scholarly journals Butterfly Cartilage Tympanoplasty as an Alternative to Conventional Surgery for Tympanic Membrane Perforations: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 014556132110154
Author(s):  
Juntao Huang ◽  
Bing Mei Teh ◽  
Yi Shen
Keyword(s):  
Postoperative Pain ◽  
Tympanic Membrane ◽  
Meta Analysis ◽  
Operation Time ◽  
Functional Results ◽  
Cochrane Library ◽  
Surgical Approaches ◽  
Tympanic Membrane Perforations ◽  
Cartilage Tympanoplasty ◽  
Fat Plug Myringoplasty

Objective: To compare the effectiveness of butterfly cartilage tympanoplasty (BCT) with that of conventional surgical approaches in the treatment of tympanic membrane perforations. Methods: A systematic search was performed by screening the PubMed, Embase, and Cochrane Library databases up to October 31, 2020. Two coauthors independently identified studies in accordance with the selection criteria. Data were pooled and analyzed via Review Manager version 5.3 and Stata version 12.0 software. The postoperative outcomes were measured and expressed as odds ratios (ORs) and standardized mean differences (SMDs). Additionally, heterogeneity was assessed through the I2 statistic. Results: A total of 15 articles were eligible for final inclusion. The OR values for the graft uptake rate, compared to conventional tympanoplasty, were 1.12 (95%CI: 0.56-2.22, I2 = 52%, P = .75) and 1.22 (95%CI: 0.58-2.59, I2 = 0%, P = .60), and the OR compared to fat plug myringoplasty was 3.02 (95%CI: 1.04-8.77, I2 = 0%, P = .04). The qualitative analysis of the hearing results reflected significant postoperative auditory gains with no significant differences between the BCT and control groups, indicating satisfactory and similar postoperative hearing improvement. Moreover, the operation time was shortened (SMD = −2.19, 95%CI: −2.79 to −1.59, I2 = 82%, P < .05), and the postoperative pain was less with the BCT approach. Conclusion: Butterfly cartilage tympanoplasty has satisfactory efficacy in terms of anatomical and functional results in small to medium perforations. It reduces operation time and postoperative pain. However, the effectiveness on large perforation requires further assessment by well-designed studies.

scholarly journals Comparison of single- and triple-port VATS for lung cancer: A meta-analysis

Open Medicine ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. 1228-1239
Author(s):  
Yunfei Gao ◽  
Abulaiti Abulimiti ◽  
Dan He ◽  
Anpeng Ran ◽  
Dongbo Luo
Keyword(s):  
Lung Cancer ◽  
Postoperative Pain ◽  
Cohort Studies ◽  
Single Port ◽  
Thoracoscopic Surgery ◽  
Meta Analysis ◽  
Operation Time ◽  
Cochrane Library ◽  
Vats Lobectomy ◽  
Significant Difference

Abstract Objective To compare the perioperative parameters between single- and triple-port video-assisted thoracoscopic surgery (VATS) lobectomy in the treatment of lung cancer. Methods The Pubmed, Embase, Cochrane library, and the Web of Science databases were electronically searched from inception to September 2019 for all relevant studies. Study quality was evaluated using the Jadad scale or the Newcastle-Ottawa scale. The results were pooled using the generic inverse-variance method and expressed as mean differences or risk ratios, with 95% confidence intervals. Results Three randomized controlled trials (RCTs) and ten cohort studies with 2,278 subjects were included in the meta-analysis. Whether based on RCTs or cohort studies, the pooled results showed no significant difference in the operation time, chest tube duration, intraoperative blood loss, postoperative hospital stays, lymph node dissection number, postoperative drainage volume, and postoperative complications between single- and triple-port VATS lobectomy (P > 0.05). Single-port VATS could relieve postoperative pain better than triple-port VATS, especially in the first day and fifth day (P < 0.05). No evidence of significant publication bias was found (P > 0.05). Conclusion Single-port VATS lobectomy can yield similar perioperative results to those of triple-port VATS lobectomy and is more effective in relieving postoperative pain.

