Dissection Methods in Abdominoplasty: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 074880682110027
Author(s):  
Peter Duy Tran ◽  
Clement Lam Tsang ◽  
Ron Paul Bezic
Keyword(s):  
Kinetic Energy ◽  
Hospital Stay ◽  
Operative Time ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Complication Rates ◽  
Postoperative Wound Infection ◽  
Plasma Kinetic ◽  
Dissection Techniques ◽  
Flap Elevation

Abdominoplasty is one of the most common cosmetic procedures performed worldwide. Despite recent advances in surgical technique, the risk of complications remains high. The advantages of using various dissection devices as a method of flap elevation in abdominoplasty remains unclear. A systematic search was undertaken to identify studies comparing electrocautery dissection with scalpel dissection and plasma-kinetic energy-based dissection methods in abdominoplasty. A meta-analysis was performed using the selected studies. Seven studies were analyzed. These studies included a total of 1143 patients who underwent abdominoplasty using electrocautery (n = 617), steel scalpel (n = 457), or plasma dissection (n = 69). A meta-analysis was conducted, which showed an overall reduction in incidences of seroma, operative time, and length of hospital stay in the scalpel dissection group compared with the electrocautery group. The plasma dissection group showed a reduction in rate of postoperative wound infection and hematoma, as well as a reduction in drain output and length of hospital stay, compared with the electrocautery group. There are few studies comparing outcomes using different dissection techniques in abdominoplasty. These studies are small and heterogeneous in design. However, using plasma-kinetic energy-based devices or scalpel dissection appears to be associated with reduced complication rates, shorter operative time, lower drain volumes, and a reduction in the length of hospital stay.

Comparison of Retrograde Intrarenal Surgery and Micro-Percutaneous Nephrolithotomy for Kidney Stones: A Meta-Analysis

2020 ◽  
pp. 1-7
Author(s):  
Zhenhua Gu ◽  
Yucheng Yang ◽  
Rui Ding ◽  
Meili Wang ◽  
Jianming Pu ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Percutaneous Nephrolithotomy ◽  
Kidney Stones ◽  
Operative Time ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Clinical Results ◽  
Retrograde Intrarenal Surgery ◽  
Alternative Approach ◽  
Significant Difference

<b><i>Background:</i></b> Advances in micro-percutaneous nephrolithotomy (PCNL) for kidney stones have made it an alternative approach to the retrograde intrarenal surgery (RIRS) approach. Nevertheless, the superiority of micro-PCNL over RIRS is still under debate. The results are controversial. <b><i>Objectives:</i></b> The purpose of this study was to systematically evaluate the clinical results in patients presenting with kidney stones treated with micro-PCNL or RIRS. <b><i>Methods:</i></b> A literature search was done for electronic databases to identify researches that compared micro-PCNL and RIRS till December 2019. The clinical outcome included complications, stone-free rates (SFRs), hemoglobin reduction, length of hospital stay, and operative time. <b><i>Results:</i></b> Five articles were included in our study. The pooled results revealed no statistical difference in the rate of complications (OR = 0.99, 95% CI = 0.57–1.74, <i>p</i> = 0.99), length of hospital stay (MD = −0.29, 95% CI = −0.82 to 0.24, <i>p</i> = 0.28), and operative time (MD = −6.63, 95% CI = −27.34 to 14.08, <i>p</i> = 0.53) between the 2 groups. However, significant difference was present in hemoglobin reduction (MD = −0.43, 95% CI = −0.55 to 0.30, <i>p</i> &#x3c; 0.001) and the SFRs (OR = 0.59, 95% CI = 0.36–0.98, <i>p</i> = 0.04) when comparing RIRS with micro-PCNL. <b><i>Conclusions:</i></b> Compared with micro-PCNL to treat kidney stones, RIRS is associated with better stone clearance and bearing higher hemoglobin loss. As the advantages of both technologies have been shown in some fields, the continuation of well-designed clinical trials may be necessary.

