Oral Mucosa vs. Penile Skin Flap in Substitution Urethroplasty for Anterior Urethral Strictures: A Systematic Review and Meta-Analysis

Background: The purpose of this study is to compare the effectiveness and safety of oral mucosa and penile skin flaps in the treatment of anterior urethral stricture.Methods: This meta-analysis was carried out according to the principle of preferred reporting items for systematic reviews and meta-analysis (PRISMA) and registered at PROSPERO (CRD42021277688). The Cochrane Library, PubMed, Embase, CKNI databases were searched and reviewed up to Sep 2021. Quality evaluation was performed with Newcastle-Ottawa Scale (NOS) system for non-randomized studies and Cochrane stools for randomized studies. Data synthesis was conducted with RevMan 5.4 software (Cochrane) and a Stata 15.0 environment (Stata Corpor, College Station, TX, USA).Results: After the research screening, eight studies (comprising 445 patients) were finally included in the quantitative analysis. In the success rate comparison, there was no significant difference between oral mucosa and penile skin flaps (oral mucosa vs. penile skin flap, Mantel-Haenszel statistic [M-H] fixed model, OR: 0.80, 95% CI: 0.47–1.34, P = 0.39). There was no significant difference in the post-operative complication comparison (oral mucosa vs. penile skin flap, Mantel-Haenszel statistic [M-H] fixed model, OR: 0.68, 95% CI: 0.40–1.16, P = 0.15). However, considering that the site of oral mucosa is far from the anterior urethra, it may have advantages in operation time through simultaneous operations (oral mucosa vs. penile skin flap, MD: −40.05, 95% CI: −79.42, −0.68, P = 0.046).Conclusion: When the oral mucosal graft was used in the anterior urethra urethroplasty, it had a similar success rate and post-operative complication rate, and oral mucosa substitution had a shorter operation time. This evidence-based medical research further supports the view that oral mucosa is the preferred substitution material for the anterior urethra urethroplasty.

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Microscopic Versus Endoscopic Stapes Surgery: A Systematic Review and Meta-analysis

10.22541/au.161575303.38017326/v1 ◽

2021 ◽

Author(s):

JIANNIS HAJIIOANNOU ◽

Eleni Gkrinia ◽

Konstantinos Tzimkas-Dakis ◽

Effrosyni Palla ◽

Alexandros Brotis ◽

...

Keyword(s):

Success Rate ◽

Meta Analysis ◽

Operation Time ◽

Stapes Surgery ◽

Cochrane Library ◽

Efficacy And Safety ◽

Quality Of Evidence ◽

Randomized Controlled Studies ◽

Significant Difference

Objectives Endoscopic approaches constitute a newly introduced and promising technique in the field of stapes surgery, presenting favorable outcomes, so far. This study aims to compare endoscopic and microscopic stapes surgery based on current literature evidence, in terms of their efficacy and safety characteristics. Design We conducted a systematic literature search of three medical databases (Pubmed, Cochrane Library, and Scopus). We focused on randomized controlled studies or observational studies comparing microscopic to endoscopic stapes surgery. Data related to the efficacy and safety of each technique were extracted. Outcome data were summarized using the pooled mean differences or pooled odds ratio along with their 95% confidence intervals, according to the available data. The quality of evidence was assessed according to the GRADE recommendations. Results Thirteen studies with 705 patients were included in the meta-analysis. Success rate was evaluated by estimating air-bone gap improvement, resulting in comparable outcomes for the two techniques (mean difference: -0.20; 95% CI: -0.53, 0.14). No statistically significant difference was detected concerning postoperative complications, except for dysgeusia that was in favor of the endoscopic approach (OR: -1.46; 95% CI: -2.45, -.047). The overall quality of evidence was assessed to range from “Low” to “Very Low”. Conclusion Endoscopic stapes surgery is an innovative alternative to the microscopic technique, resulting in commensurate outcomes in terms of success rate and complications. Further high-quality studies are needed, to adequately compare the two approaches, particularly in terms of operation time, learning curve, cost-effectiveness, and otology surgical skills acquisition.