scholarly journals Comparison of the effectiveness of sacrospinous ligament fixation and sacrocolpopexy: a meta-analysis

2021 ◽  
Author(s):  
Wenju Zhang ◽  
Willy Cecilia Cheon ◽  
Li Zhang ◽  
Xiaozhong Wang ◽  
Yuzhen Wei ◽  
...  
Keyword(s):  
Operative Time ◽  
Meta Analysis ◽  
Current Evidence ◽  
Cochrane Library ◽  
Surgical Approaches ◽  
Sacrospinous Ligament ◽  
Gastrointestinal Complications ◽  
Sacrospinous Ligament Fixation ◽  
Apical Support ◽  
Abdominal Sacrocolpopexy

Abstract Introduction and hypothesis Sacrocolpopexy and sacrospinous ligament fixation (SSLF) have been used for the restoration of apical support. Studies comparing sacrocolpopexy and SSLF have reported conflicting results. We aim to assess the current evidence regarding efficiency and the complications of sacrocolpopexy compared with SSLF. Methods We searched PubMed, Embase, and Cochrane Library and performed a systematic review meta-analysis to assess the two surgical approaches. Results 5Five randomized controlled trials, 8 retrospective studies, and 2 prospective studies including 4,120 cases were identified. Compared with abdominal sacrocolpopexy (ASC), SSLF was associated with a lower success rate (88.32% and 91.45%; OR 0.52; 95% CI 0.29–0.95; p = 0.03), higher recurrence (11.58% and 8.32%; OR 1.97; 95% CI 1.04–3.46; p = 0.04), and dyspareunia rate (14.36% and 4.67%; OR 3.10; 95% CI 1.28–7.50; p = 0.01). Patients in this group may benefit from shorter operative time (weighted mean difference −25.08 min; 95% CI −42.29 to −7.88; p = 0.004), lower hemorrhage rate (0.85% and 2.58%; OR 0.45; 95% CI 0.25–0.85; p = 0.009), wound infection rate (3.30% and 5.76%; OR 0.55; 95% CI 0.39–0.77; p = 0.0005), and fewer gastrointestinal complications (1.33% and 6.19%; OR 0.33; 95% CI 0.15–0.76; p = 0.009). Conclusion Both sacrocolpopexy and SSLF offer an efficient alternative to the restoration of apical support. When anatomical durability and sexual function is a priority, ASC may be the preferred option. When considering factors of mesh erosion, operative time, gastrointestinal complications, hemorrhage, and wound infections, SSLF may be the better option.

scholarly journals The Role of Local Bupivacaine Irrigation in Postoperative Pain Control After Augmentation Mammoplasty: A Systematic Review and Meta-Analysis

2017 ◽  
Vol 25 (1) ◽  
pp. 32-39
Author(s):  
Shan Shan Qiu ◽  
Marta Roque ◽  
Yi-Chieh Chen
Keyword(s):  
Systematic Review ◽  
Postoperative Pain ◽  
Normal Saline ◽  
Pain Control ◽  
Meta Analysis ◽  
A Priori ◽  
Cochrane Collaboration ◽  
Cochrane Library ◽  
Augmentation Mammoplasty ◽  
Mesh Terms

