K. K. Kuo ◽

S. C. Chuang ◽

S. J. Wang ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Resection ◽

Average Length ◽

Survival Rates ◽

Laparoscopic Approach ◽

Operation Time ◽

Open Approach ◽

Full Diet ◽

Or Groups ◽

Significant Difference

In this study, we try to compare the benefit of laparoscopic versus open operative procedures.Patients and Methods. One hundred and sixteen patients underwent laparoscopic liver resection (LR) and another 208 patients went for open liver resection (OR) for hepatocellular carcinoma (HCC). Patients' selection for open or laparoscopic approach was not randomized.Results. The CLIP score for LR and OR was 0.59 ± 0.75 and 0.86 ± 1.04, respectively, (). The operation time was 156.3 ± 308.2 and 190.9 ± 79.2 min for LR and OR groups, respectively. The necessity for blood transfusion was found in 8 patients (6.9%) and 106 patients (50.9%) for LR and OR groups. Patients resumed full diet on the 2nd and 3rd postoperative day, and the average length of hospital stay was 6 days and 12 days for LR and OR groups. The complication rate and mortality rate were 0% and 6.0%, 2.9% and 30.2% for LR and OR groups, respectively. The 1-yr, 3-yr, and 5-yr survival rate was 87.0%, 70.4%, 62.2% and 83.2%, 76.0%, 71.8% for LR and OR group, respectively, of non-significant difference. From these results, HCC patients accepted laparoscopic or open approach were of no significant differences between their survival rates.

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RA05.04: MANAGEMENT & OUTCOMES OF ANASTOMOTIC LEAKS FOLLOWING ESOPHAGECTOMY: A PROSPECTIVE 10-YEAR SINGLE-SITE EXPERIENCE

Diseases of the Esophagus ◽

10.1093/dote/doy089.ra05.04 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 28-28

Author(s):

Joel Lambert ◽

Sanya Caratella ◽

Eloise Lawrence ◽

Bilal Alkhaffaf

Keyword(s):

Minimally Invasive ◽

Anastomotic Leak ◽

Surgical Intervention ◽

Type I ◽

Oral Contrast ◽

Open Approach ◽

Type Ii ◽

Anastomotic Leaks ◽

Type Iii ◽

Significant Difference

Abstract Background Anastomotic leak after esophagectomy is associated with high levels of morbidity and may impact negatively on oncological outcomes. The aim of this single centre study was to describe our experience in managing these complications Methods From 2007–2017 data was reviewed retrospectively from our prospectively maintained electronic database. All patients underwent either 2 or 3 phase esophagectomy for cancer of the oesophagus or esophago-gastric junction. All histological sub-types and stage of cancer were included in the analysis. Anastomotic leaks were classified according to the Esophagectomy Complications Consensus Group (ECCG) guidelines; type I—conservative management, type II—non-surgical intervention, type III—surgical intervention. Results 224 esophagectomies were included in our analysis (104 (46%) minimally invasive, 120 (54%) open approach). The incidence of all anastomotic leaks was 10% (23/224). Surgical approach did not influence the incidence of anastomotic leak (minimally invasive 10 (43%), open approach 13(57%), P = 0.76). Five patients (22%) had a type I leak, 9 patients (39%) type II and 9 (39%) had a type III leak. There was an increase in the number of leaks managed non-surgically over the last 5 years compared to those in the first five years of our dataset (2012–2017: 11/23 (48%) vs 2007–2012: 4/23 (17%) P = 0.08). The median time for leak diagnosis was 8 days. Most leaks were diagnosed with oral contrast CT 19 (83%). Median hospital stay after anastomotic leak was 58.5 days. Type III leaks were associated with an increased length of stay (median 84 days) compared to type I&II leaks (median (38.5 days) (P = 0.002 95% CI 18.19- 74.41). There was no significant difference in 30-day mortality between type I&II (0 patients) and type III leaks (1 patient) P = 0.260. Conclusion Low mortality rates with anastomotic leak can be achieved. In centres with experienced radiological and endoscopic skills, most anastomotic leaks can be managed non-surgically. Disclosure All authors have declared no conflicts of interest.