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Preclinical efficacy of stem cell therapy for skin flap: a systematic review and meta-analysis

Stem Cell Research & Therapy ◽

10.1186/s13287-020-02103-w ◽

2021 ◽

Vol 12 (1) ◽

Author(s):

Yuan Li ◽

Qi-lin Jiang ◽

Leanne Van der Merwe ◽

Dong-hao Lou ◽

Cai Lin

Keyword(s):

Systematic Review ◽

Stem Cells ◽

Stem Cell ◽

Survival Rate ◽

Meta Analysis ◽

Skin Flap ◽

Cochrane Library ◽

Skin Flaps ◽

Cell Based Therapy ◽

Stem Cell Treatment

Abstract Background A skin flap is one of the most critical surgical techniques for the restoration of cutaneous defects. However, the distal necrosis of the skin flap severely restricts the clinical application of flap surgery. As there is no consensus on the treatment methods to prevent distal necrosis of skin flaps, more effective and feasible interventions to prevent skin flaps from necrosis are urgently needed. Stem therapy as a potential method to improve the survival rate of skin flaps is receiving increasing attention. Methods This review followed the recommendations from the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statements. Twenty studies with 500 animals were included by searching Web of Science, EMBASE, PubMed, and Cochrane Library databases, up until October 8, 2020. Moreover, the references of the included articles were searched manually to obtain other studies. All analyses were conducted using Review Manager V.5.3 software. Results Meta-analysis of all 20 studies demonstrated stem cell treatment has significant effects on reducing necrosis of skin flap compared with the control group (SMD: 3.20, 95% CI 2.47 to 3.93). Besides, subgroup analysis showed differences in the efficacy of stem cells in improving the survival rate of skin flaps in areas of skin flap, cell type, transplant types, and method of administration of stem cells. The meta-analysis also showed that stem cell treatment had a significant effect on increasing blood vessel density (SMD: 2.96, 95% CI 2.21 to 3.72) and increasing the expression of vascular endothelial growth factor (VEGF, SMD: 4.34, 95% CI 2.48 to 6.1). Conclusions The preclinical evidence of our systematic review indicate that stem cell-based therapy is effective for promoting early angiogenesis by up regulating VEGF and ultimately improving the survival rate of skin flap. In summary, small area skin flap, the administration method of intra-arterial injection, ASCs and MSCs, and xenogenic stem cells from humans showed more effective for the survival of animal skin flaps. In general, stem cell-based therapy may be a promising method to prevent skin flap necrosis.

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Systematic Review and Meta-analysis of Complications Following Mastectomy and Prosthetic Reconstruction in Patients With and Without Prior Breast Augmentation

Aesthetic Surgery Journal ◽

10.1093/asj/sjab028 ◽

2021 ◽

Author(s):

Maria Chicco ◽

Ali R Ahmadi ◽

Hsu-Tang Cheng

Keyword(s):

Systematic Review ◽

Postoperative Complications ◽

Meta Analysis ◽

Skin Flap ◽

Prosthetic Reconstruction ◽

Hematoma Formation ◽

Significant Difference ◽

Nipple Sparing Mastectomy ◽

Nipple Sparing ◽

Early Late

Abstract Background There is limited evidence available in literature with regard to the complication profile of mastectomy and immediate prosthetic reconstruction in augmented patients. Objectives The purpose of this systematic review and meta-analysis is to compare postoperative complications between women with versus without prior augmentation undergoing skin- or nipple-sparing mastectomy and immediate prosthetic reconstruction. Methods A systematic search was conducted in February 2020 for studies comparing women with versus without prior augmentation undergoing skin- or nipple-sparing mastectomy and immediate prosthetic reconstruction with documentation of postoperative complications. Outcomes analyzed included early, late and overall complications. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were obtained through meta-analysis. Results Our meta-analysis, which included six studies comparing 241 breasts with prior augmentation and 1441 without, demonstrated no significant difference between the two groups in rates of early (36.7% vs. 24.8%; OR=1.57, 95% CI 0.94 to 2.64; P=0.09), late (10.1% vs. 19.9%; OR=0.53, 95% CI 0.06 to 4.89; P=0.57) and overall complications (36.5% vs. 31.2%; OR=1.23, 95% CI 0.76 to 2.00; P=0.40). Subgroup analysis showed a significantly higher rate of hematoma formation in the augmented group (3.39% versus 2.15%; OR=2.68, 95% CI 1.00 to 7.16; P=0.05), but no difference in rates of seroma, infection, mastectomy skin flap necrosis and prosthesis loss. Conclusions Our meta-analysis suggests that prior augmentation does not significantly increase overall postoperative complications in women undergoing skin- or nipple-sparing mastectomy and immediate prosthetic reconstruction. However, the significantly higher rate of hematoma formation in augmented patients warrants further investigation and preoperative discussion.