Background: The objective of this study is to analyze the efficacy of local bupivacaine irrigation after augmentation mammoplasty for the control of postoperative pain. Methods: A systematic review and meta-analysis was conducted including all randomized controlled trials (RCTs) that compared the irrigation of bupivacaine (±ketorolac) versus normal saline or no irrigation for pain control after breast augmentation. The primary outcome was postoperative pain measured by visual analog scale. The study protocol was established a priori according to the recommendations of the Cochrane Collaboration. A bibliographical search was conducted in September 2015 in the following Cochrane Library databases: CENTRAL, MEDLINE, EMBASE, and Scielo. The strategy used for the search was ((augmentation AND (“mammoplasty”[MeSH Terms] OR “mammoplasty”)) OR ((“breast”[MeSH Terms] OR “breast”) AND augmentation)) AND ((“pain, postoperative”[MeSH Terms])). Results: Four RCTs with a total of 264 participants were included. Two trials compared bupivacaine alone versus placebo (normal saline or no irrigation) and 3 trials compared bupivacaine plus ketorolac versus placebo. The combined irrigation of bupivacaine and ketorolac showed a clinically significant reduction of pain in the first postoperative hour and on postoperative day 5. The irrigation with bupivacaine compared with placebo significantly reduced pain assessed on postoperative day 4. Conclusion: The irrigation of bupivacaine with or without ketorolac was associated with a reduction of postoperative pain compared with control groups for the first 5 postoperative days. Due to the few number of trials included, these results should be correlated further clinically.

scholarly journals Comparison between Minimally Invasive Plate Osteosynthesis and Conventional Open Plating for Midshaft Clavicle Fractures: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 2019 ◽  
pp. 1-9 ◽  
Author(s):  
Enzhe Zhao ◽  
Rui Zhang ◽  
Dou Wu ◽  
Yao Guo ◽  
Qiang Liu
Keyword(s):  
Systematic Review ◽  
Minimally Invasive ◽  
Cohort Studies ◽  
Functional Outcome ◽  
Plate Osteosynthesis ◽  
Meta Analysis ◽  
Operation Time ◽  
Cochrane Library ◽  
Minimally Invasive Plate Osteosynthesis ◽  
Clavicle Fractures

Objective. The aim of this study was to compare the functional outcome and complications in midshaft clavicle fractures receiving minimally invasive plate osteosynthesis and conventional open plating. Methods. Relevant studies were searched in the databases of Medline, EMBASE, Cochrane Library, Ovid, and Web of Science from inception to March 1, 2019. Pooled data were analyzed with Cochrane Collaboration’s Review Manager 5.3. Results. A total of 7 studies were included, of which 2 were randomized controlled trials, 3 were retrospective cohort studies, and 2 were prospective cohort studies including 316 patients. No statistical differences in functional outcome (weighted mean difference [WMD] = 0.99, P=0.12), operation time (WMD = −10.44, P=0.07) and time to bone union (WMD = −0.23, P=0.70) were observed between the two groups. However, minimally invasive plate osteosynthesis reduced rates of skin numbness (odds ratio (OR) = 0.25, 95% CI : 0.13 to 0.48; P<0.0001) and complications (OR = 0.33, 95% CI : 0.16 to 0.71; P=0.005) compared with conventional open plating. Conclusion. This systematic review and meta-analysis found no differences in terms of functional outcomes, operation time, and fracture healing time between minimally invasive plate osteosynthesis and conventional open plating. However, minimally invasive plate osteosynthesis had apparent advantages in rates of skin numbness and complications.

scholarly journals The Effect of Intraoperative Methadone Compared to Morphine on Postsurgical Pain: A Meta-Analysis of Randomized Controlled Trials

2020 ◽  
Vol 2020 ◽  
pp. 1-9 ◽  
Author(s):  
Mark C. Kendall ◽  
Lucas J. Alves ◽  
Kristi Pence ◽  
Taif Mukhdomi ◽  
Daniel Croxford ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Randomized Controlled Trials ◽  
Surgical Procedures ◽  
Meta Analysis ◽  
Analgesic Efficacy ◽  
Opioid Consumption ◽  
Cochrane Library ◽  
Postanesthesia Care Unit ◽  
Controlled Trials ◽  
Randomized Controlled