The Self-Retaining Barbed Suture for Parenchymal Repair in Laparoscopic Partial Nephrectomy: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 26 (6) ◽  
pp. 744-752
Author(s):  
Hailun Zhan ◽  
Chunping Huang ◽  
Tengcheng Li ◽  
Fei Yang ◽  
Jiarong Cai ◽  
...  
Keyword(s):  
Renal Function ◽  
Blood Loss ◽  
Hospital Stay ◽  
Partial Nephrectomy ◽  
Operative Time ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
The Self ◽  
Barbed Suture ◽  
Estimated Blood Loss

Objectives. The warm ischemia time (WIT) is key to successful laparoscopic partial nephrectomy (LPN). The aim of this study was to perform a meta-analysis comparing the self-retaining barbed suture (SRBS) with a non-SRBS for parenchymal repair during LPN. Methods. A systematic search of PubMed, Scopus, and the Cochrane Library was performed up to March 2018. Inclusion criteria for this study were randomized controlled trials (RCTs) and observational comparative studies assessing the SRBS and non-SRBS for parenchymal repair during LPN. Outcomes of interest included WIT, complications, overall operative time, estimated blood loss, length of hospital stay, and change of renal function. Results. One RCT and 7 retrospective studies were identified, which included a total of 461 cases. Compared with the non-SRBS, use of the SRBS for parenchymal repair during LPN was associated with shorter WIT ( P < .00001), shorter overall operative time ( P < .00001), lower estimated blood loss ( P = .02), and better renal function preservation ( P = .001). There was no significant difference between the SRBS and non-SRBS with regard to complications ( P = .08) and length of hospital stay ( P = .25). Conclusions. The SRBS for parenchymal repair during LPN can significantly shorten the WIT and overall operative time, decrease blood loss, and preserve renal function.

scholarly journals Intercostal nerve cryoablation versus thoracic epidural for postoperative analgesia following pectus excavatum repair: a systematic review and meta-analysis

2020 ◽  
Vol 31 (4) ◽  
pp. 486-498
Author(s):  
Jean H T Daemen ◽  
Erik R de Loos ◽  
Yvonne L J Vissers ◽  
Maikel J A M Bakens ◽  
Jos G Maessen ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Epidural Analgesia ◽  
Hospital Stay ◽  
Pectus Excavatum ◽  
Operative Time ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Intercostal Nerve ◽  
Nuss Procedure ◽  
Thoracic Epidural

Abstract OBJECTIVES Minimally invasive pectus excavatum repair via the Nuss procedure is associated with significant postoperative pain that is considered as the dominant factor affecting the duration of hospitalization. Postoperative pain after the Nuss procedures is commonly controlled by thoracic epidural analgesia. Recently, intercostal nerve cryoablation has been proposed as an alternative method with long-acting pain control and shortened hospitalization. The subsequent objective was to systematically review the outcomes of intercostal nerve cryoablation in comparison to thoracic epidural after the Nuss procedure. METHODS Six scientific databases were searched. Data concerning the length of hospital stay, operative time and postoperative opioid usage were extracted. If possible, data were submitted to meta-analysis using the mean of differences, random-effects model with inverse variance method and I2 test for heterogeneity. RESULTS Four observational and 1 randomized study were included, enrolling a total of 196 patients. Meta-analyses demonstrated a significantly shortened length of hospital stay [mean difference −2.91 days; 95% confidence interval (CI) −3.68 to −2.15; P &lt; 0.001] and increased operative time (mean difference 40.91 min; 95% CI 14.42–67.40; P &lt; 0.001) for cryoablation. Both analyses demonstrated significant heterogeneity (both I2 = 91%; P &lt; 0.001). Qualitative analysis demonstrated the amount of postoperative opioid usage to be significantly lower for cryoablation in 3 out of 4 reporting studies. CONCLUSIONS Intercostal nerve cryoablation during the Nuss procedure may be an attractive alternative to thoracic epidural analgesia, resulting in shortened hospitalization. However, given the low quality and heterogeneity of studies, more randomized controlled trials are needed.

scholarly journals Evaluating the safety of two human experimental intestinal ischemia reperfusion models: A retrospective observational study

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0253506
Author(s):  
Inca H. R. Hundscheid ◽  
Dirk H. S. M. Schellekens ◽  
Joep Grootjans ◽  
Marcel Den Dulk ◽  
Ronald M. Van Dam ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Blood Loss ◽  
Hospital Stay ◽  
Pancreatic Surgery ◽  
Intestinal Ischemia ◽  
Operative Time ◽  
Ischemia Reperfusion ◽  
Length Of Hospital Stay ◽  
Secondary Outcome ◽  
Complication Rates

