scholarly journals What is The Main Problem in The Conservative Management of Complicated Appendicitis? A Meta-Analysis.

2020 ◽  
Author(s):  
Chi Zhang ◽  
Xuemeng Ren ◽  
Peng Gao
Keyword(s):  
Surgical Treatment ◽  
Conservative Treatment ◽  
Conservative Management ◽  
Meta Analysis ◽  
Operation Time ◽  
Complicated Appendicitis ◽  
Management Group ◽  
Hospitalization Time ◽  
Standardized Treatment ◽  
The Difference

Abstract Background: As one of the classified groups of appendicitis, complicated appendicitis has no standardized treatment methods for adults.Method: The efficacy of surgical treatment and conservative treatment for complicated appendicitis was evaluated based on the literatures systematically searched on PubMed, Cochrane and Web of Science. A focus was given to important aspects, such as the outcomes of the length of stay, operation time, postoperative complications and unplanned additional interventions. Result: A total of 14 studies were involved in the meta-analysis, which included 845 patients in the immediate operation group (IO) and 756 patients in the conservative management group (CM). The total hospitalization time for patients with surgical treatment was decreased by 1 day (WMD= -1.29, 95% CI [-2.42, -0.16], P= 0.03< 0.05) compared to that of patients with conservative treatment. The incidence of unplanned additional interventions in patients who underwent emergency surgery is lower than that of patients with conservative treatment (OR=0.18, 95%CI [0.11, 0.30], P<0.00001). Compared to patients with conservative treatment, patients who received surgery are more likely to develop complications such as wound infection (OR=2.41, 95%CI [1.08, 5.38], P=0.03<0.05) and intestinal obstruction (OR=4.14, 95%CI [2.21, 7.75], P<0.00001). The incidence of abdominal abscess in patients with surgery treatment was lower than that of patients with conservative treatment, but the difference was not statistically significant (OR=0.9, 95%CI [0.54, 1.47], P=0.66>0.05). Conclusion: In treating complicated appendicitis, patients who received immediate operation, when compared to patients managed under conservative treatment, have shorter hospitalization time and less unplanned interventions; hence significantly reduce the likelihood of readmission. This can decrease the requirements for follow-up treatments and ultimately lower the consumption of medical resources.

scholarly journals What is the main problem in the conservative management of complicated appendicitis? A meta-analysis

2020 ◽  
Author(s):  
Chi Zhang ◽  
Xuemeng Ren ◽  
Peng Gao
Keyword(s):  
Surgical Treatment ◽  
Conservative Treatment ◽  
Conservative Management ◽  
Meta Analysis ◽  
Operation Time ◽  
Complicated Appendicitis ◽  
Management Group ◽  
Hospitalization Time ◽  
Standardized Treatment ◽  
The Difference

Abstract Background: As one of the classified groups of appendicitis, complicated appendicitis has no standardized treatment methods for adults.Method: The efficacy of surgical treatment and conservative treatment for complicated appendicitis was evaluated based on the literatures systematically searched on PubMed, Cochrane and Web of Science. A focus was given to important aspects, such as the outcomes of the length of stay, operation time, postoperative complications and unplanned additional interventions. Result: A total of 14 studies were involved in the meta-analysis, which included 845 patients in the immediate operation group (IO) and 756 patients in the conservative management group (CM). The total hospitalization time for patients with surgical treatment was decreased by 1 day (WMD= -1.29, 95% CI [-2.42, -0.16], P= 0.03< 0.05) compared to that of patients with conservative treatment. The incidence of unplanned additional interventions in patients who underwent emergency surgery is lower than that of patients with conservative treatment (OR=0.18, 95%CI [0.11, 0.30], P<0.00001). Compared to patients with conservative treatment, patients who received surgery are more likely to develop complications such as wound infection (OR=2.41, 95%CI [1.08, 5.38], P=0.03<0.05) and intestinal obstruction (OR=4.14, 95%CI [2.21, 7.75], P<0.00001). The incidence of abdominal abscess in patients with surgery treatment was lower than that of patients with conservative treatment, but the difference was not statistically significant (OR=0.9, 95%CI [0.54, 1.47], P=0.66>0.05). Conclusion: In treating complicated appendicitis, patients who received immediate operation, when compared to patients managed under conservative treatment, have shorter hospitalization time and less unplanned interventions; hence significantly reduce the likelihood of readmission. This can decrease the requirements for follow-up treatments and ultimately lower the consumption of medical resources.

