Muhammad S. Sajid

Laparoscopic versus open repair of incisional/ventral hernia: a meta-analysis

BACKGROUND The aim of this article is to analyze laparoscopic versus open repair of incisional/ventral hernia (IVH). METHODS A systematic review of the literature was undertaken to analyze clinical trials on IVH. RESULTS Five randomized controlled trials involving a total of 366 patients were analyzed. There were 183 patients in each group. Open repair of IVH was associated with significantly higher complication rates and longer hospital stays than laparoscopic repair. There was also some evidence that surgical times may be longer for open repair of IVH. However, statistically there was no difference in wound pain or recurrence rates. CONCLUSIONS Laparoscopic repair of IVH is safe, with fewer complications and shorter hospital stays, and possibly a shorter surgical time. However, postoperative pain and recurrence rates are similar for both techniques. Hence, the laparoscopic approach may be considered for IVH repair if technically feasible, but more trials with longer follow-up evaluations are required to strengthen the evidence.

Comparison of radioguided occult lesion localization (ROLL) and wire localization for non‐palpable breast cancers: A meta‐analysis

Four randomized trials encompassing 449 patients of non‐palpable breast cancer undergoing with radio‐guided occult lesion localization (ROLL) or wire guided localization (WGL). In the fixed effects model, accurate localization, peri‐procedural complications, and reoperation rate were comparable between two techniques. Risk of having positive resection margins following WGL was higher. Duration of localization and surgical excision was shorter for ROLL. Volume and weight of the excised occult breast lesion was similar in WGL and ROLL groups. J. Surg. Oncol. 2012; 105:852–858.

Elective laparoscopic sigmoid resection for diverticular disease has fewer complications than conventional surgery: a meta-analysis

BACKGROUND We performed a meta-analysis of published literature comparing the complications after open and laparoscopic elective sigmoidectomy for diverticular disease. METHODS Electronic databases were searched from January 1991 to March 2009. A systematic review was performed to obtain a summative outcome. RESULTS Nineteen comparative studies involving 2,383 patients were analyzed. There were 1,014 patients in the laparoscopic group and 1,369 patients in the open group. There was no significant heterogeneity among any of the complications analyzed. Patients in the laparoscopic sigmoid resection group had fewer wound infections (fixed effects model: risk ratio [RR], .54; 95% confidence interval [CI], .36-.80; z, -3.05; P < .01; random effects model: RR, .59; 95% CI, .39-.89; z, -2.54; P < .05), blood transfusions (fixed effects model: RR, .25; 95% CI, .10-.60; z, -3.10; P < .01; random effects model: RR, .28; 95% CI, .11-.68; z, -2.81; P < .01), and ileus rates (fixed effects model: RR, .37; 95% CI, .20-.66; z, -3.34; P = .001; random effects model: RR, .37; 95% CI, .20-.68; z, -3.21; P = .001) compared with open sigmoid resections. No difference was seen for medical complications, need for rehospitalization, and reoperation. CONCLUSIONS Laparoscopic sigmoid resection is safe and has fewer postoperative surgical complications. This approach should be considered for elective cases, however, more randomized controlled trials are required to strengthen the evidence.

Use of endo-GIA versus endo-loop for securing the appendicular stump in laparoscopic appendicectomy: a systematic review

Objective To systematically analyze the trials on laparoscopic appendicectomy (LA) that has evaluated the effectiveness of endo-loop and/or endo-GIA (a linear stapling device) to secure the stump of the appendix. Methods Clinical trials on LA were selected from the electronic database and analyzed to generate summative data. Results Five randomized trials on 622 patients were analyzed. In both fixed and random effect models, operative time for endo-loop group was longer than endo-GIA group. There was no difference in total hospital stay and in the incidence of intra-abdominal abscess formation between 2 groups. In the fixed effect model, endo-loop technique was associated with higher complication rate. Conclusions Use of endo-loop to secure the appendicular stump during LA though takes longer than the use of endo-GIA but it is associated with equal hospital stay, perioperative complication rate, and incidence of intra-abdominal abscess. Endo-loop may be used safely and preferably to secure the appendicular stump.

Effect of heated and humidified carbon dioxide on patients after laparoscopic procedures: a meta-analysis.

Objective To systematically analyze the role of heated humidified carbon dioxide (CO2) in laparoscopy. Methods Clinical trials on laparoscopic procedures using standard dry CO2 versus heated humidified CO2 for pneumoperitoneum were analyzed. Results Ten randomized controlled trials on 565 patients were analyzed. In both the fixed and random effect models, postoperative pain was significantly less in heated humidified CO2 group. Heated humidified CO2 group was also associated with significantly lower risk of hypothermia and lower analgesic requirement. However, statistically there was no difference in total hospital stay and lens fogging rate. Conclusions The use of heated humidified CO2 for pneumoperitoneum in laparoscopic procedures is associated with lesser postoperative pain, lower risk of postoperative hypothermia, and lower analgesic requirements. However, total hospital stay and lens fogging rates do not differ. Hence, the heated and humidified CO2 may be considered as the first choice for pneumoperitoneum in laparoscopic procedures.

