scholarly journals Prophylactic Intra-Peritoneal Drainage After Pancreatic Resection: An Updated Meta-Analysis

2021 ◽  
Vol 11 ◽  
Author(s):  
Xinxin Liu ◽  
Kai Chen ◽  
Xiangyu Chu ◽  
Guangnian Liu ◽  
Yinmo Yang ◽  
...  
Keyword(s):  
Wound Infection ◽  
Pancreatic Fistula ◽  
Meta Analysis ◽  
Bile Leak ◽  
Cochrane Library ◽  
Individual Treatment ◽  
Abdominal Abscess ◽  
Peritoneal Drainage ◽  
Drain Group ◽  
Drain Placement

IntroductionProphylactic intra-peritoneal drainage has been considered to be an effective measure to reduce postoperative complications after pancreatectomy. However, routinely placed drainage during abdominal surgery may be unnecessary or even harmful to some patients, due to the possibility of increasing complications. And there is still controversy about the prophylactic intra-peritoneal drainage after pancreatectomy. This meta-analysis aimed to analyze the incidence of complications after either pancreaticoduodenectomy (PD) or distal pancreatectomy (DP) in the drain group and no-drain group.MethodsData were retrieved from four electronic databases PubMed, EMBASE, the Cochrane Library and Web of Science up to December 2020, including the outcomes of individual treatment after PD and DP, mortality, morbidity, clinically relevant postoperative pancreatic fistula (CR-POPF), bile leak, wound infection, postoperative hemorrhage, delayed gastric emptying (DGE), intra-abdominal abscess, reoperation, intervened radiology (IR), and readmission. Cochrane Collaboration Handbook and the criteria of the Newcastle-Ottawa scale were used to assess the quality of studies included.ResultsWe included 15 studies after strict screening. 13 studies with 16,648 patients were analyzed to assess the effect of drain placement on patients with different surgery procedures, and 4 studies with 6,990 patients were analyzed to assess the effect of drain placement on patients with different fistula risk. For patients undergoing PD, the drain group had lower mortality but higher rate of CR-POPF than the no-drain group. For patients undergoing DP, the drain group had higher rates of CR-POPF, wound infection and readmission. There were no significant differences in bile leak, hemorrhage, DGE, intra-abdominal abscess, and IR in either overall or each subgroup. For Low-risk subgroup, the rates of hemorrhage, DGE and morbidity were higher after drainage. For High-risk subgroup, the rate of hemorrhage was higher while the rates of reoperation and morbidity were lower in the drain group.ConclusionsIntraperitoneal drainage may benefit some patients undergoing PD, especially those with high pancreatic fistula risk. For DP, current evidences suggest that routine drainage might not benefit patients, but no clear conclusions can be drawn because of the study limitations.

scholarly journals Safety and Efficacy for Robot-Assisted Versus Open Pancreaticoduodenectomy: A Meta-Analysis of Multiple Worldwide Centers

2020 ◽  
Author(s):  
Wei Zhang ◽  
jian wei Zhang ◽  
Xu Che
Keyword(s):  
Wound Infection ◽  
Pancreatic Fistula ◽  
Infection Rate ◽  
Random Effect ◽  
Reoperation Rate ◽  
Wound Infection Rate ◽  
Cochrane Library ◽  
Robot Assisted ◽  
Estimated Blood Loss ◽  
Open Pancreaticoduodenectomy

