Comparison of the Safety and Efficacy of Laparoscopic Left Lateral Hepatectomy and Open Left Lateral Hepatectomy for Hepatolithiasis: A Meta-Analysis

Background: Intrahepatic duct (IHD) stones, also known as hepatolithiasis, refers to any intrahepatic stones of the left and right hepatic ducts. It is a benign biliary tract disease with a high recurrence rate, with many complications, and difficulty in radical cure. The aim of this review and meta-analysis is to compare the safety and efficacy of the laparoscopic left lateral hepatectomy (LLLH) and open left lateral hepatectomy (OLLH) for IHD stones.Methods: Pubmed, Embase, Cochrane, WangFang Data, and China National Knowledge Infrastructure were searched for randomized controlled trials (RCTs) regarding the comparison of LLLH and OLLH in the treatment of hepatolithiasis. Standard mean difference (SMD), odds ratio (OR), and 95% CI were calculated using the random-effects model or fixed-effects model according to the heterogeneity between studies.Results: From January 01, 2001 to May 30, 2021, 1,056 articles were retrieved, but only 13 articles were finally included for the meta-analysis. The results showed that compared to the OLLH group, LLLH resulted in smaller surgical incision, less intraoperative blood loss, faster postoperative recovery, and fewer postoperative complications (surgical incision: SMD = −3.76, 95% CI: −5.40, −2.12; intraoperative blood loss: SMD = −0.95, 95% CI: −1.69, −0.21; length of hospital stay: SMD = −1.56, 95% CI: −2.37, −0.75; postoperative complications: OR = 0.45, 95% CI: 0.26, 0.78).Conclusions: In the treatment of hepatolithiasis, compared with OLLH, LLLH has the advantages of less intraoperative blood loss, smaller incisions, less postoperative complications, shorter hospital stay, shorter time to first postoperative exhaust, and postoperative ambulation, and rapid postoperative recovery.

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Effects of Preoperative Iodine Administration on Thyroidectomy for Hyperthyroidism: A Systematic Review and Meta-analysis

Otolaryngology ◽

10.1177/0194599819829052 ◽

2019 ◽

Vol 160 (6) ◽

pp. 993-1002 ◽

Cited By ~ 1

Author(s):

Chung-Hsin Tsai ◽

Po-Sheng Yang ◽

Jie-Jen Lee ◽

Tsang-Pai Liu ◽

Chi-Yu Kuo ◽

...

Keyword(s):

Postoperative Complications ◽

Blood Loss ◽

Operative Time ◽

Meta Analysis ◽

Thyroid Volume ◽

Vocal Cord Palsy ◽

Significant Heterogeneity ◽

Intraoperative Blood Loss ◽

Significant Difference ◽

And Control

Objective The current guidelines recommend that potassium iodide be given in the immediate preoperative period for patients with Graves’ disease who are undergoing thyroidectomy. Nonetheless, the evidence behind this recommendation is tenuous. The purpose of this study is to clarify the benefits of preoperative iodine administration from published comparative studies. Data Sources We searched PubMed, Embase, Cochrane, and CINAHL from 1980 to June 2018. Review Methods Studies were included that compared preoperative iodine administration and no premedication before thyroidectomy. For the meta-analysis, studies were pooled with the random-effects model. Results A total of 510 patients were divided into the iodine (n = 223) and control (n = 287) groups from 9 selected studies. Preoperative iodine administration was significantly associated with decreased thyroid vascularity and intraoperative blood loss. Significant heterogeneity was present among studies. We found no significant difference in thyroid volume or operative time. Furthermore, the meta-analysis showed no difference in the risk of postoperative complications, including vocal cord palsy, hypoparathyroidism/hypocalcemia, and hemorrhage or hematoma after thyroidectomy. Conclusion Preoperative iodine administration decreases thyroid vascularity and intraoperative blood loss. Nonetheless, it does not translate to more clinically meaningful differences in terms of operative time and postoperative complications.

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Effect of anaesthesia on the perioperative outcomes of pelvi-acetabular fracture surgeries in the apex trauma centre of a developing country–a retrospective analysis

Burns & Trauma ◽

10.1186/s41038-015-0011-y ◽

2015 ◽

Vol 3 ◽

pp. 1-6

Author(s):

Naveen Yadav ◽

Suma Rabab Ahmad ◽

Nisha Saini ◽

Babita Gupta ◽

Chhavi Sawhney ◽

...