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Evaluation of platelet-rich plasma gel as an angiogenesis-inducing agent in canineadvancement skin flaps

Pesquisa Veterinária Brasileira ◽

10.1590/1678-5150-pvb-6512 ◽

2020 ◽

Vol 40 (6) ◽

pp. 474-478

Author(s):

Grazielle A.S. Aleixo ◽

Maria C.O.C. Coelho ◽

Telga L.A. Almeida ◽

Márcia F. Pereira ◽

Miriam N. Teixeira ◽

...

Keyword(s):

Blood Vessel ◽

Skin Color ◽

Platelet Rich Plasma ◽

Skin Flap ◽

Skin Flaps ◽

Experimental Conditions ◽

Significant Difference ◽

Experimental Group ◽

Prp Gel ◽

Made In

ABSTRACT: This work aimed to evaluate the effect of platelet-rich plasma (PRP) on advancement skin flaps in dogs regarding improvement of vascularization, with focus on increasing its viable area, since there are reports that it is a potential angiogenesis stimulator. The experimental group was composed of eight adult bitches, in which two advancement skin flaps were made in the ventral abdominal region. No product was applied in the control flap (CF), while PRP was used in the contralateral flap, called treated flap (TF). The areas were clinically evaluated every two days until the 7th postoperative day regarding skin color and presence of necrosis. At 10 days, both flaps were removed and submitted to histological examination and blood vessel morphometry. The vessels counted in each group were statistically analyzed by the F-test at 1% probability. Results showed no significant difference in macroscopic changes in the wound, or CF and TF vascularization, thus suggesting that PRP gel did not improve advancement skin flap angiogenesis in bitches under the experimental conditions in which this research was developed.

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Comparison between Ologen implant and Mitomycin C in trabeculectomy: A Systematic Review and Meta-Analysis

10.21203/rs.2.10619/v1 ◽

2019 ◽

Author(s):

Xiaoyan Liu ◽

Yali Du ◽

Min Lei ◽

Leyi Zhuang ◽

Peng Lv

Keyword(s):

Adverse Events ◽

Success Rate ◽

Data Extraction ◽

Meta Analysis ◽

Collagen Matrix ◽

Current Evidence ◽

Cochrane Library ◽

Significant Difference ◽

Mean Differences ◽

Alternative Choice

Abstract Objective To evaluate the effectiveness and safety of the biodegradable collagen matrix (Ologen) implant in trabeculectomy. Research design and methods We searched Pubmed, Cochrane library, Embase and Web of Science databases to find studies that met our pre-stated inclusion criteria. Reference lists of retrieved articles were also reviewed. The search was finished by February 2019. Study selection, data extraction, quality assessment, and data analyses were performed according to the Cochrane standards. Either a fixed or a random-effects model was used to calculate the overall combined risk estimates. The efficacy measures were the weighted mean differences (WMDs) for the intraocular pressure reduction (IOPR) and the glaucoma medications reduction, the odds ratio (OR) for the success rate and adverse events. Results Fifteen randomized controlled trials involved 682 eyes were included in the meta-analysis. There were no statistically differences between two groups in the IOPR at any time postoperatively. The MD of the IOPR was [MD= -0.45,95% Confidence Interval (CI), (-2.36,1.46), P=0.65] at one day, [MD= -0.82,95% CI, (-1.97, 0.33), P=0.16] at one week, [MD= -1.33, 95% CI,(-3.12, 0.47), P=0.15] at one month, [MD= 0.11,95% CI, (-1.87, 2.08), P=0.92] at three months, [MD= -0.60,95% CI, (-2.27, 1.06), P=0.48] at six months, [MD= -0.33,95% CI, (-1.99, 1.32), P=0.69] at one year, [MD= -0.13,95% CI, (-1.90, 1.65), P=0.89] at two years, [MD= 2.54,95% CI, (-2.83, 7.90), P=0.35] at three years, [MD= 3.04,95% CI, (-3.95, 10.03), P=0.39] at five years. There was no statistically significant difference between the Ologen groups and MMC groups concerned the complete success rate [OR=1.19, 95%CI, (0.83, 1.71), P=0.35]. With regard to the adverse events, no obvirously significance was observed. Seven studies reported the change of antiglaucoma medications. We found that the change of antiglaucoma medications is higher in MMC groups than that in Ologen groups [MD=-0.18, 95%CI, (-0.33, -0.03), P=0.02]. There is no significant difference in complications between the two groups. Conclusions From the current evidence, Ologen may be an alternative choice for trabeculectomy when considering the efficacy and safety. However, MMC might be the preferred choice concerned cost-effectiveness.