Abstract Objectives: To compare the efficacy of robot-assisted pancreaticoduodenectomy with that of laparotomy.Methods: The PubMed, EMBASE, Cochrane Library, and other databases were searched for literature available from their respective inception dates up to May 2020 to find studies comparing robot-assisted pancreaticoduodenectomy (RPD) with open pancreaticoduodenectomy (OPD). The RevMan 5.3 statistical software was used for analysis to evaluate surgical outcome and oncology safety. The combination ratio (RR) and weighted mean difference (WMD) and their 95% confidence intervals (CIs) were calculated using fixed effect or random effect models.Results: 18 cohort studies from 16 medical centers were eligible with a total of 5795 patients including 1420 RPD group patients and 4375 OPD group patients. The RPD group fared better than the OPD group in terms of estimated blood loss (EBL) (WMD =-175.65, 95% CI (-251.85, -99.44), P<0.00001), wound infection rate (RR=0.60, 95%CI (0.44,0.81), P= 0.001), reoperation rate (RR=0.61, 95%CI (0.41,0.91), P=0.02), hospital day (WMD = -2.95, 95% CI (-5.33,-0.56), P = 0.02), intraoperative blood transfusion (RR = 0.56, 95% CI(0.42, 0.76), P=0.0001), overall complication (RR = 0.78, 95% CI(0.64,0.95), P = 0.01), and clinical pancreatic fistula (PF) (RR = 0.54, 95% CI(0.41,0.70), P < 0.0001). In terms of lymph node clearance (WMD = 0.48, 95% CI(-2.05,3.02), P = 0.71), R0 rate (RR = 1.05, 95% CI(1.00,1.11), P = 0.05), postoperative pancreatic fistula (POPF) (RR=1, 95% CI(0.85,1.19), P = 0.97), bile leakage (RR = 0.99, 95% CI(0.54,1.83), P = 0.98), delayed gastric emptying (DGE) (RR = 0.79, 95% CI(0.60,1.03), P = 0.08), mortality (RR = 0.82, 95% CI(0.62,1.10), P=0.19), and severe complication (RR = 0.98, 95% CI(0.71,1.36), P = 0.91), there were no significant differences between the two groups. Laparoscopic surgery was inferior to open surgery in terms of operational time (WMD = 80.85, 95% CI (16.09,145.61), P=0.01).Conclusions: RPD is not inferior to OPD, and it is even more advantageous for DGE, wound infection rate, reoperation rate, hospital stay, transfusion, overall complication and clinical PF. However, these findings need to be further verified by high-quality randomized controlled trials.

scholarly journals Hemostatic Agents in Hepatobiliary and Pancreas Surgery: A Review of the Literature and Critical Evaluation of a Novel Carrier-Bound Fibrin Sealant (TachoSil)

ISRN Surgery ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-12 ◽  
Author(s):  
K. A. Simo ◽  
E. M. Hanna ◽  
D. K. Imagawa ◽  
D. A. Iannitti
Keyword(s):  
Pancreatic Fistula ◽  
Fibrin Sealant ◽  
Scientific Evidence ◽  
Critical Evaluation ◽  
Bile Leak ◽  
Surgical Techniques ◽  
Postoperative Mortality ◽  
Cochrane Library ◽  
Biliary Leakage ◽  
Mortality And Morbidity

Background. Despite progress in surgical techniques applied during hepatobiliary and pancreas (HPB) surgery, bleeding and bile leak remain significant contributors to postoperative mortality and morbidity. Topical hemostatics have been developed and utilized across surgical specialties, but data regarding effectiveness remains inconsistent and sparse in HPB surgery. Methods. A comprehensive search for studies and reviews on hemostatics in HPB surgery was performed via an October 2011 query of Medline, EMBASE, and Cochrane Library. In-depth evaluation of a novel carrier-bound fibrin sealant (TachoSil) was also performed. Results. The literature review illustrates multiple attempts have been made at developing different topical hemostatics and sealants to aid in surgical procedures. In HPB surgery, efforts have been directed at decreasing bleeding, biliary leakage, and pancreatic fistula. Conflicting scientific evidence exists regarding the effectiveness of these agents. Critical evaluation of the literature demonstrates TachoSil is a valuable tool in achieving hemostasis, and possibly biliostasis and pancreatic fistula prevention. Conclusion. While progress has been made in topical hemostatics for HPB surgery, an ideal agent has not yet been identified. TachoSil is promising, but larger randomized, controlled clinical trials are required to more fully evaluate its efficacy in reducing bleeding, biliary leakage, and pancreatic fistulas in HPB surgery.

scholarly journals Does Pancreatic Fistula Affect Long-Term Survival after Resection for Pancreatic Cancer? A Systematic Review and Meta-Analysis