Background and Objectives. Methadone is commonly used in chronic pain, but it is not frequently used as an intraoperative analgesic. Several randomized studies have compared intraoperative methadone to morphine regarding postsurgical analgesia, but they have generated conflicting results. The aim of this investigation was to compare the analgesic efficacy of intraoperative methadone to morphine in patients undergoing surgical procedures. Methods. We performed a quantitative systematic review of randomized controlled trials in PubMed, Embase, Cochrane Library, and Google Scholar electronic databases. Meta-analysis was performed using the random effects model, weighted mean differences (WMD), standard deviation, 95% confidence intervals, and sample size. Methodological quality was evaluated using Cochrane Collaboration’s tool. Results. Seven randomized controlled trials evaluating 337 patients across different surgical procedures were included. The aggregated effect of intraoperative methadone on postoperative opioid consumption did not reveal a significant effect, WMD (95% CI) of −0.51 (−1.79 to 0.76), (P=0.43) IV morphine equivalents. In contrast, the effect of methadone on postoperative pain demonstrated a significant effect in the postanesthesia care unit, WMD (95% CI) of −1.11 (−1.88 to −0.33), P=0.005, and at 24 hours, WMD (95% CI) of −1.35 (−2.03 to −0.67), P<0.001. Conclusions. The use of intraoperative methadone reduces postoperative pain when compared to morphine. In addition, the beneficial effect of methadone on postoperative pain is not attributable to an increase in postsurgical opioid consumption. Our results suggest that intraoperative methadone may be a viable strategy to reduce acute pain in surgical patients.

scholarly journals Effect of endoscopic resection on short-term surgical outcomes of subsequent laparoscopic gastrectomy: a meta-analysis

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Dong Peng ◽  
Yu-Xi Cheng ◽  
Gang Liao
Keyword(s):  
Endoscopic Resection ◽  
Laparoscopic Gastrectomy ◽  
Surgical Outcomes ◽  
Meta Analysis ◽  
Operation Time ◽  
Oral Feeding ◽  
Cochrane Library ◽  
Short Term ◽  
Significant Difference ◽  
Grade Ii

Abstract Background Endoscopic resection (ER) might affect subsequent laparoscopic gastrectomy (LG) because of the electrical coagulation, but the effect remains controversial. The purpose of this meta-analysis was to analyze the effect of ER on the short-term surgical outcomes of subsequent LG. Materials and methods The PubMed, EMBASE, and Cochrane Library databases were searched to find eligible studies published from inception to March 21, 2021. Short-term surgical outcomes were compared between the ER-LG group and the LG-only group. The registration ID of this current meta-analysis on PROSPERO is CRD42021238031. Results Nine studies involving 3611 patients were included in this meta-analysis. The LG-only group had a higher T stage (T1-T2: OR=2.42, 95% CI=1.09 to 5.34, P=0.03; T3-T4: OR=0.41, 95% CI=0.19 to 0.91, P=0.03) than the ER-LG group. The ER-LG group showed a shorter operation time than the LG-only group (MD=−5.98, 95% CI=−10.99 to −0.97, P=0.02). However, no difference was found in operation time after subgroup analysis of propensity score matching studies. No significant difference was found in intraoperative blood loss, time to first oral feeding, or postoperative hospital stay between the ER-LG group and the LG-only group. And no significance was found in overall complications (OR=1.16, 95% CI=0.89 to 1.50, P=0.27), complications of grade ≥ II (OR=1.11, 95% CI=0.71 to 1.73, P=0.64), complications of grade ≥ III b (OR=1.47, 95% CI=0.49 to 4.43, P=0.49) between the ER-LG group and the LG-only group. Conclusions ER did not affect subsequent LG in terms of short-term outcomes, and the ER-LG group might have a shorter operation time than the LG-only group.

scholarly journals Non-surgical approach for repairing perforations of pars tensa in tympanic membrane using TCA cauterization

2019 ◽  
Vol 5 (2) ◽  
pp. 299
Author(s):  
Sushil Gaur ◽  
Monika Patel ◽  
Prince Hirdesh ◽  
Vandana Singh
Keyword(s):  
Acetic Acid ◽  
Success Rate ◽  
Tympanic Membrane ◽  
Ossicular Chain ◽  
Surgical Approaches ◽  
Cost Burden ◽  
Surgical Interventions ◽  
Pars Tensa ◽  
Tympanic Membrane Perforations ◽  
One Year

