Surgery
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Review Meta Analysis Comparative Study
Meta-analysis of trials comparing laparoscopic transperitoneal and retroperitoneal adrenalectomy.
Laparoscopic adrenalectomies are being performed increasingly, either with transperitoneal or retroperitoneal approaches. Studies comparing the 2 approaches have not shown the superiority of either technique, but these studies are limited by small sample sizes and single-institution designs. To overcome these limitations, we performed a meta-analysis of studies comparing lateral transperitoneal adrenalectomy and retroperitoneal adrenalectomy. ⋯ Both lateral transperitoneal adrenalectomy and retroperitoneal adrenalectomy are associated with very low rates of perioperative complications. According to our meta-analysis, clinical outcomes after either technique are similar. For most adrenal lesions requiring operation, minimally invasive adrenalectomy can be performed safely and effectively with either transperitoneal or the retroperitoneal approach. Additional studies may be needed to analyze if any difference in long-term results exist.
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Review Meta Analysis
Use of antibiotics alone for treatment of uncomplicated acute appendicitis: a systematic review and meta-analysis.
The use of antibiotics alone in the treatment of uncomplicated acute appendicitis has been controversial. The present report is based on a systematic review and meta-analysis of existing studies that compared antibiotics treatment to appendectomy in patients with uncomplicated acute appendicitis. ⋯ In some cases, antibiotic treatment may fail, and there is a risk of recurrence. However, surgically treated patients, including those with the potential for spontaneous resolution and those with a normal appendix, are subjected to the risks of operative morbidity and mortality. Antibiotic therapy incurs significantly fewer complications. Prospective randomized studies are urgently needed to conclusively define the roles of appendectomy and antibiotic treatment in the management of uncomplicated acute appendicitis.
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Review Meta Analysis
Planned ilioinguinal nerve excision for prevention of chronic pain after inguinal hernia repair: a meta-analysis.
Inguinal hernia repair is a common operative procedure, but the development of chronic postoperative pain is a dreaded potential complication. The role of neurectomy in decreasing the incidence of chronic pain after inguinal hernia repair is currently unknown. Our objective was to determine whether a planned ilioinguinal nerve excision results in a decrease in the development of chronic pain experienced after inguinal hernia repair. ⋯ A planned resection of the ilioinguinal nerve at the time of inguinal hernia repair is associated with a decrease in the incidence of chronic postoperative pain. Thus, carrying out this simple maneuver at the time of operation might decrease a major source of postoperative patient morbidity.
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Health care systems provide care to increasingly complex and elderly patients. Colorectal surgery is a prime example, with high volumes of major procedures, significant morbidity, prolonged hospital stays, and unplanned readmissions. This situation is exacerbated by an exponential rise in costs that threatens the stability of health care systems. Enhanced recovery pathways (ERP) have been proposed as a means to reduce morbidity and improve effectiveness of care. We have reviewed the evidence supporting the implementation of ERP in clinical practice. ⋯ Adherence to ERP achieves a reproducible improvement in the quality of care by enabling standardization of health care processes. Thus, while accelerating recovery and safely reducing hospital stay, ERPs optimize utilization of health care resources. ERPs can and should be routinely used in care after colorectal and other major gastrointestinal procedures.
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Meta Analysis
A meta-analysis comparing conservative treatment versus acute appendectomy for complicated appendicitis (abscess or phlegmon).
No standardized approach is available for the management of complicated appendicitis defined as appendiceal abscess and phlegmon. This study used meta-analytic techniques to compare conservative treatment versus acute appendectomy. ⋯ The conservative management of complicated appendicitis is associated with a decrease in complication and reoperation rate compared with acute appendectomy, and it has a similar duration of hospital stay. Because of significant heterogeneity between studies, additional studies should be undertaken to confirm these findings.