Cancers ◽  
2021 ◽  
Vol 13 (22) ◽  
pp. 5803
Author(s):  
Andrea Grego ◽  
Alberto Friziero ◽  
Simone Serafini ◽  
Amanda Belluzzi ◽  
Lucia Moletta ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Meta Analysis ◽  
Disease Free Survival ◽  
Ductal Adenocarcinoma ◽  
Cochrane Library ◽  
Recurrence Rates ◽  
Term Survival ◽  
Free Survival ◽  
The Impact ◽  
Disease Free

Background: The impact of postoperative pancreatic fistula (POPF) on survival after resection for pancreatic ductal adenocarcinoma (PDAC) remains unclear. Methods: The MEDLINE, Scopus, Embase, Web of Science, and Cochrane Library databases were searched for studies reporting on survival in patients with and without POPF. A meta-analysis was performed to investigate the impact of POPF on disease-free survival (DFS) and overall survival (OS). Results: Sixteen retrospective cohort studies concerning a total of 5019 patients with an overall clinically relevant POPF (CR-POPF) rate of 12.63% (n = 634 patients) were considered. Five of eleven studies including DFS data reported higher recurrence rates in patients with POPF, and one study showed a higher recurrence rate in the peritoneal cavity. Six of sixteen studies reported worse OS rates in patients with POPF. Sufficient data for a meta-analysis were available in 11 studies for DFS, and in 16 studies for OS. The meta-analysis identified a shorter DFS in patients with CR-POPF (HR 1.59, p = 0.0025), and a worse OS in patients with POPF, CR-POPF (HR 1.15, p = 0.0043), grade-C POPF (HR 2.21, p = 0.0007), or CR-POPF after neoadjuvant therapy. Conclusions: CR-POPF after resection for PDAC is significantly associated with worse overall and disease-free survival.

346 Meta-Analysis of Simultaneous Versus Staged Colorectal and Hepatic Resections for Colorectal Cancer with Synchronous Hepatic Metastases

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
G Nawaz ◽  
M Qayum ◽  
S Hajibandeh ◽  
S Hajibandeh
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Hospital Stay ◽  
Wound Infection ◽  
Bile Leak ◽  
Hepatic Metastases ◽  
Length Of Hospital Stay ◽  
Abdominal Abscess ◽  
Procedure Time ◽  
Perioperative Morbidity

Abstract Aim To evaluate the comparative outcomes of simultaneous and staged colorectal and hepatic resections for colorectal cancer with synchronous hepatic metastases Method We conducted a systematic search of electronic information sources, and bibliographic reference lists. Perioperative morbidity and mortality, anastomotic leak, wound infection, bile leak, bleeding, intra-abdominal abscess, sub-phrenic abscess, reoperation, recurrence, 5-year overall survival, procedure time, and length of hospital stay were the evaluated outcome parameters. Combined overall effect sizes were calculated using random-effects models. Results We identified 41 comparative studies reporting a total of 12,081 patients who underwent simultaneous (n = 5,013) or staged (n = 7.068) resections for colorectal cancer with synchronous hepatic metastases. The simultaneous resection was associated with significantly lower rate of bleeding (OR: 0.60, p = 0.03) and shorter length of hospital stay (MD:-5.40, p &lt; 0.00001) compared to the staged resection. However, no significant difference was found in perioperative morbidity (OR:1.04, p = 0.63), mortality (RD:0.00, p = 0.19), anastomotic leak (RD:0.01, p = 0.33), bile leak (OR:0.83, p = 0.50), wound infection (OR:1.17, p = 0.19), intra-abdominal abscess (RD:0.01, p = 0.26), sub-phrenic abscess (OR:1.26, p = 0.48), reoperation (OR:1.32, p = 0.18), recurrence (OR:1.33, p = 0.10), 5-year overall survival (OR:0.88, p = 0.19), or procedure time (MD:-23.64, p = 041) between two groups. Conclusions Despite demonstrating nearly comparable outcomes, the best available evidence (level 2) regarding simultaneous and staged colorectal and hepatic resections for colorectal cancer with synchronous hepatic metastases is associated with major selection bias. It is time to conduct high quality randomised studies with respect to burden and laterality of disease. We recommend the staged approach for complex cases.