<p class="abstract"><strong>Background:</strong> Tympanic membrane perforations occurring due to mucosal COM usually require surgical interventions for repair (myringoplasty or tympanoplasty) depending on the size and site of the perforation and the ossicular chain continuity. Various studies have shown TCA cautery as an efficacious non surgical method for repairing small and medium sized TM perforations. This technique was successfully used and popularized for repairing small and medium sized perforations by Derlacki in 1953.</p><p class="abstract"><strong>Methods:</strong> In this study we included dry pars tensa perforations in 100 patients occurring due to trauma or unresolved cases after inflammation/infection of middle ear. 50% w/v trichloro acetic acid was used for a maximum number of 5 applications at the margins of the perforations which were followed up for the next one year.  </p><p class="abstract"><strong>Results:</strong> In this study, involving a total of 125 perforations (75 unilateral and 50 bilateral), success rate was high among the patients with traumatic perforations and small sized perforations while a few number of perforations only reduced in size, which were later corrected with surgical approaches (myringoplasty/tympanoplasty). The overall success rate achieved in this study was 72.16%.</p><p class="abstract"><strong>Conclusions:</strong> Though there are various materials and methods available for this procedure, the principle remains the same. This technique should be attempted for patients that fit the criteria for undergoing this procedure before being undertaken for surgical approaches to minimize the risks and cost burden associated with surgery and anesthesia.</p>

scholarly journals ENDOSCOPIC CARTILAGE TYMPANOPLASTY. OUR TECHNIQUE AND EXPERIENCE OF 157 CASES

2021 ◽  
Vol 71 (Suppl-3) ◽  
pp. S440-444
Author(s):  
Muhammad Atif Najam ◽  
Urwa Sarwar ◽  
Maqbool Raza ◽  
Khalid Azam Khan ◽  
Humaira Saleem ◽  
...  
Keyword(s):  
Tympanic Membrane ◽  
Demographic Data ◽  
Tympanic Membrane Perforation ◽  
Pars Tensa ◽  
Tympanic Membrane Perforations ◽  
Cartilage Tympanoplasty ◽  
Membrane Perforation ◽  
Percent Success ◽  
And Gender ◽  
Endoscopic Cartilage Tympanoplasty

Objective: To assess the graft take rate and hearing gain in trans-canal endoscopic tympanoplasty Study Design: Descriptive study. Place and Duration of Study: Pakistan Naval Ship Hafeez, Islamabad Pakistan, form Dec 2015 to Jun 2018 Methodology: All patients with dry central perforations of >3 months history were included in the study. All Patients with perforations of pars tensa were booked for endoscopic cartilage tympanoplasty. All perforations were divided into four types small, medium, large and subtotal or total based on size of the tympanic membrane perforations. Small perforations involving <25% area of Pars Tensa. Medium perforation are Perforations involving 25-50% of Tympanic membrane. Large perforations include Perforations involving 50-75% of pars tensa. Subtotal or total perforations are defined as perforations with >75% perforation of the tympanic membranes. Wet Ears and perforations involving the Pars Flacida were excluded from the study. Preoperative Audiogram was carried out for all patients and A-B Gap were noted for all groups separately so as the demographic data including age and gender. Success was defined as complete closure of Tympanic membrane perforation at 3 months. All patients were operated with 0 Degree 3mm, 14cm rigid endoscope under general anesthesia. Results: Mean age of patients was. 37 years and standard deviation was 12.34 (range 12-58 years). Out of total 157 cases 81 patients male were males (51%) and 76 patients were females (49). Out of 157 ears operated 146 Perforations healed completely an overall success rate of 92%. Patients with small perforations had 100 percent success.....

scholarly journals Comparison between minimally invasive plate osteosynthesis and open reduction–internal fixation for proximal humeral fractures: a meta-analysis based on 1050 individuals

