Surg J R Coll Surg E
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Surg J R Coll Surg E · Dec 2017
Review Meta Analysis Comparative StudyCT- versus MRI-based patient-specific instrumentation for total knee arthroplasty: A systematic review and meta-analysis.
To determine whether computed tomography (CT) or magnetic resonance imaging (MRI) is more suitable for the patient-specific instrumentation (PSI) systems for total knee arthroplasty (TKA). ⋯ The current limited evidence suggests that MRI-based PSI systems exhibit higher accuracy for TKA regarding the coronal limb axis than CT-based PSI systems. However, well-designed studies comparing CT-versus MRI-based PSI systems for TKA are warrant to confirm these results before widespread use of this technique can be recommended.
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Surg J R Coll Surg E · Oct 2017
Review Meta AnalysisAntibiotics-first strategy for uncomplicated acute appendicitis in adults is associated with increased rates of peritonitis at surgery. A systematic review with meta-analysis of randomized controlled trials comparing appendectomy and non-operative management with antibiotics.
Acute appendicitis is the most common surgical diagnosis in young patients, with lifetime prevalence of about 7%. Debate remains on whether uncomplicated AA should be operated or not. Aim of this meta-analysis of randomized controlled trials was to assess current evidence on antibiotic treatment for uncomplicated AA compared to standard surgical treatment. ⋯ With significantly higher efficacy and low complication rates, appendectomy remains the most effective treatment for patients with uncomplicated AA. The subgroups of patients with uncomplicated AA where antibiotics can be more effective, should be accurately identified.
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Surg J R Coll Surg E · Feb 2017
Review Meta Analysis Comparative StudyLocal anaesthesia versus spinal anaesthesia in inguinal hernia repair: A systematic review and meta-analysis.
Inguinal hernias are a significant cause of morbidity. The purpose of this systematic review and meta-analysis is to determine the totality of evidence regarding the effectiveness of local anaesthesia when compared to spinal anaesthesia in individuals undergoing open inguinal hernia repair. ⋯ Our findings support the use of local anaesthetic in adult patients undergoing open repair for a primary inguinal hernia.
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Surg J R Coll Surg E · Aug 2015
Review Meta AnalysisDecompressive hemicraniectomy in patients with malignant middle cerebral artery infarction: A systematic review and meta-analysis.
Malignant middle cerebral artery infarctions (mMCAI) are one of the most devastating ischemic strokes, with up to 80% mortality in non-surgically treated patients. With the publication of three European randomized controlled trials (RCTs), decompressive hemicraniectomy (DHC) was recommended in patients with mMCAI who are aged ≤ 60 years. Recently, three other RCTs enrolling patients aged > 60 years were published; thus, it is necessary to update the previous meta-analysis to re-evaluate the effects of DHC in mMCAI. ⋯ Compared to conservative treatment, DHC significantly decreased mortality and improved functional outcome, with a non-significant increase in the proportion of survivors with major disability. Further studies are required for multidimensional evaluation of DHC for mMCAI.
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Surg J R Coll Surg E · Aug 2014
Review Meta AnalysisDuodenopancreatectomy: open or minimally invasive approach?
Minimally invasive pancreaticoduodenectomy (MIPD) is a complex procedure, offered to selected patients at institutions highly experienced with the procedure. It is still not clear if this approach may enhance patient recovery and reduce postoperative complications comparing to open pancreaticoduodenectomy (OPD), as demonstrated for other abdominal procedures. ⋯ The MIPD procedure is feasible, safe, and effective in selected patients. MIPD may have some potential advantages over OPD, and should be performed and further developed by use in selected patients at highly experienced medical centers.