scholarly journals Ultrasonic Dissection versus Conventional Dissection for Pancreatic Surgery: A Meta-Analysis

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Haiming Lei ◽  
Dong Xu ◽  
Xinghua Shi ◽  
Koulan Han
Keyword(s):  
Pancreatic Fistula ◽  
Pancreatic Surgery ◽  
Meta Analysis ◽  
Operation Time ◽  
Perioperative Outcomes ◽  
Cochrane Library ◽  
Ultrasonic Dissection ◽  
Significant Difference ◽  
Fistula Rate ◽  
The Cochrane Library

Background. The role of ultrasonic dissection (UD) in pancreatic surgery remains controversial. The aim of this meta-analysis was to evaluate the clinical effect of UD in pancreatic surgery when compared with conventional dissection (CD).Materials and Methods. A comprehensive literature search was performed to identify eligible studies that compared UD with CD for pancreatic surgery in PubMed, EMBASE, Web of Science, and the Cochrane Library. Risk ratio (RR) or mean difference with 95% confidence interval (CI) was calculated.Results. Six studies were included with a total of 215 patients undergoing UD and 210 undergoing CD. In comparison with CD in distal pancreatectomy, UD was associated with lower rates of pancreatic fistula (RR = 0.46, 95% CI: 0.27–0.76) and abdominal abscess and shorter operation time and hospital stay (P<0.05). In pancreaticoduodenectomy, there was no significant difference in pancreatic fistula rate between two groups (RR = 0.79, 95% CI: 0.48–1.29). However, the significantly less intraoperative blood loss and the transfused blood unit were found in patients receiving UD (P<0.05).Conclusions. The results of this meta-analysis show that, in comparison with CD, UD is associated with better perioperative outcomes in pancreatic surgery.

scholarly journals Systematic review and meta-analysis of the efficacy of prophylactic abdominal drainage in major liver resections

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Sepehr Abbasi Dezfouli ◽  
Umut Kaan Ünal ◽  
Omid Ghamarnejad ◽  
Elias Khajeh ◽  
Sadeq Ali-Hasan-Al-Saegh ◽  
...  
Keyword(s):  
Systematic Review ◽  
Liver Resection ◽  
Hospital Stay ◽  
Meta Analysis ◽  
Bile Leak ◽  
Length Of Hospital Stay ◽  
Research Assessment ◽  
Major Liver Resection ◽  
Prophylactic Drainage ◽  
Drain Group

AbstractProphylactic drainage after major liver resection remains controversial. This systematic review and meta-analysis evaluate the value of prophylactic drainage after major liver resection. PubMed, Web of Science, and Cochrane Central were searched. Postoperative bile leak, bleeding, interventional drainage, wound infection, total complications, and length of hospital stay were the outcomes of interest. Dichotomous outcomes were presented as odds ratios (OR) and for continuous outcomes, weighted mean differences (MDs) were computed by the inverse variance method. Summary effect measures are presented together with their corresponding 95% confidence intervals (CI). The certainty of evidence was evaluated using the Grades of Research, Assessment, Development and Evaluation (GRADE) approach, which was mostly moderate for evaluated outcomes. Three randomized controlled trials and five non-randomized trials including 5,050 patients were included. Bile leakage rate was higher in the drain group (OR: 2.32; 95% CI 1.18–4.55; p = 0.01) and interventional drains were inserted more frequently in this group (OR: 1.53; 95% CI 1.11–2.10; p = 0.009). Total complications were higher (OR: 1.71; 95% CI 1.45–2.03; p < 0.001) and length of hospital stay was longer (MD: 1.01 days; 95% CI 0.47–1.56 days; p < 0.001) in the drain group. The use of prophylactic drainage showed no beneficial effects after major liver resection; however, the definitions and classifications used to report on postoperative complications and surgical complexity are heterogeneous among the published studies. Further well-designed RCTs with large sample sizes are required to conclusively determine the effects of drainage after major liver resection.

scholarly journals Aspiration versus peritoneal lavage in appendicitis: a meta-analysis

