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Letter to the Editor, Reply to “Commentary on Meta-analysis of Prospective Randomized Studies Comparing Single-Incision Laparoscopic Cholecystectomy (SILC) and Conventional Multiport Laparoscopic Cholecystectomy (CMLC)” by Pisanu et al. (J Gastrointest Surg 2012; 16:1790–1801)
No full textMeta-analysis and review of prospective randomized trials comparing laparoscopic and Lichtenstein techniques in recurrent inguinal hernia repair
No full textPurpose The hypothesis of this meta-analysis was to
assess whether laparoscopic approach shows real benefits
over Lichtenstein technique in recurrent inguinal hernia
repair.
Methods A literature search for prospective randomized
trials comparing laparoscopic and Lichtenstein procedure
in recurrent inguinal hernia repair was performed. Trials
were reviewed for primary outcome measures: re-recurrence,
chronic inguinal pain and ischemic orchitis; and for
secondary outcome measures. Standardized mean difference
(SMD) was calculated for continuous variables and
odds ratio for dichotomous variables.
Results Seven studies comparing laparoscopic and Lichtenstein
technique were considered suitable for the pooled
analysis. Overall 647 patients with recurrent inguinal hernia
were randomized to either laparoscopic repair (333,
51.5 %, transabdominal preperitoneal approach, TAPP and
totally extraperitoneal approach, TEP) or anterior open
repair (314, 48.5 %, Lichtenstein operation). Patients who
underwent laparoscopic repair experienced significantly
less chronic pain (9.2 % vs. 21.5 %, p = 0.003). Patients
of the laparoscopic group had a significantly earlier return
to normal daily activities (13.9 vs. 18.4 days, SMD =
-0.68, 95 % CI = -0.94 to –0.43, p\0.000001). Operative
time was significantly longer in laparoscopic
operations (62.9 vs. 54.2 min, SMD 0.46, 95 % CI 0.03,
0.89; p = 0.04). No other differences were found.
Conclusions Laparoscopy showed reduced chronic
inguinal pain and an earlier return to normal daily activities
but significantly longer operative time. Despite the
expected advantages, the choice between laparoscopy and
other techniques still depends on local expertise availability.
Only dedicated centers are able to routinely offer
laparoscopy for recurrent inguinal hernia repair
Meta-analysis of studies comparing single-incision laparoscopic appendectomy and conventional multiport laparoscopic appendectomy
No full textBackground: There is no consensus that single-incision laparoscopic appendectomy (SILS-A)
is on a par with conventional multiport laparoscopic appendectomy (CMLA). The aim of
this meta-analysis was to assess feasibility, safety, and potential benefits of SILS-A when
compared with CMLA.
Methods: A literature search for studies comparing SILS-A and CMLA was performed. Studies
were reviewed for the outcome of interest: patient characteristics, operative outcome,
postoperative recovery, postoperative morbidity, patient satisfaction, and cosmetic results.
Results: Thirteen studies comparing SILS-A and CMLA were reviewed: two prospective
randomized trials, four prospective studies, and seven retrospective studies. Overall, 893
patients were operated on: by SILS-A in 402 cases (45.0%) versus 491 cases (55.0%) by CMLA.
Patients in the SILS-A group were significantly younger than those in the CMLA group (31.2
versus 33.5 y). No other differences were found. Patient satisfaction score was impossible to
meta-analyze.
Conclusions: Appendectomy via SILS-A may be considered as an alternative to CMLA.
However, these results must be approached with caution as they are based on data from
nonrandomized observational studies. The feasibility and safety of SILS-A must be mainly
assessed for difficult clinical situations such as severe obesity, localized abscess, or diffuse
peritonitis from a ruptured appendix in the setting of new prospective randomized trials
Meta-analysis of Prospective Randomized Studies Comparing Single-Incision Laparoscopic Cholecystectomy (SILC) and Conventional Multiport Laparoscopic Cholecystectomy (CMLC)
No full textBackground Single-incision laparoscopic cholecystectomy (SILC) has gained acceptance among surgeons as there is a trend
to minimize the invasiveness of laparoscopy. The aim of this meta-analysis has been to assess the feasibility and safety of
SILC when compared to conventional multiport laparoscopic cholecystectomy (CMLC).