Background We developed a jejunal and colonic experimental human ischemia-reperfusion (IR) model to study pathophysiological intestinal IR mechanisms and potential new intestinal ischemia biomarkers. Our objective was to evaluate the safety of these IR models by comparing patients undergoing surgery with and without in vivo intestinal IR. Methods A retrospective study was performed comparing complication rates and severity, based on the Clavien-Dindo classification system, in patients undergoing pancreatoduodenectomy with (n = 10) and without (n = 20 matched controls) jejunal IR or colorectal surgery with (n = 10) and without (n = 20 matched controls) colon IR. Secondary outcome parameters were operative time, blood loss, 90-day mortality and length of hospital stay. Results Following pancreatic surgery, 63% of the patients experienced one or more postoperative complications. There was no significant difference in incidence or severity of complications between patients undergoing pancreatic surgery with (70%) or without (60%, P = 0.7) jejunal IR. Following colorectal surgery, 60% of the patients experienced one or more postoperative complication. Complication rate and severity were similar in patients with (50%) and without (65%, P = 0.46) colonic IR. Operative time, amount of blood loss, postoperative C-reactive protein, length of hospital stay or mortality were equal in both intervention and control groups for jejunal and colon IR. Conclusion This study showed that human experimental intestinal IR models are safe in patients undergoing pancreatic or colorectal surgery.

Single-Incision Laparoscopic Inguinal Hernioplasty Versus Conventional Laparoscopic Inguinal Hernioplasty

2017 ◽  
Vol 24 (2) ◽  
pp. 171-182 ◽  
Author(s):  
Shanshan Luo ◽  
Shike Wu ◽  
Hao Lai ◽  
Xianwei Mo ◽  
Jiansi Chen
Keyword(s):  
Inguinal Hernia ◽  
Postoperative Pain ◽  
Hospital Stay ◽  
Operative Time ◽  
Single Incision ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Cochrane Library ◽  
Inguinal Hernioplasty ◽  
Conventional Laparoscopic

Purpose: Additional studies comparing single-incision laparoscopic inguinal hernioplasty (SILH) and conventional laparoscopic inguinal hernioplasty (CLH) have been published, and this study updates the meta-analysis of this subject. Methods: Two reviewers independently searched the PubMed, Embase, Google Scholar, and Cochrane Library electronic databases to locate original articles that compared SILH and CLH for inguinal hernia that were published until October 2015. Operative time, conversions, complications, length of hospital stay, recurrence, postoperative pain at 24 hours, and postoperative pain at 7 days were compared using Stata software, version 12.0. Results: Sixteen studies were selected for this analysis, which included a total of 1672 patients (907 in SILH and 765 in CLH). SILH showed a longer operative time; however, conversions, complications, length of hospital stay, recurrence, postoperative pain at 24 hours, and postoperative pain at 7 days were similar between the 2 groups. Conclusions: Our meta-analysis has shown that inguinal hernia repair using SILH is as safe as CLH. However, based on our evidence, we currently believe that SILH is not an efficacious surgical alternative to CLH for inguinal hernias due to the fact that it does not provide significant benefit in postoperative pain and cosmetic outcomes. However, large-scale, well-designed, and multicenter studies will be needed to further confirm the results of this study.

scholarly journals Effectiveness of Enhanced Recovery After Surgery (ERAS) for patients undergoing hysterectomy: A systematic review and meta-analysis

2021 ◽  
Author(s):  
Chengyi Ho ◽  
Hui Xian Oh ◽  
Zi An Shian Seah ◽  
Jiemin Zhu ◽  
Hong-Gu HE
Keyword(s):  
Systematic Review ◽  
Hospital Stay ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Data Extraction ◽  
Meta Analysis ◽  
Experimental Studies ◽  
Length Of Hospital Stay ◽  
Laparoscopic Hysterectomy ◽  
Complication Rates

Background: There is a lack of systematic review exploring the effectiveness of Enhanced Recovery After Surgery (ERAS) in hysterectomy in promoting better recovery. Objectives: To synthesize the best available evidence of the effectiveness of ERAS intervention in promoting better recovery of shortened length of hospital stay (primary outcome), lower readmission, and complication rates (secondary outcomes) among patients undergoing hysterectomy due to benign conditions as compared to conventional perioperative care. Search Strategy: Seven electronic databases were searched from the date of inception to December 2020. Selection Criteria: Randomized controlled trials, cohort studies, or quasi-experimental studies published in English examining the effects of ERAS for women diagnosed with benign gynecologic diseases and underwent either abdominal or laparoscopic hysterectomy were included. Data Collection and Analysis: Two reviewers independently conducted database search, data extraction, and methodological quality assessment. Meta-analyses were performed for all outcomes. The overall quality of evidence was assessed using GRADE. Main Results: Nine studies were included in this review. Meta-analysis showed a statistically significant reduction in length of hospital stay (SMD = -0.76, 95% CI [-1.06, -0.46], Z = 4.72, p < .00001), readmission rate (RR = 0.65, 95% CI [0.44-0.96]; Z = 2.16, p = .03) and complication rate (RR = 0.61, 95% CI [0.48-0.77]; Z = 4.17, p < .0001), with high certainty of evidence. Conclusions: The effectiveness of ERAS in improving recovery indicates that hospitals could adopt the protocol to improve patients’ health and wellbeing. Future studies can focus more on standardizing the protocol’s elements.