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Gloria Burini ◽  
Maria Chiara Cianci ◽  
Marco Coccetta ◽  
Alessandro Spizzirri ◽  
Salomone Di Saverio ◽  
...  
Keyword(s):  
Systematic Review ◽  
Wound Infection ◽  
Operative Time ◽  
Peritoneal Lavage ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Laparoscopic Group ◽  
Reoperation Rate ◽  
Abdominal Abscess ◽  
Surgical Emergencies

Abstract Background Acute appendicitis is one of the most frequent abdominal surgical emergencies. Intra-abdominal abscess is a frequent post-operative complication. The aim of this meta-analysis was to compare peritoneal irrigation and suction versus suction only when performing appendectomy for complicated appendicitis. Methods According to PRISMA guidelines, a systematic review was conducted and registered into the Prospero register (CRD42020186848). The risk of bias was defined to be from low to moderate. Results Seventeen studies (9 RCTs and 8 CCTs) were selected, including 5315 patients. There was no statistical significance in post-operative intra-abdominal abscess in open (RR 1.27, 95% CI 0.75–2.15; I2 = 74%) and laparoscopic group (RR 1.51, 95% CI 0.73–3.13; I2 = 83%). No statistical significance in reoperation rate in open (RR 1.27, 95% CI 0.04–2.49; I2 = 18%) and laparoscopic group (RR 1.42, 95% CI 0.64–2.49; I2 = 18%). In both open and laparoscopic groups, operative time was lower in the suction group (RR 7.13, 95% CI 3.14–11.12); no statistical significance was found for hospital stay (MD − 0.39, 95% CI − 1.07 to 0.30; I2 = 91%) and the rate of wound infection (MD 1.16, 95% CI 0.56–2.38; I2 = 71%). Conclusions This systematic review has failed to demonstrate the statistical superiority of employing intra-operative peritoneal irrigation and suction over suction-only to reduce the rate of post-operative complications after appendectomy, but all the articles report clinical superiority in terms of post-operative abscess, wound infection and operative times in suction-only group.

scholarly journals Intravenous versus intravenous/oral antibiotics for perforated appendicitis in pediatric patients: a systematic review and meta-analysis

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Chuan Wang ◽  
Yanan Li ◽  
Yi Ji
Keyword(s):  
Antibiotic Therapy ◽  
Wound Infection ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Perforated Appendicitis ◽  
Cochrane Library ◽  
Statistical Heterogeneity ◽  
Newcastle Ottawa Scale ◽  
The Cost

Abstract Background The use of oral (PO) antibiotics following a course of certain intravenous (IV) antibiotics is proposed in order to avoid the complications of IV medications and to decrease the cost. However, the efficacy and safety of sequential IV/PO antibiotics is unclear and requires further study. Methods The databases, including PubMed, EMBASE and Cochrane Library, were searched. Studies comparing outcomes in patients with perforated appendicitis receiving sequential IV/PO and PO antibiotics therapy were screened. The Newcastle-Ottawa Scale (NOS) and the Jadad score were used to evaluate the quality of the cohort and the randomized controlled portions of the trial, respectively. Statistical heterogeneity was assessed using the I2 value. A fixed or random-effect model was applied according to the I2 value. Results Five controlled studies including a total of 580 patients were evaluated. The pooled estimates revealed that sequential IV/PO antibiotic therapy did not increase the risk of complications, with a risk ratio (RR) of 0.97 (95% CI 0.51–1.83, P = 0.93) for postoperative abscess, 1.04 (95% CI 0.25–4.36, P = 0.96) for wound infection and 0.62 (95% CI 0.33–1.16, P = 0.13) for readmission. Conclusions Our study demonstrates that sequential IV/PO antibiotic therapy is noninferior to IV antibiotic therapy regarding postoperative abscess, wound infection and readmission.

