Effect of ghrelin administration on postoperative inflammatory response and bodyweight loss in patients with oesophageal cancer undergoing oesophagectomy: a systematic review and meta-analysis

Objectives To investigate the effect of postoperative ghrelin therapy on postoperative inflammatory response and bodyweight loss in patients undergoing an oesophagectomy for oesophageal cancer. Methods We conducted a systematic search using electronic information databases in accordance to PRISMA standards to identify studies comparing outcomes after oesophagectomy in patients who were and were not administered ghrelin in the postoperative period. Meta-analysis of the outcomes using random effects modelling was conducted. The Cochrane collaboration’s tool and ROBINS-I tool were used for risk of bias assessment of the included studies. Results Five studies including 192 patients were selected for analysis. Ghrelin therapy was associated with a significantly shorter duration of systemic inflammatory response syndrome (SIRS) (MD: − 2.72, P = 0.0001), lower CRP level on postoperative day 3 (MD: − 3.64, P < 0.0001), and less total bodyweight loss (MD: − 1.87, P = 0.14). There was no differences between the two groups in IL-6 level on postoperative day 3 (MD: − 19.65, P = 0.32), total lean body weight loss (MD: − 1.87, P = 0.14), total body fat loss (MD: 0.15, P = 0.84), pulmonary complications (OR: 0.47, P = 0.12), anastomotic leak (OR: 1.17, P = 0.78), wound complications (OR: 1.64, P = 0.63), postoperative bleeding (OR: 0.32, P = 0.33), arrhythmia (OR: 1.22, P = 0.77). Conclusions Administration of ghrelin following oesophagoectomy may reduce duration of postoperative SIRS and bodyweight loss. Whether shorter duration of SIRS and less bodyweight loss resulted from postoperative ghrelin therapy can translate into improved morbidity or mortality outcomes remains unknown. There is a need for randomised controlled trials with robust statistical power to investigate the role of postoperative ghrelin therapy on morbidity and mortality outcomes in patients undergoing oesophagectomy

Laparoscopic peritoneal lavage versus sigmoidectomy for management of perforated diverticulitis: meta-analysis of Randomized Controlled Trials

Introduction: Controversy exists regarding the role of laparoscopic peritoneal lavage in patients with perforated diverticulitis. Our objective was to conduct the first meta-analysis of Randomized Controlled Trials (RCT's) to compare the outcomes of patient undergoing laparoscopic peritoneal lavage with sigmoidectomy in patients with perforated diverticulitis. Methods: In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement standards, we conducted a systematic search of electronic information sources, including MEDLINE; EMBASE; CINAHL; CENTRAL; The World Health Organization International Clinical Trials Registry; ClinicalTrials.gov; ISRCTN Register and bibliographic reference lists. We applied a combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators and limits in each of the above databases. Overall morbidity, mortality, and postoperative complications were defined as the primary outcome parameters. Procedure time and length of hospital stay were secondary outcomes. The combined overall effect sizes were calculated using fixed-effect or random-effects models. Results: We identified 4 RCT's comparing outcomes of laparoscopic peritoneal lavage and open sigmoidectomy for perforated diverticulitis. All studies included only Hinchey grade III diverticulitis. The subsequent analysis, including 390 patients, demonstrated that laparoscopic peritoneal lavage of perforated diverticulitis was associated with significantly increased rates of overall morbidity (OR: 1.30, 95% CI 1.07-1.57, p = 0.007) and intra-abdominal abscess (OR: 3.10, 95% CI 1.71-5.63, p = 0.0002) compared to sigmoidectomy. However, there was no significant difference in mortality (OR: 0.86, 95% CI 0.42-1.77, p = 0.69) and re-operation (OR: 1.20, 95% CI 0.36-4.02, p = 0.77) rates between the two groups. Between-study heterogeneity was non-significant in all analyses, except reoperation rate (I2 = 79%, p = 0.002). The available data did not allow an appropriate analysis of procedure time, length of hospital stay and other postoperative complications. Conclusion: Our analysis of randomised trials demonstrated that laparoscopic peritoneal lavage of perforated diverticulitis may lead to more adverse events than open sigmoid resection. Future high quality RCT's are indeed required to provide stronger evidence as no definitive conclusion can be drawn considering the limited number of available RCT's