2019 ◽  
Author(s):  
Feilong Li ◽  
Tao Nie ◽  
Xuqiang Liu ◽  
Fuqiang Wang ◽  
Zhiping Gu ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Blood Loss ◽  
Nerve Injury ◽  
Plate Osteosynthesis ◽  
Meta Analysis ◽  
Operation Time ◽  
Axillary Nerve ◽  
Open Reduction Internal Fixation ◽  
Minimally Invasive Plate Osteosynthesis ◽  
Fracture Union

Abstract Background This meta-analysis aimed to compare the clinical outcomes and complications of minimally invasive plate osteosynthesis (MIPO) and open reduction–internal fixation (ORIF) in patients with proximal humeral fractures. Methods We searched PubMed, EMBASE, Ovid, and the Cochrane Library to identify all relevant studies from inception to April 2019. Cochrane Collaboration’s Review Manage 5.3 was used for meta-analysis. Results Sixteen studies involving 1050 patients (464 patients in the MIPO group and 586 patients in the ORIF group) were finally included. According to the meta-analysis, MIPO was superior to ORIF in operation time, blood loss, postoperative pain, fracture union time, and constant score. However, MIPO was associated with more exposure to radiation and axillary nerve injury. No significant differences were found in length of hospital stays and complication except for axillary nerve injury. Conclusion The present evidence indicates that compared to ORIF, MIPO had advantages in functional outcomes, operation time, blood loss, postoperative pain, and fracture union time for the treatment of PHFs. However, the MIPO technique had a higher rate of axillary nerve injury and longer radiation time compared to ORIF.

scholarly journals Effect of preoperative administration of systemic alpha-2 agonists on postoperative pain: a systematic review and meta-analysis

2020 ◽  
Vol 15 (2) ◽  
pp. 157-166
Author(s):  
Ji Youn Ju ◽  
Kye-Min Kim ◽  
Sangseok Lee
Keyword(s):  
Postoperative Pain ◽  
Pain Intensity ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Cochrane Collaboration ◽  
Systemic Administration ◽  
Opioid Consumption ◽  
Cochrane Library ◽  
Preoperative Administration

Background: Alpha-2 agonists have sedative, analgesic, and opioid-sparing effects. Moreover, intraoperative or postoperative systemic administration of alpha-2 adrenergic agonists is known to reduce postoperative pain and opioid consumption. This meta-analysis investigated whether preoperative administration of alpha-2 agonists can affect postoperative pain and opioid consumption.Methods: We searched the MEDLINE, EMBASE, Cochrane Library (CENTRAL), KoreaMed, and KMbase databases through March 2019 to identify relevant randomized controlled trials (RCTs) on the effect of preoperative systemic administration of alpha-2 agonists on postoperative pain and opioid consumption. We conducted a meta-analysis according to the Cochrane Collaboration guidelines. Standardized mean differences (SMDs) of postoperative pain intensity or dose of opioid consumption in the alpha-2 agonist group were extracted and combined using a random-effect model and were compared to those of the control group.Results: Eleven RCTs involving 748 participants were included in this meta-analysis. Preoperative administration of systemic alpha-2 agonists significantly reduced cumulative opioid consumption up to 6 h (SMD, –0.52; 95% confidence interval [–0.90 to –0.14]) and 24 h (SMD, –0.68 [–1.27 to –0.09]) after surgery. Moreover, preoperative administration of alpha-2 agonists significantly reduced postoperative pain intensity at 6 h (SMD, –0.50 [–0.78 to –0.21]) and 24 h (SMD, –0.44 [–0.86 to –0.03]).Conclusions: In this meta-analysis, high degree of heterogeneity limits the preoperative administration of alpha-2 agonists in reducing postoperative opioid consumption and pain intensity. Future powered large RCTs are required to increase the certainty of evidence on the effect in reducing postoperative opioid consumption and pain intensity.

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