Methods A literature search for trials comparing SILC and CMLC was performed. Studies were reviewed for the outcomes
of interest: patient characteristics; operative time and conversion rate; postoperative pain; length of hospital stay; postoperative
complications; and patient satisfactory score (0–10). Standardized mean difference (SMD) was calculated for continuous
variables and odds ratio for qualitative variables.
Results Twelve prospective randomized trials comparing SILC and CMLC were analyzed. Overall, 892 patients were
randomized to either SILC (465) or CMLC (427). Operative time was significantly longer in SILC (63.0 vs. 45.8 min,
SMD01.004, 95% CI00.434–1.573). Patient satisfactory score significantly favored SILC (8.2 vs. 7.2, SMD0−0.759, 95%
CI0−1.064 to −0.455). No other difference was found.
Conclusions SILC is a safe and effective procedure for the treatment of uncomplicated benign gallbladder disease with a
significant patient satisfaction. New multicenter randomized trials are expected to evaluate SILC in more complex circumstances
such as acute cholecystitis, previous abdominal surgery, and severe obesity
Le carcinome papillare encapsulé de la thyroide: une entite clinique avec un bas degree de melignité.
No full textSystematic review with meta-analysis of prospective randomized trials comparing minimally invasive video-assisted thyroidectomy (MIVAT) and conventional thyroidectomy (CT)
No full textBackground Minimally invasive video-assisted thyroidectomy
(MIVAT) has gained acceptance among surgeons as its
feasibility has been well documented. The aim of this
systematic review with meta-analysis has been to assess and
validate the safety and feasibility of MIVATwhen compared to
conventional thyroidectomy (CT) and to verify other potential
benefits and drawbacks.
Methods A literature search for prospective randomized trials
comparing MIVAT and CT was performed. Trials were
reviewed for the primary outcome measures: overall
morbidity, recurrent laryngeal nerve palsy, postoperative
hypocalcemia, and postoperative hematoma; and for the
secondary outcome measures: operative time, conversion to
standard procedure, intraoperative blood loss, intraoperative
drain insertion, nodule size and thyroid weight, postoperative
pain evaluation, length of hospital stay, patient satisfactory
score, and cosmetics results. Standardized mean difference
(SMD) was calculated for continuous variables and odds ratio
for qualitative variables.
Results Nine prospective randomized studies comparing
MIVAT and CT were analyzed. Overall, 581 patients were
randomized to either MIVAT (289, 49.7 %) or CT (292,
50.3 %). The primary outcome measures of MIVAT were
comparable with those of CT without statistically significant
difference. Patients who underwent MIVAT experienced
significantly less pain than those operated on conventionally
during the whole postoperative period. Patient satisfactory
score significantly favored MIVAT (9.0 vs. 6.8, SMD=
−3.388, 95 % CI=−5.720 to −1.057). Operative time was
significantly longer in MIVAT (75.2 vs. 59.2 min, SMD=
1.246, 95 % CI=0.227–2.266).
Conclusions MIVAT is a safe and feasible alternative for the
removal of small-volume benign thyroid disease and low-risk
papillary thyroid carcinomas showing better cosmetics results
and less postoperative pain but significantly longer operative
time when compared to CT. New multicenter randomized
studies are needed to evaluate the technique in more complex
circumstances such as intermediate-risk thyroid cancer, lymph
node removal, thyroiditis, and Graves’ disease
ENCAPSULATED PAPILLARY THYROID CARCINOMA: IS IT A DISTINCTIVE CLINICAL ENTITY WITH LOW GRADE MALIGNANCY?