scholarly journals What is the main problem in conservative management for complicated appendicitis? A systematic review

2020 ◽  
Author(s):  
Chi Zhang ◽  
Xuemeng Ren ◽  
Peng Gao
Keyword(s):  
Conservative Treatment ◽  
Conservative Management ◽  
Meta Analysis ◽  
Operation Time ◽  
Complicated Appendicitis ◽  
Additional Intervention ◽  
Management Group ◽  
Hospitalization Time ◽  
Standardized Treatment ◽  
The Difference

Abstract Background: As a classification of appendicitis, complicated appendicitis has no standardized treatment for adults.Method: According to the related literature systematically searched on PubMed, Embase, Cochrane and Web of Science, we evaluated the efficacy of surgical treatment and conservative treatment for complicated appendicitis, especially focused on the outcomes about the length of stay, operation time, postoperative complications and unplanned additional intervention, in the literature. Result: A total of 14 studies were involved in the meta-analysis, including 845 patients in the immediate operation group (IO) and 756 patients in the conservative management group (CM). Compared with conservative treatment, the total hospitalization time was reduced by 1 day (WMD=-1.29, 95%CI [-2.42, -0.16], P=0.03<0.05). The incidence of unplanned additional intervention in patients undergoing emergency surgery is lower than that of conservative treatment (OR=0.18, 95%CI [0.11, 0.30], P<0.00001). Surgical patients are more likely to have complications such as wound infection (OR=2.41, 95%CI [1.08, 5.38], P=0.03<0.05) and intestinal obstruction (OR=4.14, 95%CI [2.21, 7.75], P<0.00001) than conservative patients. The incidence of abdominal abscess was lower than that of conservative treatment, and the difference was not statistically significant (OR=0.9, 95%CI [0.54, 1.47], P=0.66>0.05). Conclusion: Compared with conservative management patients, immediately operated patients have shorter hospitalization time and less unplanned intervention, which can significantly reduce the readmission opportunity of patients with complicated appendicitis and lighten the burden of follow-up and medical resource consumption.

scholarly journals Arthroscopic meniscectomy versus non-surgical or sham treatment in patients with MRI confirmed degenerative meniscus lesions: a protocol for an individual participant data meta-analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. e031864
Author(s):  
Stan R W Wijn ◽  
Maroeska M Rovers ◽  
Jan J Rongen ◽  
Håvard Østerås ◽  
May A Risberg ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Meta Analysis ◽  
Trial Data ◽  
Individual Participant Data ◽  
Sham Treatment ◽  
Meniscus Tears ◽  
Meniscus Lesions ◽  
Individual Participant ◽  
The Difference ◽  
Non Surgical Treatment

IntroductionArthroscopic partial meniscectomy (APM) after degenerative meniscus tears is one of the most frequently performed surgeries in orthopaedics. Although several randomised controlled trials (RCTs) have been published that showed no clear benefit compared with sham treatment or non-surgical treatment, the incidence of APM remains high. The common perception by most orthopaedic surgeons is that there are subgroups of patients thatdoneed APM to improve, and they argue that each study sample of the existing trials is not representative for the day-to-day patients in the clinic. Therefore, the objective of this individual participant data meta-analysis (IPDMA) is to assess whether there are subgroups of patients with degenerative meniscus lesions who benefit from APM in comparison with non-surgical or sham treatment.Methods and analysisAn existing systematic review will be updated to identify all RCTs worldwide that evaluated APM compared with sham treatment or non-surgical treatment in patients with knee symptoms and degenerative meniscus tears. Time and effort will be spent in contacting principal investigators of the original trials and encourage them to collaborate in this project by sharing their trial data. All individual participant data will be validated for missing data, internal data consistency, randomisation integrity and censoring patterns. After validation, all datasets will be combined and analysed using a one-staged and two-staged approach. The RCTs’ characteristics will be used for the assessment of clinical homogeneity and generalisability of the findings. The most important outcome will be the difference between APM and control groups in knee pain, function and quality of life 2 years after the intervention. Other outcomes of interest will include the difference in adverse events and mental health.Ethics and disseminationAll trial data will be anonymised before it is shared with the authors. The data will be encrypted and stored on a secure server located in the Netherlands. No major ethical concerns remain. This IPDMA will provide the evidence base to update and tailor diagnostic and treatment protocols as well as (international) guidelines for patients for whom orthopaedic surgeons consider APM. The results will be submitted for publication in a peer-reviewed journal.PROSPERO registration numberCRD42017067240.