scholarly journals The Safety of Selective Use of Splenic Flexure Mobilization in Sigmoid and Rectal Resections—Systematic Review and Meta-Analysis

2018 ◽  
Vol 7 (11) ◽  
pp. 392 ◽  
Author(s):  
Michał Nowakowski ◽  
Piotr Małczak ◽  
Magdalena Mizera ◽  
Mateusz Rubinkiewicz ◽  
Anna Lasek ◽  
...  
Keyword(s):  
Systematic Review ◽  
Length Of Stay ◽  
Minimally Invasive ◽  
Lymph Nodes ◽  
Hospital Stay ◽  
Splenic Flexure ◽  
Operative Time ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Splenic Flexure Mobilization

Background: According to traditional textbooks on surgery, splenic flexure mobilization is suggested as a mandatory part of open rectal resection. However, its use in minimally invasive access seems to be limited. This stage of the procedure is considered difficult in the laparoscopic approach. The aim of this study was to systematically review literature on flexure mobilization and perform meta-analysis. Methods: A systematic review of the literature was performed using the Medline, Embase and Scopus databases to identify all eligible studies that compared patients undergoing rectal or sigmoid resection with or without splenic flexure mobilization. Inclusion criteria: (1) comparison of groups of patients with and without mobilization and (2) reports on overall morbidity, anastomotic leakage, operative time, length of specimen, number of harvested lymph nodes, or length of hospital stay. The outcomes of interest were: operative time, conversion rate, number of lymph nodes harvested, overall morbidity, mortality, leakage rate, reoperation rate, and length of stay. Results: Initial search yielded 2282 studies. In the end, we included 10 studies in the meta-analysis. Splenic flexure is associated with longer operative time (95% confidence interval (CI) 23.61–41.25; p < 0.001) and higher rate of anastomotic leakage (risk ratios (RR): 1.02; 95% CI 1.10–3.35; p = 0.02), however the length of hospital stay is shorter by 0.42 days. There were no differences in remaining outcomes. Conclusions: Not mobilizing the splenic flexure results in a significantly shorter operative time and a longer length of stay. Further research is required to establish whether flexure mobilization is required in minimally invasive surgery.

scholarly journals Should the rectal defect be sutured following TEMS/TAMIS carried out for neoplastic rectal lesions? A meta-analysis

2020 ◽  
Vol 102 (9) ◽  
pp. 647-653 ◽  
Author(s):  
K Khan ◽  
IA Hunter ◽  
T Manzoor
Keyword(s):  
Hospital Stay ◽  
Statistical Difference ◽  
Operative Time ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Postoperative Bleeding ◽  
Case Series ◽  
Length Of Hospital Stay ◽  
Rectal Neoplasm ◽  
Lower Rectum

Introduction Management of the rectal defect following transanal endoscopic microsurgery (TEMS) or minimally invasive surgery (TAMIS) carried out for excision of neoplasm in the lower rectum is controversial. We aimed to extract evidence by carrying out a meta-analysis to compare the peri- and postoperative outcomes following rectal neoplasm excision carried out by TEMS and/or TAMIS, whereby the defect is either sutured or left open. Methods A literature search of Ovid MEDLINE and EMBASE was performed. Full-text comparative studies published until November 2019, in English and of adult patients, whereby TEMS or TAMIS was undertaken for rectal neoplasms were included. The main outcome measures were postoperative bleeding, infection, operative time and hospital stay. Findings Three studies (one randomised controlled trial and two comparative case series) yielded 555 cases (283 in the sutured group and 272 in the open group). The incidence of postoperative bleeding was higher and statistically significant (p = 0.006) where the rectal defect was left open following excision of the neoplasm (19/272, 6.99% vs 6/283, 2.12%). There was no statistical difference between the sutured and open groups regarding infection (p = 0.27; (10/283, 3.53% vs 5/272, 1.84%, respectively), operative time (p = 0.15) or length of stay (p = 0.67). Conclusion Suturing the rectal defect following excision of rectal neoplasm by TEMS/TAMIS reduces the incidence of postoperative bleeding in comparison to leaving the defect open. However, suturing makes the procedure slightly longer but there was no statistical difference between both groups when postoperative infection and length of hospital stay were compared.

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