Needlescopic versus laparoscopic cholecystectomy: a meta‐analysis

Background:  To systematically analyse clinical trials on needlescopic (NC) versus laparoscopic cholecystectomy (LC) that evaluated the effectiveness of both procedures for the management of cholelithiasis.

The role of perioperative warming in surgery: a systematic review.

OBJECTIVE The objective of this review was to systematically analyze the trials on the effectiveness of perioperative warming in surgical patients. METHODS A systematic review of the literature was undertaken. Clinical trials on perioperative warming were selected according to specific criteria and analyzed to generate summative data expressed as standardized mean difference (SMD). RESULTS Twenty-five studies encompassing 3,599 patients in various surgical disciplines were retrieved from the electronic databases. Nineteen randomized trials on 1785 patients qualified for this review. The no-warming group developed statistically significant hypothermia. In the fixed effect model, the warming group had significantly less pain and lower incidence of wound infection, compared with the no-warming group. In the random effect model, the warming group was also associated with lower risk of post-anesthetic shivering. Both in the random and the fixed effect models, the warming group was associated with significantly less blood loss. However, there was significant heterogeneity among the trials. CONCLUSION Perioperative warming of surgical patients is effective in reducing postoperative wound pain, wound infection and shivering. Systemic warming of the surgical patient is also associated with less perioperative blood loss through preventing hypothermia-induced coagulopathy. Perioperative warming may be given routinely to all patients of various surgical disciplines in order to counteract the consequences of hypothermia.

A meta-analysis examining the use of tacker mesh fixation versus glue mesh fixation in laparoscopic inguinal hernia repair

BACKGROUND The aim of this study was to systematically analyze the randomized trials comparing tacker mesh fixation with glue mesh fixation (GMF) in laparoscopic inguinal hernia repair (LIHR). METHODS Standard electronic database were searched to retrieve relevant randomized trials comparing tacker mesh fixation with GMF in LIHR, which were analyzed systematically using RevMan. RESULTS Five randomized controlled trials encompassing 1,001 patients were retrieved from the electronic databases. In a random-effects model, operating time, postoperative pain, postoperative complications, length of hospital stay and risk for hernia recurrence were statistically comparable between the 2 techniques of mesh fixation in LIHR. However, GMF was associated with a reduced risk for developing chronic groin pain. CONCLUSIONS GMF in LIHR does not increase the risk for hernia recurrence and reduces the risk for developing chronic groin pain. It is comparable with tacker mesh fixation in terms of operation time, postoperative pain, postoperative complications, length of hospital stay, and risk for hernia recurrence.

A systematic review and meta-analysis evaluating the effectiveness of lightweight mesh against heavyweight mesh in influencing the incidence of chronic groin pain following laparoscopic inguinal hernia repair

BACKGROUND A systematic analysis was conducted of randomized controlled trials (RCTs) comparing lightweight mesh (LWM) with heavyweight mesh in laparoscopic inguinal hernia repair. METHODS Data extracted from the included RCTs were analyzed according to the principles of meta-analysis. RESULTS Eleven RCTs encompassing 2,189 patients were analyzed. In a fixed-effects model, operating time, postoperative pain, and recurrence rate were statistically similar between LWM and heavyweight mesh. LWM was associated with fewer perioperative complications and a reduced risk for developing chronic groin pain. There was also a reduced risk for developing other groin symptoms, such as foreign body sensations, but it was not statistically significant. CONCLUSIONS The use of LWM for laparoscopic inguinal hernia repair is not associated with an increased risk for hernia recurrence. LWM reduces the incidence of chronic groin pain, groin stiffness, and foreign body sensations. Therefore, LWM may routinely be used in laparoscopic inguinal hernia repair. However, high-quality RCTs with longer follow-up periods are required to validate these findings.

Prevention of Postoperative Seroma-Related Morbidity by Quilting of Latissimus Dorsi Flap Donor Site: A Systematic Review

OBJECTIVE To systematically analyze the effectiveness of quilting of latissimus dorsi (LD) flap donor site in the prevention of seroma and related morbidities. METHODS All published studies comparing the effectiveness of quilting versus no-quilting of LD flap donor site in the prevention of seroma and related morbidities in patients undergoing breast reconstruction were analysed systemically. RESULTS Five comparative studies on quilting versus no-quilting encompassing 440 patients were suitable for statistical analysis. There was no heterogeneity among trials. Therefore, in the fixed-effects model, quilting was effective in terms of reducing the incidence of donor-site seroma formation, reducing the average volume of the seroma, and reducing the total volume of drained seroma. In addition, quilting did not increase the risk of postoperative complications. Combined quilting and fibrin glue was also effective in reducing the average volume of the seroma and total drained volume of the seroma. Combination of quilting and glue did not influence the incidence of seroma formation at LD flap donor site and overall operative complications. CONCLUSION Quilting of the LD flap donor site is helpful in reducing the incidence of seroma formation, reducing seroma volume, and reducing total drained seroma volume. Combined quilting and fibrin glue further enhances its effectiveness. Quilting with or without fibrin glue may be considered an option in patients undergoing LD flap breast reconstruction to control seroma-related morbidity. However, a major multicenter randomized controlled trial is required to achieve stronger and reliable evidence before recommending it as a routine procedure.