Keyword(s):

Postoperative Complications ◽

Blood Loss ◽

Hospital Stay ◽

General Anaesthesia ◽

Acetabular Fracture ◽

Regional Anaesthesia ◽

Trauma Centre ◽

Intraoperative Blood Loss ◽

Duration Of Hospital Stay ◽

Duration Of Surgery

Abstract Background Regional anaesthesia has been proposed to reduce intraoperative blood loss, duration of hospital stay and in-hospital complications with improved postoperative pain control. General anaesthesia is advantageous for prolonged surgeries. We hypothesized that combined regional and general anaesthesia would offer advantages of both in pelvi-acetabular fracture surgeries. Methods We identified 71 patients who underwent open reduction and internal fixation of pelvi-acetabular fractures from May 2012 to 2013 in our trauma centre. We excluded patients with incomplete records (n = 4) and other injuries operated along (n = 8). Hence, 59 patients were divided into three groups: G group (general anaesthesia), R group (regional anaesthesia) and GR group (combined regional and general anaesthesia). Main outcome measurements studied were intraoperative blood loss, duration of hospital stay, duration of surgery and intraoperative and postoperative complications. Results No differences were obtained in between the groups in terms of age, gender, Injury Severity Score, number of comorbidities, or duration from injury to surgery. No significant differences were found between the three groups for intraoperative blood loss, days of hospital stay and duration of surgery. Intraoperative and postoperative complications were also comparable between the groups (p > 0.05). Conclusions There is no specific significant advantage of the technique of anaesthesia on the observed perioperative complications in pelvi-acetabular fracture surgeries.

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Laparoscopic Spleen-Preserving Distal Pancreatectomy (LSPDP) versus Open Spleen-Preserving Distal Pancreatectomy (OSPDP): A Comparative Study

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2019/9367868 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Jing Huang ◽

Dipesh Kumar Yadav ◽

Chaojie Xiong ◽

Ye Sheng ◽

Xinhua’ Zhou ◽

...

Keyword(s):

Postoperative Complications ◽

Blood Loss ◽

Hospital Stay ◽

Pancreatic Fistula ◽

Distal Pancreatectomy ◽

Operative Time ◽

Malignant Tumors ◽

Low Grade ◽

Intraoperative Blood Loss ◽

Spleen Preserving

Objective. To compare outcomes between laparoscopic spleen-preserving distal pancreatectomy (LSPDP) and open spleen-preserving distal pancreatectomy (OSPDP) for treatment of benign and low-grade malignant tumors of the pancreas and evaluate feasibility and safety of LSPDP. Methods. The clinical data of 53 cases of LSPDP and 44 cases of OSPDP performed between January 2008 and August 2018 were retrospectively analyzed. The clinical outcomes between the two groups were compared. Results. There was no significant difference in preoperative data between the two groups. However, the LSPDP group had statistically significant shorter operative time (145.3±55.9 versus 184.7±33.5, P=0.03) and lesser intraoperative blood loss (150.6±180.8 versus 253.5±76.2, P=0.03) than that of the OSPDP group. Moreover, the LSPDP group also had statistically significant earlier passing of first flatus (2.2±1.4 versus 3.1±1.9, P=0.01), earlier diet intake (2.3±1.8 versus 3.4±2.0, P=0.01), and shorter hospital stay (6.2±7.2 versus 8.8±9.3, 0.04) than that of the OSPDP group. However, postoperative pancreatic fistula (P=0.64) and total postoperative complications (P=0.59) were not significantly different between the groups. The rate of pancreatic fistula and total postoperative complications occurred in 62.5% and 64.5%, respectively, in LSPDP group and, similarly, 70% and 70.0%, respectively, in OSPDP group. Conclusion. This study confirms that LSPDP is safe, feasible, and superior to OSPDP in terms of operative time, intraoperative blood loss, hospital stay, and postoperative recovery. Hence, it is worth popularizing LSPDP for benign and low-grade malignant tumors of the pancreas.

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Laparoscopic Major Gastrointestinal Surgery Is Safe for Properly Selected Patient with COPD: A Meta-Analysis

BioMed Research International ◽

10.1155/2019/8280358 ◽

2019 ◽

Vol 2019 ◽

pp. 1-8

Author(s):

Yulin Guo ◽

Feng Cao ◽

Yixuan Ding ◽

Haichen Sun ◽

Shuang Liu ◽

...