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Assessment of Prophylactic Carbapenem Antibiotics Administration for Severe Acute Pancreatitis: An Updated Systematic Review and Meta-Analysis

Digestion ◽

10.1159/000520892 ◽

2022 ◽

pp. 1-9

Author(s):

Daxin Guo ◽

Wei Dai ◽

Jingyi Shen ◽

Mengting Zhang ◽

Yetan Shi ◽

...

Keyword(s):

Acute Pancreatitis ◽

Organ Failure ◽

Severe Acute Pancreatitis ◽

Pancreatic Pseudocyst ◽

Meta Analysis ◽

Fluid Collection ◽

Cochrane Library ◽

Intensive Care Unit Treatment ◽

Significant Difference ◽

And Control

Background: The effectiveness of prophylactic antibiotics in severe acute pancreatitis (SAP) remains a debatable issue. This meta-analysis aimed to determine the efficacy of prophylactic carbapenem antibiotics in SAP. Methods: This meta-analysis of prophylactic carbapenem antibiotics for SAP was conducted in PubMed, EMBASE, Web of Science, MEDLINE, and Cochrane Library up to February 2021. The related bibliographies were manually searched. The primary outcomes involved infected pancreatic or peripancreatic necrosis, mortality, complications, infections, and organ failure. Results: Seven articles comprised 5 randomized controlled trials and 2 retrospective observational studies, including 3,864 SAP participants. Prophylactic carbapenem antibiotics in SAP were associated with a statistically significant reduction in the incidence of infections (odds ratio [OR]: 0.27; p = 0.03) and complications (OR: 0.48; p = 0.009). Nevertheless, no statistically significant difference was demonstrated in the incidence of infected pancreatic or peripancreatic necrosis (OR: 0.74; p = 0.24), mortality (OR: 0.69; p = 0.17), extrapancreatic infection (OR: 0.64, p = 0.54), pulmonary infection (OR: 1.23; p = 0.69), blood infection (OR: 0.60; p = 0.35), urinary tract infection (OR: 0.97; p = 0.97), pancreatic pseudocyst (OR: 0.59; p = 0.28), fluid collection (OR: 0.91; p = 0.76), organ failure (OR: 0.63; p = 0.19), acute respiratory distress syndrome (OR: 0.80; p = 0.61), surgical intervention (OR: 0.97; p = 0.93), dialysis (OR: 2.34; p = 0.57), use of respirator or ventilator (OR: 1.90; p = 0.40), intensive care unit treatment (OR: 2.97; p = 0.18), and additional antibiotics (OR: 0.59; p = 0.28) between the experimental and control groups. Conclusions: It is not recommended to administer routine prophylactic carbapenem antibiotics in SAP.

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Total hip arthroplasty performed by direct anterior approach – Does experience influence the learning curve?

SICOT-J ◽

10.1051/sicotj/2020015 ◽

2020 ◽

Vol 6 ◽

pp. 15 ◽

Cited By ~ 2

Author(s):

Constant Foissey ◽

Mathieu Fauvernier ◽

Cam Fary ◽

Elvire Servien ◽

Sébastien Lustig ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Learning Curve ◽

Hip Arthroplasty ◽

Anterior Approach ◽

Operating Time ◽

Surgical Techniques ◽

Direct Anterior Approach ◽

Clinical Results ◽

Total Hip ◽

Significant Difference

Introduction: Proficiency in the direct anterior approach (DAA) as with many surgical techniques is considered to be challenging. Added to this is the controversy of the benefits of DAA compared to other total hip arthroplasty (THA) approaches. Our study aims to assess the influence of experience on learning curve and clinical results when transitioning from THA via posterior approach in a lateral position to DAA in a supine position. Methods: A consecutive retrospective series of 525 total hip arthroplasty of one senior and six junior surgeons was retrospectively analysed from May 2013 to December 2017. Clinical results were analysed and compared between the two groups and represented as a learning curve. Mean follow up was 36.2 months ± 11.8. Results: This study found a significant difference in complications between the senior and junior surgeons for operating time, infection rate, and lateral femoral cutaneous nerve (LFCN) neuropraxia. A trainee’s learning curve was an average of 10 DAA procedures before matching the senior surgeon. Of note, the early complications correlated with intraoperative fractures increased with experience in both groups. Operating time for the senior equalised after 70 cases. Dislocation rate and limb length discrepancy were excellent and did not show a learning curve between the two groups. Conclusion: DAA is a safe approach to implant a THA. There is a learning curve and initial supervision is recommended for both seniors and trainees. Level of evidence: Retrospective, consecutive case series; level IV.