Surgical treatment of medial patellofemoral ligament injuries achieves better outcomes than conservative management in patients with primary patellar dislocation: a meta-analysis

2017 ◽  
Vol 3 (2) ◽  
pp. 98-104 ◽  
Author(s):  
Amre Hussein ◽  
Asser A Sallam ◽  
Mohamed A Imam ◽  
Martyn Snow
Keyword(s):  
Conservative Treatment ◽  
Surgical Management ◽  
Conservative Management ◽  
Patellar Dislocation ◽  
Medial Patellofemoral Ligament ◽  
Meta Analysis ◽  
Treated Group ◽  
Current Evidence ◽  
Conservative Group ◽  
Kujala Score

ImportanceLateral patellar dislocation is a commonly encountered disorder that affects mainly young and active adults and is associated with potential long-term morbidity. Primary traumatic dislocations can result in injury to the medial patellofemoral ligament (MPFL). There is controversy in literature about the superiority of early surgical intervention over conservative treatment of MPFL injuries.ObjectiveThe aim of this project was to undertake a meta-analysis to evaluate the clinical outcomes of the surgical management of MPFL injuries compared with conservative treatment in patients with primary patellar dislocation.Evidence reviewA systematic review of the English literature combining electronic databases Allied and Complementary Medicine (AMED), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase and MEDLINE ((Ovid) and PubMed) and the reference lists of the final studies was performed during the last week of June 2017 using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Four eligible randomised controlled trials comparing MPFL repair/reconstruction to conservative management met our inclusion criteria. They were identified and critically appraised, and the results were quantitatively evaluated giving data of a total of 171 patients. They were divided into two groups: surgically treated group (92 patients) and conservatively treated group (79 patients). The performed surgical procedures included: reconstruction and repair of the MPFL. The conservative management group included mainly physiotherapy. The outcomes evaluated were the rate of recurrent dislocation of the patella and the Kujala score.FindingsOur analysis showed high statistical significance favouring the surgical management in reducing the redislocation rate (6.74%) in comparison with the conservative group (28.5%) (P<0.001). The surgical group also demonstrated significantly higher Kujala score (70.8) compared with the conservative group (59.8) (P<0.001).Conclusions and relevanceContrary to the available current evidence in the literature, we report that the surgical management of MPFL injuries in patients with primary patellar dislocation results in a significantly reduced rate of redislocation when compared with non-operative management.Level of evidenceMeta-analysis, therapeutic type II.

scholarly journals Comparing Surgical and Conservative Treatment on Achilles Tendon Rupture: A Comprehensive Meta-Analysis of RCTs

2020 ◽  
Author(s):  
Guorong She ◽  
Qiang Teng ◽  
Jieruo Li ◽  
Xiaofei Zheng ◽  
Lin Chen ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Conservative Treatment ◽  
Achilles Tendon ◽  
Randomized Controlled Trials ◽  
Complication Rate ◽  
Tendon Rupture ◽  
Meta Analysis ◽  
Achilles Tendon Rupture ◽  
Controlled Trials ◽  
Randomized Controlled

Abstract Background Achilles tendon is the strongest tendon in human and frequently injured mainly in young to middle age active population. Increasing incidence of Achilles tendon rupture (ATR) is still reported in several studies. Surgical repair and conservative treatment are two major management strategy widely adopted in ATR patients but the consensus of optimal treatment strategy is still debated. We aimed at fully reviewing the ATR topic with additional assessments and performed a most comprehensive meta-analysis of randomized controlled trials (RCTs).Method We comprehensively searched database of PubMed, Embase, Cochrane and ClinicalTrial.gov and retrieved all randomized controlled trials comparing surgical and conservative treatment on achilles tendon rupture for further analysis. Data extraction was performed by two independent reviewer and random effect model was adopted when I2 > 50%, with data presentation of risk ratio, risk difference or mean difference and 95% confidence interval. Results A total of 13 randomized control trials were included in this meta-analysis. Significant difference was observed in events of re-rupture, complication rate, adhesion to underlying tendon, sural nerve injury and superficial infection. For surgical treatment, significant reduction in re-rupture rate could be observed while complication rate was higher compared with conservative treatment. Conclusion Surgical treatment was revealed significance in reduction of re-rupture rate but associated with higher complication rate while conservative treatment showed similar outcomes with lower complication rate. Collectively, we recommend conservative treatment if patients’ status and expectation are suitable, but surgeon as well as physician’s discretion is also important in decision making.