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Meta Analysis ◽

Gastrointestinal Surgery ◽

Laparoscopic Approach ◽

Length Of Hospital Stay ◽

Pulmonary Complications ◽

Cochrane Library ◽

Chronic Obstructive ◽

Intraoperative Blood Loss

Background. Laparoscopy has been widely applied in gastrointestinal surgery, with benefits such as less intraoperative blood loss, faster recovery, and shorter length of hospital stay. However, it remains controversial if laparoscopic major gastrointestinal surgery could be conducted for patients with chronic obstructive pulmonary disease (COPD) which was traditionally considered as an important risk factor for postoperative pulmonary complications. The present study was conducted to review and assess the safety and feasibility of laparoscopic major abdominal surgery for patient with COPD. Materials and Methods. Databases including PubMed, EmBase, Cochrane Library, and Wan-fang were searched for all years up to Jul 1, 2018. Studies comparing perioperative results for COPD patients undergoing major gastrointestinal surgery between laparoscopic and open approaches were enrolled. Results. Laparoscopic approach was associated with less intraoperative blood loss (MD = -174.03; 95% CI: −232.16 to -115.91, P < 0.00001; P < 0.00001, I2=93% for heterogeneity) and shorter length of hospital stay (MD = -3.30; 95% CI: −3.75 to -2.86, P < 0.00001; P = 0.99, I2=0% for heterogeneity). As for pulmonary complications, laparoscopic approach was associated with lower overall pulmonary complications rate (OR = 0.58; 95% CI: 0.48 to 0.71, P < 0.00001; P = 0.42, I2=0% for heterogeneity) and lower postoperative pneumonia rate (OR = 0.53; 95% CI: 0.41 to 0.67, P < 0.00001; P = 0.57, I2=0% for heterogeneity). Moreover, laparoscopic approach was associated with lower wound infection (OR = 0.51; 95% CI: 0.42 to 0.63, P < 0.00001; P = 0.99, I2=0% for heterogeneity) and abdominal abscess rates (OR = 0.59; 95% CI: 0.44 to 0.79, P < 0.0004; P = 0.24, I2=30% for heterogeneity). Conclusions. Laparoscopic major gastrointestinal surgery for properly selected COPD patient was safe and feasible, with shorter term benefits.

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Harmonic Scalpel versus Conventional Haemostasis in Neck Dissection: A Prospective Randomized Study

International Journal of Surgical Oncology ◽

10.1155/2013/369345 ◽

2013 ◽

Vol 2013 ◽

pp. 1-8 ◽

Cited By ~ 2

Author(s):

Emanuele Ferri ◽

Enrico Armato ◽

Giacomo Spinato ◽

Marcello Lunghi ◽

Giancarlo Tirelli ◽

...

Keyword(s):

Postoperative Pain ◽

Postoperative Complications ◽

Blood Loss ◽

Hospital Stay ◽

Neck Dissection ◽

Operative Time ◽

Harmonic Scalpel ◽

Intraoperative Blood Loss ◽

Bipolar Diathermy ◽

Classic Technique

Purpose.The aim of this prospective randomized trial was to compare operative factors, postoperative outcomes, and surgical complications of neck dissection (ND) when using the harmonic scalpel (HS) versus conventional haemostasis (CH) (classic technique of tying and knots, resorbable ligature, and bipolar diathermy).Materials and methods.Sixty-one patients who underwent ND with primary head and neck cancer (HNSCC) resection were enrolled in this study and were randomized into two homogeneous groups: CH (conventional haemostasis with classic technique of tying and knots, resorbable ligature, and bipolar diathermy) and HS (haemostasis with harmonic scalpel). Outcomes of the study included operative time, intraoperative blood loss, drainage volume, postoperative pain, hospital stay, and incidence of intraoperative and postoperative complications.Results.The use of the HS reduced significantly the operating time, the intraoperative blood loss, the postoperative pain, and the volume of drainage. No significant difference was observed in mean hospital stay and perioperative, and postoperative complications.Conclusion.The HS is a reliable and safe tool for reducing intraoperative blood loss, operative time, volume of drainage and postoperative pain in patients undergoing ND for HNSCC. Multicenter randomized studies need to be done to confirm the advantages of this technique and to evaluate the cost-benefit ratio.

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Laparoscopic procedure is associated with lower morbidity for simultaneous resection of colorectal cancer and liver metastases: an updated meta-analysis

World Journal of Surgical Oncology ◽

10.1186/s12957-020-02018-z ◽

2020 ◽

Vol 18 (1) ◽

Author(s):

Long Pan ◽

Chenhao Tong ◽

Siyuan Fu ◽

Jing Fang ◽

Qiuxia Gu ◽

...