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Reconstruction Methods and Complications of Esophagogastrostomy and Jejunal Interposition in Proximal Gastrectomy for Gastric Cancer: A Meta-Analysis

Gastroenterology Research and Practice ◽

10.1155/2020/8179254 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Nan Du ◽

Pei Wu ◽

Pengliang Wang ◽

Yuwei Du ◽

Kai Li ◽

...

Keyword(s):

Gastric Cancer ◽

Lower Risk ◽

Meta Analysis ◽

Proximal Gastrectomy ◽

Operating Time ◽

Perioperative Period ◽

Jejunal Interposition ◽

Cochrane Library ◽

Reconstruction Methods ◽

Significant Difference

Background. Proximal gastrectomy is used for the treatment of primary gastric cancer by open or laparoscopic surgery in the upper third of the stomach. Esophagogastrostomy (EG) or jejunal interposition (JI) is widely used in various reconstruction methods after proximal gastrectomy. We conducted a meta-analysis of EG and JI for treatment of gastric cancer. Materials and Methods. A search of PubMed, Embase, MEDLINE, J-STAGE, and Cochrane Library identified retrospective series on EG and JI. Weight mean differences (WMDs), odds ratios (ORs), and 95% confidence intervals (CIs) were used to analyze the operation-related data and postoperative complications. Heterogeneity was evaluated by the I2 test, and potential publication bias was assessed with Egger regression tests and sensitivity analysis. Results. Eight studies were selected, and 496 patients were included. EG group benefits were 44.81 min shorter operating time (P<0.001), 56.58 mL less blood loss (P=0.03), and 7.4 days shorter hospital stay time (P<0.001) than the JI group. Between the two groups, there was no significant difference in anastomotic leakage; otherwise, the EG group had a lower risk of anastomotic stenosis (OR=0.44, 95%CI=0.20 to 0.97, P=0.04), lower risk of intestinal obstruction (OR=0.07, 95%CI=0.01 to 0.43, P=0.004), and higher risk of reflux esophagitis (OR=2.47, 95%CI=1.07 to 5.72, P=0.03). Conclusion. The results of our study indicated that EG has significant advantages during the perioperative period and in short-term outcomes compared to JI.

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Role of Laparoscopic Surgery in the Current Management of Mirizzi Syndrome

The American Surgeon ◽

10.1177/000313481808400517 ◽

2018 ◽

Vol 84 (5) ◽

pp. 667-671 ◽

Cited By ~ 2

Author(s):

Rondi Gelbard ◽

Desmond Khor ◽

Kenji Inaba ◽

Obi Okoye ◽

Crystal Szczepanski ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Length Of Stay ◽

Open Cholecystectomy ◽

Disease Process ◽

Laparoscopic Approach ◽

Mirizzi Syndrome ◽

Open Approach ◽

Significant Difference ◽

Care Surgery

Mirizzi syndrome (MS) is an uncommon complication of cholelithiasis caused by extrinsic biliary compression by stones in the gallbladder infundibulum or cystic duct. The purpose of this study was to evaluate the outcomes associated with a laparoscopic approach to this disease process. This is a 10-year, retrospective study conducted at two academic medical centers with established acute care surgery practices. Patients with a diagnosis of MS confirmed intraoperatively were included. Eighty-eight patients with MS were identified with 55 (62.5%) being type 1. Twenty six (29.5%) patients, all type 1, underwent successful laparoscopic cholecystectomy. Of the 62 patients that underwent open cholecystectomy, 27.3 per cent had a laparoscopy converted to open procedure. There was no significant difference in overall complications (19.2 vs 29%) among those undergoing laparoscopic versus open cholecystectomy. Length of stay was lower in patients that had a laparoscopic approach ( P = 0.001). Laparoscopic cholecystectomy can safely be attempted in type 1 MS and seems to be associated with fewer overall complications and shorter length of stay compared with an open approach.