TP7.2.10 The Un-abating Debate of using Drains following Colorectal Anastomosis: a systematic review

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Mubashar Hussain
Keyword(s):  
High Risk ◽  
Postoperative Complications ◽  
Colorectal Surgery ◽  
Wound Infection ◽  
Anastomotic Leak ◽  
Systematic Reviews ◽  
Meta Analysis ◽  
High Risk Patients ◽  
Risk Patients ◽  
Drain Group

Abstract Aims To study whether routine use of drains in colorectal surgery/anastomosis help reduce postoperative complications and whether has a selective role in high risk patients. Methods A systematic search of electronic database performed using PubMed, Embase, and Cochrane Central database. Clinical literature from 1988 to 2018 was reviewed including randomized, non-randomized controlled studies, meta-analysis and systematic reviews for routine use of drain versus no usage of drain at index surgery & compared for clinical benefits. Terms used for search were ‘colorectal’, ‘rectal’, ‘colonic’ surgery/anastomosis’ and drain. Main outcome: anastomotic leak whilst secondary outcome were to study collections, re-surgical intervention, wound infection, DVT/PE, chest complications & mortality. Case reports and small cohort studies (&lt;25 patients) were excluded. Results 2243 patients were included from 14 RCTs, 2 meta-analysis and 3 systematic reviews. 1178 patients in the drain group and 1065 patients in the no drain group. Using Chi square test, data analysis demonstrated no statistically significant differences between the two groups (drains Versus no drains) for anastomotic leakage, P &gt;0.35; re-operation, P &gt;0.41, wound infection, P &gt;0.41; DVT/PE, P &gt; 1.1; chest complications, P &gt; 0.51 and mortality, P &gt;0.48. Conclusions Routine use of drains in colorectal surgery/anastomosis does not confer significant benefit in reducing postoperative complications. However, selective use of drains in the high risk patients for anastomotic leak may have a role but warrants more studies.

scholarly journals Laparoscopic Excision Versus Open Excision for the Treatment of Choledochal Cysts: A Systematic Review and Meta-Analysis

2015 ◽  
Vol 100 (1) ◽  
pp. 115-122 ◽  
Author(s):  
Chen Zhen ◽  
Zhang Xia ◽  
Li Long ◽  
Ma Lishuang ◽  
Yu Pu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cohort Studies ◽  
Choledochal Cyst ◽  
Meta Analysis ◽  
Bile Leak ◽  
Cochrane Library ◽  
Cyst Excision ◽  
Significant Difference ◽  
Laparoscopic Excision ◽  
Open Excision

Abstract In 1723, Vater first described choledochal cyst and in 1977, Todani et al classified this disease. For many years, open excision (OP) as the standard procedure made a great impact in the treatment of choledochal cyst. Since 1995, when Farello et al first reported laparoscopic choledochal cyst excision, laparoscopic excision (LA) has been used worldwide. However, its safety remains a major concern. The aim of this meta-analysis was to compare OP with LA in treating choledochal cyst and then to determine whether LA is safe and valid. The design of this study involved systematic review and meta-analysis. Data sources were Medline, Ovid, Elsevier, Google Scholar, Embase, and Cochrane library. The study selection entailed comparative cohort studies. For data extraction, 2 investigators independently assessed selected studies and extracted the following information: study characteristics, quality, outcomes data, etc. For the results, 7 comparative cohort studies about the effectiveness of LA compared with OP were performed meta-analysis. The results showed that although the LA group had a longer operative time (MD = 56.57; 95% CI = 32.20–80.93; P &lt; 0.00001), LA had a shorter duration of hospital stay (MD = −1.93; 95% CI = −2.51 to −1.36; P &lt; 0.00001), and recovery of bowel function (MD = −0.94; 95% CI = −1.33 to −0.55; P &lt; 0.00001). Meta-analysis found no significant difference between most of the 2 groups: bile leak (RR = 0.60; 95% CI = 0.29–1.24; P = 0.17), abdominal bleeding (RR = 0.33; 95% CI = 0.01–8.98; P = 0.51), pancreatitis (RR = 0.26, 95% CI = 0.06–1.03; P = 0.06), total postoperative complications (RR = 1.04; 95% CI = 0.66–1.62; P = 0.88). The LA group had significant lower rates in intraoperative blood transfusion (RR = 0.20; 95% CI = 0.11–0.38; P &lt; 0.00001), and adhesive intestinal obstruction (RR = 0.17, 95% CI = 0.04–0.77; P = 0.02). In conclusion, compared with open excision, laparoscopic excision is a safe, valid, and feasible alternative to open excision.

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