No full textBackground Encapsulated papillary thyroid carcinoma (EPTC) is commonly retained as a tumor with indolent clinical courses. Herein we focused on the search for factors predicting biological behavior and influencing prognosis of EPTC in comparison with the non-encapsulated counterpart of papillary thyroid carcinoma (NEPTC). Methods From January 1998 to May 2009, 348 patients underwent thyroidectomy in our surgical department because of papillary thyroid carcinoma (PTC). A cross-sectional study of 52 patients with EPTC and 296 patients with NEPTC was carried out: demographic data, tumor characteristics, diagnostic results, patient management, postoperative and follow up results were evaluated. Results EPTC patients were significantly younger than patients with NEPTC (44.5 vs. 48.8 years, p<0.04). Mean tumor size was significantly greater for EPTCs than for NEPTCs (2.36 vs. 1.41 cm, p<0.001). Tumor multifocality, thyroid capsular invasion and lymph node involvement at diagnosis were significantly associated with NEPTC (p=0.0001, p<0.0001, and p=0.027, respectively). Multivariate analyses showed that NEPTCs classical variant were at risk for both thyroid capsular invasion and nodal involvement (Odds Ratio 6.870 and 9.514, respectively) while EPTCs were not. Nodal metastasis at diagnosis was the only factor influencing recurrence. Conclusions: The majority of EPTCs had risk-free clinical courses as a result of their low risk of locoregional spread. However, definitive recommendations need a longer follow up and a comparison with a lesser treated group of patients belonging to the same category of risk at diagnosis
Méta-analyse des études comparant les résultats des thyroïdectomies avec monitorage des nerfs laryngés récurrents contre la seule visualisation
No full textContexte: Le rôle du neuromonitorage peropératoire (NIM) du nerf laryngé récurrent (NLR) au
cours d’une thyroïdectomie est encore discutable. L'objectif de cette méta-analyse était d’évaluer
les avantages potentiels du NIM contre la seule visualisation du NLR dans la réduction de
l'incidence de paralysie des cordes vocales. Méthodes: Une recherche des études comparant le
neuromonitorage du NLR et la seule visualisation pendant une thyroïdectomie a été réalisée. Les
données suivantes ont été examinées: les caractéristiques des patients, les résultats et la morbidité
post-opératoire et, en particulier, la totalité d’incidence de paralysie du nerf récurrent, les paralysies
transitoires et les permanentes. La différence moyenne standardisée (DMS) a été calculée pour les
variables continues et l’odd ratio (OR) pour les variables qualitatives. Résultats: Dix-neuf études
comparant la thyroïdectomie avec et sans le NIM ont été examinées: trois études prospectives
randomisées, six études prospectives et dix études rétrospectives. En détail, 28377 patients ont été
opérés, dont 20335 cas (71,6%) avec NIM par rapport à 8042 cas (28,4%) sans monitorage.
L'incidence totale de la paralysie du nerf récurrent a été de 3,9% contre 4,8% avec et sans NIM,
respectivement (0,039 vs 0,048, OR 0,945, IC à 95%: de 0.831 à 1.075). L'incidence de la paralysie
transitoire du NLR a été 2,9% contre 3,4% avec et sans NIM, respectivement (0,029 vs 0,034, OR
0,972, IC à 95%: 0,835 à 1,131). L'incidence de la paralysie permanente du NLR était 0,8% contre
1,2% avec et sans NIM, respectivement (0,008 vs 0,012, OR 0,875, IC à 95%: 0.675 à 1.133).
Cependant, toutes ces différences n'étaient pas statistiquement significatives. Conclusions: Cette
méta-analyse n'a pas montré des différences statistiquement significatives sur l'incidence de la
paralysie du NLR avec le NIM par rapport à la seule visualisation. Cependant, ces résultats doivent
être approchés avec prudence, parce que principalement basés sur des données des études
d'observation non randomisées. D'autres études prospectives randomisées multicentriques sont
nécessaires pour vérifier les résultats d'intérêt de cette analyse regroupée
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