Keyword(s):

Colorectal Cancer ◽

Laparoscopic Surgery ◽

Postoperative Complications ◽

Blood Loss ◽

Meta Analysis ◽

Effective Length ◽

Cochrane Library ◽

Intraoperative Blood Loss ◽

Surgery Group ◽

Simultaneous Resection

Abstract Background It has been demonstrated that simultaneous resection of both primary colorectal lesion and metastatic hepatic lesion is a safe approach with low mortality and postoperative complication rates. However, there are some controversies over which kind of surgical approach is better. The aim of study was to compare the efficacy and safety of laparoscopic surgeries and open surgeries for simultaneous resection of colorectal cancer (CRC) and synchronous colorectal liver metastasis (SCRLM). Methods A systemic search of online database including PubMed, Web of Science, Cochrane Library, and Embase was performed until June 5, 2019. Intraoperative complications, postoperative complications, and long-term outcomes were synthesized by using STATA, version 15.0. Cumulative and single-arm meta-analyses were also conducted. Results It contained twelve studies with 616 patients (273 vs 343, laparoscopic surgery group and open surgery group, respectively) and manifested latest surgical results for the treatment of CRC and SCRLM. Among patients who underwent laparoscopic surgeries, they had lower rates of postoperative complications (OR = 0.66, 95% CI: 0.46 to 0.96, P = 0.028), less intraoperative blood loss (weight mean difference (WMD) = − 113.31, 95% CI: − 189.03 to − 37.59, P = 0.003), less time in the hospital and recovering after surgeries (WMD = − 2.70, 95% CI: − 3.99 to − 1.40, P = 0.000; WMD = − 3.20, 95% CI: − 5.06 to − 1.34, P = 0.001), but more operating time (WMD = 36.57, 95% CI: 7.80 to 65.35, P = 0.013). Additionally, there were no statistical significance between two kinds of surgical approaches in disease-free survival and overall survival. Moreover, cumulative meta-analysis indicated statistical difference in favor of laparoscopic surgery in terms of morbidity was firstly detected in the 12th study in 2018 (OR = 0.66, 95% CI: 0.46 to 0.96, P = 0.028) as the 95% CI narrowed. Conclusion Compared with open surgeries, laparoscopic surgeries are safer (postoperative complications and intraoperative blood loss) and more effective (length of hospital stay and postoperative stay), and it can be considered as the first option for management of SCRLM in high-volume laparoscopic centers. Trial registration CRD42020151176

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723 Neuroendoscopy versus Craniotomy in Basal Ganglia Haemorrhage: A Systematic Review and Meta-Analysis

British Journal of Surgery ◽

10.1093/bjs/znab258 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

T K Tan ◽

J Merola ◽

M Zaben ◽

W Gray ◽

P Leach

Keyword(s):

Systematic Review ◽

Basal Ganglia ◽

Mortality Rate ◽

Blood Loss ◽

Hospital Stay ◽

Operative Time ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

Endoscopic Approach ◽

Intraoperative Blood Loss

Abstract Aim Basal ganglia haemorrhage (BGH) is the most common type of intracerebral bleed with high morbidity and mortality rate. The efficacy between craniotomy and endoscopic approach in BGH is still debatable and advancement in minimally invasive technique has made endoscopic approach the preferred option. The aim of this systematic review and meta-analysis was to evaluate the outcomes of craniotomy and endoscopic approach in BGH. Method Databases of PubMed, EMBASE, MEDLINE and CENTRAL were systematically searched from its inception until December 2020. All randomized clinical trials and observational studies comparing craniotomy versus endoscopic approach in BGH were included. Results Twelve studies enrolling 1297 patients (craniotomy:675, endoscopy:632) were included for qualitative and quantitative analysis. Endoscopic approach was associated with significantly lower postoperative mortality (OR:0.35, P < 0.00001), higher haematoma evacuation rate (MD:4.95, P = 0.0002), shorter operative time (MD:-117.03, P < 0.00001), lesser intraoperative blood loss (MD:-328.47, P < 0.00001), higher postoperative Glasgow Coma Scale (GCS) (MD:1.14, P = 0.01), higher postoperative Glasgow Outcome Scale (GOS) (MD:0.44, P = 0.05), shorter length of hospital stay (MD:-2.90, P < 0.00001), lower complication rate (OR:0.30, P = 0.0004), lower infection rate (OR:0.29, P < 0.00001) and lower modified Rankin Scale (mRS) (MD:-0.57, P = 0.004) compared to craniotomy. No significant difference was detected in reoperation, intracranial infection, re-bleeding. Conclusions The best available evidence suggest that endoscopic approach has better outcomes in mortality rate, operative time, haematoma evacuation rate, intraoperative blood loss, length of hospital stay, mRS, postoperative GCS and GOS compared with craniotomy in the management of BGH. However, there is a need for high quality randomised controlled trials with large sample size for definite conclusions.