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Survival Outcomes of Hemoperfusion and Hemodialysis versus Hemodialysis in Patients with End-Stage Renal Disease: A Systematic Review and Meta-Analysis

Blood Purification ◽

10.1159/000514187 ◽

2021 ◽

pp. 1-13

Author(s):

Wendi Cheng ◽

Yashuang Luo ◽

Haiyin Wang ◽

Xiaoxiao Qin ◽

Xin Liu ◽

...

Keyword(s):

Life Expectancy ◽

Clinical Decision Making ◽

Meta Analysis ◽

Age Groups ◽

Cochrane Library ◽

Original Research ◽

Qualitative Synthesis ◽

Significant Difference ◽

Esrd Patients ◽

Better Than

Background: The maintenance treatment of ESRD puts a great burden on individual patients, society, and the country of China as a whole. Hemoperfusion plus hemodialysis (HP + HD) in ESRD patients can yield modified outcomes such as prolonged life expectancy and improved dialysis quality and quality of life. This study aimed to systematically analyze the effect of HP + HD on the overall survival (OS) rates of ESRD patients and to provide support for clinical decision-making. Methods: A computerized search was performed in the PubMed, Embase, Cochrane Library, CNKI, WanFang Data and SinoMed databases for relevant original research articles. Studies were included or excluded based on their compliance with predefined selection criteria. Results: Twelve studies were included in the qualitative synthesis and quantitative synthesis (meta-analysis). The meta-analysis showed that the 1-year OS rate (odds ratio [OR]: 3.35, 95% CI: 1.89, 5.91, p < 0.05), 2-year OS rate (OR: 2.88, 95% CI: 1.84, 4.53, p < 0.05), and 5-year OS rate (χ2 = 4.3092, p < 0.05) of patients with ESRD treated with HP + HD were better than those treated with HD, but there was no significant difference in 3-year OS rate (OR: 1.97, 95% CI: 0.76, 5.06, p > 0.05). Subgroup analysis showed the same outcomes in different study designs (1-year OS rate: randomized controlled trials [RCTs]: OR: 4.38, 95% CI: 1.61, 11.88, p < 0.05; cohort studies: OR: 2.90, 95% CI: 1.44, 5.85, p < 0.05; 2-year OS rate: RCTs: OR: 2.99, 95% CI: 1.84, 4.84, p < 0.05) and different age-groups (1-year OS rate: 45–50 years: OR: 3.19, 95% CI: 1.55, 6.57, p < 0.05; 55–60 years: OR: 3.37, 95% CI: 1.07, 10.61, p < 0.05; 2-year OS rate: 50–55 years: OR: 2.86, 95% CI: 1.59, 5.16, p < 0.05: 60–65 years: OR: 4.41, 95% CI: 1.19, 16.30, p < 0.05). Conclusions: This meta-analysis suggests that the OS rates of ESRD patients treated with HP + HD were better than those of patients treated with HD. A speculative hypothesis for why this is the case may be that HP + HD can achieve the complementary elimination of metabolites, effectively preventing and treating complications caused by long-term dialysis and prolonging life expectancy. Therefore, HP + HD should be widely used in ESRD patients.

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Staples Versus Sutures For Skin Closure In Hip Arthroplasty: A Meta-Analysis And Systematic Review

10.21203/rs.3.rs-958981/v1 ◽

2021 ◽

Author(s):

Zirui Liu ◽

Binfeng Liu ◽

Hao Yang ◽

Liang Zhao

Keyword(s):

Hip Arthroplasty ◽

Meta Analysis ◽

Operating Time ◽

Cochrane Library ◽

Skin Closure ◽

Risk Of Infection ◽

Patient’S Satisfaction ◽

Significant Difference ◽

Suture Group ◽

Prolonged Discharge

Abstract Objective: The purpose of this present study was to estimate complication and other outcomes associated with staples and sutures closure after hip arthroplasty through meta- analysis techniques and system review. Methods: We searched for articles on EMBASE, PubMed, Medline, Web of Science and Cochrane Library. Eligibility of the searched trials. Cochrane Collaboration's Review Manager software is used to perform meta-analysis.Results: Four randomized controlled trials and one retrospective cohort trial chosen into our study. Our study indicated that the risk of infection and prolonged discharge higher with staples than with sutures for skin closure after hip arthroplasty. Meanwhile, there was no significant difference in allergic reaction, dehiscence, inflammation, abscess formation, Hollander Wound Evaluation Score and patient's satisfaction with skin closure methods between the two groups after hip arthroplasty. However, the suture group may require additional operating time.Conclusions: Closure with suture have a lower risk of infection and prolonged discharge when compared with staples skin closure in hip arthroplasty, while it may take more time.