scholarly journals COMPARISON OF EFFICACY OF INJECTABLE STEROIDS VERSUS CONSERVATIVE MANAGEMENT FOR DE QUERVAINS’S TENOSYNOVITIS

2021 ◽  
Vol 12 (3) ◽  
pp. 217-221
Author(s):  
Nasim Ilyas ◽  
Fouzia Hanif ◽  
Rajesh Kumar Panjwani ◽  
Sheikh Kashif Rahim ◽  
Asma Abdul Qadeer ◽  
...  
Keyword(s):  
Conservative Management ◽  
Steroid Injection ◽  
Corticosteroid Injection ◽  
Post Intervention ◽  
De Quervain’S Tenosynovitis ◽  
Management Group ◽  
Group A ◽  
The Mean ◽  
The Difference ◽  
Group B

BACKGROUND & OBJECTIVE: De Quervain's tenosynovitis is tenosynovitis of the abductor pollicis longus and extensor pollicis brevis tendons, occurs due to chronic overuse of the wrist and hand. To compare effectiveness of steroid injection with conservative management of De Quervains’s tenosynovitis. METHODOLOGY: Randomized prospective study was conducted at the various private orthopedic clinic across Rawalpindi district, along with collaboration of community medicine department, Rawal Institute of health sciences, Islamabad. The study population was divided into two groups, i.e., group A and group B. Group A was given inj. corticosteroid and group B was given conservative management. The severity of pain (Visual analogue scale) and Finkelstein test were recorded on baseline and after 3 weeks follow up. RESULTS: Our study included 96 diagnosed cases of de Quervains tenosynovitis on a positive Finkelstein test; 48 were given corticosteroid injection and 48 were conservatively treated. The mean age in corticosteroid’s injection group was 34.76+6.95 years whereas the mean age in conservative management group was 31.7+8.91 years. Post-intervention 13, 29 patients had a positive Finkelstein test in corticosteroid and conservative groups respectively. Although the difference in pre intervention pain score between the two groups was not statistically significant but significantly lesser pain scores in the corticosteroid group; (p= 0.00). CONCLUSION: Steroid injection produced better results in terms of relief in pain and negative Finkelstein test as compared to conservative treatment.

Is arthroscopic decompression better than conservative management for shoulder impingement? A systematic review and meta-analysis

2019 ◽  
Author(s):  
Shujing Liu ◽  
Yingying Yu ◽  
Guangxu Lu ◽  
Hui Dong ◽  
Wenliang Wang
Keyword(s):  
Conservative Treatment ◽  
Conservative Management ◽  
Meta Analysis ◽  
Arthroscopic Surgery ◽  
Shoulder Function ◽  
Controlled Trials ◽  
Short Term ◽  
Shoulder Impingement ◽  
Significant Difference

Abstract Background Arthroscopic decompression is commonly used to treat shoulder impingement, while the role of conservative treatment in these patients remains unclear. The objective of this paper is to synthesise available evidence regarding the effectiveness of subacromial decompression for shoulder impingement compared with conservative treatment to verify whether arthroscopic surgery is superior to conservative treatment. Methods We systematicly retrieved the Cochrane databases, Embase as well as Pubmed (from inception to July. 02, 2019) for randomized controlled trials. Cochrane risk-of-bias tool was used to assess all referred studies’ quality and we pooled outcomes with a random-effects model. We divided the outcomes into short-term subgroup(<2 years) and long-term subgroup (≥2 years). Results 7 randomised controlled trials (RCTs) were included, involving a total of 607 patients, 297 patients operated arthroscopic decompression, compared to 310 patients treated with conservative management. We found no significant differences either in shoulder pain scores or shoulder function scores between arthroscopic decompression and conservative management wether in long-term or short-term follow-up subgroups. Conclusion No significant difference was demonstrated on the treatment outcomes of shoulder impingement between arthroscopic decompression and conservative management in our meta-analysis. Thus, we suggested that conservative management should be chosen firstly for patients with shoulder impingement, when patients’ symptom cannot be relieved from the conservative treatment, arthroscopic decompression should be taken into consideration.Levels of Evidence Level-I study