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Comparison of conservative treatment with appendectomy for acute uncomplicated pediatric appendicitis: a meta-analysis

Journal of Comparative Effectiveness Research ◽

10.2217/cer-2019-0036 ◽

2019 ◽

Vol 8 (10) ◽

pp. 767-780

Author(s):

Le-wee Bi ◽

Bei-lei Yan ◽

Qian-yu Yang ◽

Hua-lei Cui

Keyword(s):

Statistical Analysis ◽

Treatment Group ◽

Conservative Treatment ◽

Success Rate ◽

Treatment Efficacy ◽

Meta Analysis ◽

Cochrane Library ◽

Significant Difference ◽

The Cochrane Library

Aim: We aimed to compare conservative treatment with surgery for uncomplicated pediatric appendicitis to estimate effectiveness and safety. Methods: Data recorded until September 2018 were searched, and relevant academic articles from PubMed, EMBASE, the Cochrane Library and other libraries were selected. STATA version 13.0 (Stata Corporation, TX, USA) was used for statistical analysis. Results: We identified nine eligible papers. The study reported a significant difference in the success rate of treatment in 1 month and in 1 year, and no difference in the incidence of complications. The patients with fecaliths showed low treatment efficacy in conservative treatment group (p < 0.05). Conclusion: Standardized conservative treatment as inpatients for pediatric appendicitis is safe and feasible. Appendectomy was the better choice for patients with fecaliths.

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Sphincterotomy with endoscopic biliary drainage for severe acute cholangitis: a meta-analysis

Endoscopy International Open ◽

10.1055/s-0042-120412 ◽

2017 ◽

Vol 05 (02) ◽

pp. E103-E109 ◽

Cited By ~ 4

Author(s):

Tarek Sawas ◽

Noura Arwani ◽

Shadi Al Halabi ◽

John Vargo

Keyword(s):

Success Rate ◽

Biliary Drainage ◽

Meta Analysis ◽

Acute Cholangitis ◽

Endoscopic Drainage ◽

Endoscopic Biliary Drainage ◽

Significant Difference ◽

Obstructive Cholangitis ◽

Effective Drainage

Abstract Aims To investigate the role of endoscopic sphincterotomy (ES) with endoscopic biliary drainage (EBD) in acute severe obstructive cholangitis management by performing a meta-analysis of controlled trials. Method We searched PubMed and Embase for controlled studies that compared endoscopic drainage with ES versus Non-ES in acute obstructive cholangitis. Two reviewers selected the studies and extracted the data. Disagreement was addressed by a third reviewer. Heterogeneity of the studies was analyzed by Cochran’s Q statistics. A Mantel–Haenszel risk ratio was calculated utilizing a random effects model. Results Four controlled studies met our inclusion criteria with 392 participants (201 ES, 191 Non-ES). The outcomes were drainage insertion success rate, drainage effectiveness, post drainage pancreatitis, bleeding, procedure duration, perforation, cholecystitis, and 30-day mortality. Drainage insertion success rate was identical in both groups (RR: 1.00, 95 %CI% 0.96 – 1.04). Effective drainage was not significantly different (RR: 1.11, 95 %CI 0.73 – 1.7). There was no significant difference in the incidence of pancreatitis post EBD between the ES and Non-ES groups at 3 % and 4 %, respectively (RR: 0.73, 95 %CI 0.24 – 2.27). However, there was a significant increase in post EBD bleeding with ES compared to Non-ES (RR: 8.58, 95 %CI 2.03 – 36.34). Thirty-day mortality was similar between ES and Non-ES groups at 0.7 % and 1 %, respectively (RR: 0.5, 95 %CI 0.05 – 5.28). Conclusion Our findings show that EBD without ES is an effective drainage technique and carries less risk for post procedure bleeding. Patients who are critically ill and have coagulopathy should be spared from undergoing ES in the acute phase.

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

World Journal of Surgical Oncology ◽

10.1186/s12957-021-02230-5 ◽

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.

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Does zero-profile anchored cage accompanied by a higher postoperative subsidence compared with cage-plate construct? A meta-analysis

10.21203/rs.2.19553/v3 ◽

2020 ◽

Author(s):

Yingjie Lu ◽

Yuepeng Fang ◽

Xu Shen ◽

Dongdong Lu ◽

Liyu Zhou ◽

...