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Video-Assisted Thoracic Surgery vs. Thoracotomy for the Treatment in Patients With Esophageal Leiomyoma: A Systematic Review and Meta-Analysis

Frontiers in Surgery ◽

10.3389/fsurg.2021.809253 ◽

2022 ◽

Vol 8 ◽

Author(s):

Cheng Shen ◽

Jue Li ◽

Guowei Che

Keyword(s):

Thoracic Surgery ◽

Meta Analysis ◽

Random Effect ◽

Cochrane Library ◽

Open Approach ◽

Esophageal Leiomyoma ◽

Invasive Approach ◽

Video Assisted Thoracic Surgery ◽

Video Assisted ◽

Significant Difference

Background: Surgical treatment is usually suitable for patients with esophageal leiomyoma. Video-assisted thoracic surgery (VATS) offers a minimally invasive approach to thoracotomy. However, there is no clear conclusion on whether VATS can achieve an equal or even better surgical effect when compared with the traditional open approach in the treatment of esophageal leiomyoma. We performed this meta-analysis to explore and compare the outcomes of VATS vs. thoracotomy for patients with esophageal leiomyoma.Methods: PubMed, Cochrane Library, EMBASE, China National Knowledge Infrastructure (CNKI), Medline, and Web of Science databases were searched for full-text literature citations. The quality of the articles was evaluated using the Newcastle–Ottawa Scale and the data were analyzed using the Review Manager 5.3 software. Fixed or random effect models were applied according to heterogeneity.Results: A total of 8 studies with 290 patients, of whom 141 patients were in the VATS group and 149 in the thoracotomy group, were involved in the analysis. Compared with thoracotomy, VATS was associated with shorter operative time, less blood loss in operation, and shorter postoperative hospital stay. There is no significant difference in postoperative pleural drainage day and postoperative complications between the two groups.Conclusions: VATS has more advantages over thoracotomy, indicating that VATS is better than thoracotomy in terms of postoperative recovery. We look forward to more large-sample, high-quality studies published in the future.

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Is there is a role for laparoscopy for treatment of appendicular mass?

International Surgery Journal ◽

10.18203/2349-2902.isj20181579 ◽

2018 ◽

Vol 5 (5) ◽

pp. 1610

Author(s):

Asem F. Mohammed ◽

Mahmoud A. Shaheen ◽

Mahmoud S. Eldesouky

Keyword(s):

Hospital Readmission ◽

Operative Time ◽

Surgical Intervention ◽

Postoperative Hospital Stay ◽

Interquartile Range ◽

Open Approach ◽

Suspected Appendicitis ◽

Generalized Peritonitis ◽

Significant Difference ◽

Appendicular Mass

Background: The surgical intervention for acute appendicitis presenting with appendicular mass is not well established. The aim of this study was to evaluate the benefits of early laparoscopy and laparoscopic appendectomy (LA) in the treatment of appendicular mass.Methods: During a 1-year period, 48 patients underwent LA for suspected appendicitis (n = 39), generalized peritonitis (n = 1), and an appendicular mass (n = 8).Results: All appendectomies were attempted and done laparoscopically except in one case (appendicular abscess), converted to an open approach. None of appendicular mass patients developed complications. There were no deaths. There was no significant difference between appendicular mass forming patients and non-mass-forming patients who underwent LA for an early appendicular mass as regard to the operative time (median [interquartile range]: 50 [36–60] vs 45 [25–50] min, p = 0.085) and postoperative hospital stay (median [interquartile range]: 2 [1–2] vs [1–2] days, p = 0.1). Conclusions: Early LA for appendicular mass patients is feasible, safe, and avoids misdiagnoses and the need for hospital readmission.

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