A meta-analysis comparing conservative treatment versus acute appendectomy for complicated appendicitis (abscess or phlegmon)

Surgery ◽  
2010 ◽  
Vol 147 (6) ◽  
pp. 818-829 ◽  
Author(s):  
Constantinos Simillis ◽  
Panayiotis Symeonides ◽  
Andrew J. Shorthouse ◽  
Paris P. Tekkis
Keyword(s):  
Conservative Treatment ◽  
Meta Analysis ◽  
Complicated Appendicitis

scholarly journals Surgical management of penetrating spinal cord injury primarily due to shrapnel and its effect on neurological outcome: a literature review and meta-analysis

2018 ◽  
Vol 28 (1) ◽  
pp. 63-71 ◽  
Author(s):  
Michael H. Lawless ◽  
Evan J. Lytle ◽  
Andrea F. McGlynn ◽  
John A. Engler
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Conservative Treatment ◽  
Conservative Management ◽  
Meta Analysis ◽  
Neurological Recovery ◽  
Forest Plot ◽  
Odds Ratios ◽  
Significant Difference ◽  
Cord Injury

OBJECTIVEThis study was performed to determine whether decompression of penetrating spinal cord injury (SCI) due to explosive shrapnel leads to greater neurological recovery than conservative management.METHODSIn accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive literature search using PubMed/MEDLINE, Web of Science, Google Scholar, and the Defense Technical Information Center public site was conducted on May 2, 2016. Studies that described penetrating SCI with shrapnel as an etiology, included surgical and/or conservative management, and demonstrated admission and follow-up neurological status were eligible for inclusion in this study. Odds ratios were calculated for the overall effect of surgical treatment on neurological recovery. Funnel plots were used to evaluate publication bias.RESULTSFive case series (Level IV evidence) met the study criteria, and 2 of them had estimable odds ratios for use in the Forest plot analysis. Among the patients from all 5 studies, 65% were injured by shrapnel, 25% by high-velocity bullet, 8% by low-velocity bullet, and 2% by an unknown cause. A total of 288 patients were included in the overall odds ratio calculations. Patients were stratified by complete and incomplete SCI. The meta-analysis showed no significant difference in outcomes between surgical and conservative management in the complete SCI cohort or the incomplete SCI cohort. Overall rates of improvement for complete SCI were 25% with surgery and 27% with conservative treatment (OR 1.07, 95% CI 0.44–2.61, p = 0.88); for incomplete SCI, 70% with surgery and 81% with conservative treatment (OR 1.67, 95% CI 0.68–4.05, p = 0.26).CONCLUSIONSThis study demonstrates no clear benefit to surgical decompression of penetrating SCI due predominantly to shrapnel. There is a considerable need for nonrandomized prospective cohort studies examining decompression and stabilization surgery for secondary and tertiary blast injuries.

Peroral drainage of post-traumatic sialocoeles: report of three cases

2009 ◽  
Vol 123 (8) ◽  
pp. 922-924 ◽  
Author(s):  
O Edkins ◽  
A C van Lierop ◽  
J J Fagan ◽  
D E Lubbe
Keyword(s):  
Case Report ◽  
Surgical Treatment ◽  
Surgical Technique ◽  
Conservative Treatment ◽  
Conservative Management ◽  
Simple Procedure ◽  
Minimal Risk ◽  
Initial Management ◽  
Parotid Duct ◽  
Post Traumatic

AbstractObjective:To discuss the technique and outcome of this simple procedure and the management of post-traumatic parotid sialocoeles, and to review the literature regarding this condition.Case report:We report the successful surgical treatment, by peroral drainage, of three patients with post-traumatic parotid sialocoele resistant to conservative management.Discussion:We discuss the method and outcome of the surgical procedure performed, along with the causes, presentation and management of parotid sialocoele.Conclusion:Correct initial management of a parotid duct injury may prevent the formation of a sialocoele. When conservative treatment of post-traumatic parotid sialocoele fails, we advocate the surgical technique described in this report as it is effective, simple and carries minimal risk to the patient.

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