Keyword(s):

Controlled Trial ◽

Meta Analysis ◽

Operation Time ◽

Fusion Rate ◽

Subsidence Rate ◽

Radiological Data ◽

Significant Difference ◽

Score Fusion ◽

Definition Of

Abstract Background: The zero-profile anchored cage ( ZP ) has been widely used for its lower occurrence of dysphagia. However, it is still controversial whether it has the same stability as the cage-plate construct (CP) and increases the incidence of postoperative subsidence. We compared the rate of subsidence after anterior cervical discectomy and fusion (ACDF) with ZP and CP to determine whether the zero-profile device had a higher subsidence rate. Methods: We performed a meta-analysis of studies that compared the subsidence rates of ZP and CP. An extensive and systematic search covered the Medline, Embase and Web of Science databases according to the PRISMA guidelines and identified ten articles that satisfied our inclusion criteria. Relevant clinical and radiological data were extracted and analyzed by RevMan 5.3 software. Results: Ten trials involving 626 patients were included in this meta-analysis. The incidence of postoperative subsidence in the ZP group was significantly higher than that in the CP group [15.1% (89/588) vs. 8.8% (51/581), OR = 1.97 (1.34, 2.89), P = 0.0005]. In the subgroup analysis, we found that the definition of subsidence did not affect the higher subsidence rate in the ZP group. Considering the quantity of operative segments, there was no significant difference in the incidence of subsidence between the two groups after single-level fusion (OR 1.43, 95% CI 0.61-3.37, P = 0.41). However, the subsidence rate of the ZP group was significantly higher than that of the CP group (OR 2.61, 95% CI 1.55-4.40, P = 0.0003) after multilevel (≥2-level) procedures. There were no significant differences in intraoperative blood loss, JOA score, NDI score, fusion rate or cervical alignment in the final follow-up between the two groups. In addition, the CP group had a longer operation time and a higher incidence of dysphagia than the ZP group at each follow-up time. Conclusion: Based on the limited evidence, we suggest that ZP has a higher risk of postoperative subsidence than CP, although with elevated swallowing discomfort. A high-quality, multi-center randomized controlled trial is required to validate our results in the future.

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Transforaminal and Posterior Lumbar Interbody Fusion for Llumbar Degenerative Diseases, which one is better: A meta-analysis Through a Ggrade Analysis of Evidence

10.21203/rs.3.rs-910433/v1 ◽

2021 ◽

Author(s):

aixian tian ◽

xinlong ma ◽

jianxiong Ma

Keyword(s):

Blood Loss ◽

Interbody Fusion ◽

Meta Analysis ◽

Posterior Lumbar Interbody Fusion ◽

Length Of Hospital Stay ◽

Operation Time ◽

Transforaminal Lumbar Interbody Fusion ◽

Fusion Rate ◽

Lumbar Interbody Fusion ◽

Significant Difference

Abstract BackgroundTo explore the efficacy and safety between posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF) in the treatment of lumbar degenerative diseases.MethodsWe searched the literature in Pubmed, Embase, Cochrane Library and Web of Science. The index words were posterior lumbar interbody fusion, PLIF, transforaminal lumbar interbody fusion, TLIF, lumbar interbody fusion, spinal fusion, degenerative disc disease and lumbar degenerative diseases. Primary outcomes were fusion rate and complications. Secondary outcomes were visual analog scale (ΔVAS), Oswestry Disability Index (ΔODI), total blood loss, operation time and length of hospital stay. Review Manager 5.3 and Stata13.1 was used for the analysis of forest plots, heterogeneity, sensitivity and publication bias.Results17 studies were included (N=1562; PLIF, n=835; TLIF, n=727). The pooled data showed PLIF had a higher complications (P= 0.000), especially in nerve injury (p = 0.003) and dural tear (p = 0.005). PLIF required longer operation time (p = 0.004), more blood loss (p = 0.000) and hospital stays (p = 0.006). Surprisingly subgroup analysis showed there was significant difference in complications in patients under 55 (p = 0.000) and Asian countries (p = 0.000). No statistical difference was found between the two groups with regard to fusion rate (p = 0.593),ΔVAS (p = 0.364) andΔODI (p = 0.237).ConclusionsThis meta-analysis showed there were no significant difference in fusion rate, ΔVAS and ΔODI. However TLIF could reduce complications, especially nerve injury and dural tear. Besides, TLIF was associated with statistically significant less blood loss, shorter operation time and shorter length of hospital stay.

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