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Clinical Efficacy of Perioperative Immunonutrition Containing Omega-3-Fatty Acids in Patients Undergoing Hepatectomy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Annals of Nutrition and Metabolism ◽

10.1159/000509979 ◽

2020 ◽

pp. 1-12

Author(s):

Benjian Gao ◽

Jia Luo ◽

Ying Liu ◽

Furui Zhong ◽

Xiaoli Yang ◽

...

Keyword(s):

Postoperative Complications ◽

Hospital Stay ◽

Randomized Controlled Trials ◽

Fixed Effects ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

Cochrane Library ◽

Controlled Trials ◽

Randomized Controlled ◽

The Impact

Background: The effect of immunonutrition in patients undergoing hepatectomy remains unclear. This meta-analysis aimed to assess the impact of immunonutrition on postoperative clinical outcomes in patients undergoing hepatectomy. Methods: A literature search of PubMed, Cochrane Library, Web of Science, and Embase databases was performed to identify all randomized controlled trials (RCTs) exploring the effect of perioperative immunonutrition in patients undergoing hepatectomy until the end of March 10, 2020. Quality assessment and data extraction of RCTs were conducted independently by 3 reviewers. Mean difference (MD) and odds ratio (OR) with 95% confidence interval (CI) were calculated using a fixed-effects or random-effects model. The meta-analysis was performed with RevMan 5.3 software. Results: Nine RCTs involving a total of 966 patients were finally included. This meta-analysis showed that immunonutrition significantly reduced the incidences of overall postoperative complications (OR = 0.57, 95% CI: 0.34–0.95; p = 0.03), overall postoperative infectious complications (OR = 0.53, 95% CI: 0.37–0.75; p = 0.0003), and incision infection (OR = 0.50, 95% CI: 0.28–0.89; p = 0.02), and it shortened the length of hospital stay (MD = −3.80, 95% CI: −6.59 to −1.02; p = 0.007). There were no significant differences in the incidences of pulmonary infection (OR = 0.60, 95% CI: 0.32–1.12; p = 0.11), urinary tract infection (OR = 1.30, 95% CI: 0.55–3.08; p = 0.55), liver failure (OR = 0.54, 95% CI: 0.23–1.24; p = 0.15), and postoperative mortality (OR = 0.69, 95% CI: 0.26–1.83; p = 0.46). Conclusion: Given its positive impact on postoperative complications and the tendency to shorten the length of hospital stay, perioperative immunonutrition should be encouraged in patients undergoing hepatectomy.

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Predictors of complications occurring after open and robot-assisted prostate cancer surgery: a retrospective evaluation of 1062 consecutive patients treated in a tertiary referral high volume center

Journal of Robotic Surgery ◽

10.1007/s11701-021-01192-w ◽

2021 ◽

Author(s):

Antonio Benito Porcaro ◽

Alessandro Tafuri ◽

Riccardo Rizzetto ◽

Nelia Amigoni ◽

Marco Sebben ◽

...

Keyword(s):

Prostate Cancer ◽

Postoperative Complications ◽

Radical Prostatectomy ◽

Blood Loss ◽

Open Approach ◽

Intraoperative Blood Loss ◽

Tertiary Referral ◽

Robot Assisted ◽

The Third ◽

Major Complications

AbstractTo investigate factors associated with the risk of major complications after radical prostatectomy (RP) by the open (ORP) or robot-assisted (RARP) approach for prostate cancer (PCa) in a tertiary referral center. 1062 consecutive patients submitted to RP were prospectively collected. The following outcomes were addressed: (1) overall postoperative complications: subjects with Clavien-Dindo System (CD) one through five versus cases without any complication; (2) moderate to major postoperative complications: cases with CD < 2 vs. ≥ 2, and 3) major post-operative complications: subjects with CDS CD ≥ 3 vs. < 3. The association of pre-operative and intra-operative factors with the risk of postoperative complications was assessed by the logistic regression model. Overall, complications occurred in 310 out of 1062 subjects (29.2%). Major complications occurred in 58 cases (5.5%). On multivariate analysis, major complications were predicted by PCa surgery and intraoperative estimated blood loss (EBL). ORP compared to RARP increased the risk of major CD complications from 2.8 to 19.3% (OR = 8283; p < 0.0001). Performing ePLND increased the risk of major complications from 2.4 to 7.4% (OR = 3090; p < 0.0001). Assessing intraoperative blood loss, the risk of major postoperative complications was increased by BL above the third quartile when compared to subjects with intraoperative blood loss up to the third quartile (10.2% vs. 4.6%; OR = 2239; 95%CI: 1233–4064). In the present cohort, radical prostatectomy showed major postoperative complications that were independently predicted by the open approach, extended lymph-node dissection, and excessive intraoperative blood loss.

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