European association for endoscopic surgery (EAES) consensus statement on single-incision endoscopic surgery

Laparoscopic surgery changed the management of numerous surgical conditions. It was associated with many advantages over open surgery, such as decreased postoperative pain, faster recovery, shorter hospital stay and excellent cosmesis. Since two decades single-incision endoscopic surgery (SIES) was introduced to the surgical community. SIES could possibly result in even better postoperative outcomes than multi-port laparoscopic surgery, especially concerning cosmetic outcomes and pain. However, the single-incision surgical procedure is associated with quite some challenges.This article is freely available via Open Access, click on the Publisher's URL to access the full-text.Publishe

Who should lead a trauma team: surgeon or non surgeon? A systematic review and meta-analysis

Background: Presence of a trauma team leader (TTL) in the trauma team is associated with positive patient outcomes in major trauma. The TTL is traditionally a surgeon who coordinates the resuscitation and ensures adherence to Advanced Trauma Life Support (ATLS) guidelines. The necessity of routine surgical leadership in the resuscitative component of trauma care has been questioned by some authors. Therefore, it remains controversial who should lead the trauma team. We aimed to evaluate outcomes associated with surgeon versus non-surgeon TTLs in management of trauma patients. Methods: In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement standards, we performed a systematic review. Electronic databases MEDLINE, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched to identify randomized and non-randomized studies investigating outcomes associated with surgeon versus non-surgeon TTL in management of trauma patients. The Newcastle-Ottawa scale was used to assess the methodological quality and risk of bias of the selected studies. Fixed-effect model was applied to calculate pooled outcome data. Results: Three retrospective cohort studies, enrolling 2,519 adult major trauma patients, were included. Our analysis showed that there was no difference in survival [odds ratio (OR): 0.82, 95% confidence interval (CI) 0.61-1.10, P=0.19] and length of stay when trauma team was led by surgeon or non-surgeon TTLs; however, fewer injuries were missed when the trauma team was led by a surgeon (OR: 0.48, 95% CI 0.25-0.92, P=0.03). Conclusions: Despite constant debate, the comparative evidence about outcomes associated with surgeon and non-surgeon trauma team leader is insufficient. The best available evidence suggests that there is no significant difference in outcomes of surgeon or non-surgeon trauma team leaders. High quality randomized controlled trials are required to compare the effectiveness of surgeon and non-surgeon trauma team leaders in order to resolve the controversy about who should lead the trauma team. Clinically significant missed injuries should be considered as important outcome in future studies

Systematic review: effect of whole-body computed tomography on mortality in trauma patients

Abstract: Background: The initial diagnostic evaluation and management of trauma patients is mainly based on Advanced Trauma Life Support (ATLS) guidelines worldwide. Based on ATLS principles, conventional diagnostics such as conventional radiography (CR) and focused abdominal sonography in trauma (FAST) should precede selective use of CT. Whole-body CT (WBCT) is highly accurate and allows detection of life threatening injuries with good sensitivity and specificity. WBCT is faster than conventional diagnostics and saves more time in management of trauma patients. This study aims to review studies investigating the effect of WBCT on mortality in trauma patients. Methods: Literatures were found by searching keywords in Medline, PubMed and Cochrane library. The relevant articles were selected by two independent reviewers based on title, abstract and introduction sections. Full-texts of selected articles were reviewed and those investigating effect of WBCT on mortality in trauma patients were included. Results: Searching the keywords in Medline and PubMed resulted in 178 and 167 articles,respectively. Nine studies met the inclusion criteria and were reviewed. These included 8 retrospective and 1 prospective cohort studies. Mortality was measured as mortality rate or standardised mortality ratio (SMR) in the included studies. Conclusions: Unlike previous systematic reviews, this review indicates that use of WBCT in blunt trauma patients is associated with reduced overall mortality rate and that WBCT can potentially improve the probability of survival in haemodynamically stable and unstable blunt trauma patients. High quality RCTs are required to describe a causal relationship between WBCT and mortality in trauma patient

Robotic vs. Laparoscopic Splenectomy in Management of Non-traumatic Splenic Pathologies: A Systematic Review and Meta-Analysis.

We aimed to evaluate comparative outcomes of robotic and laparoscopic splenectomy in patients with non-traumatic splenic pathologies. A systematic search of electronic databases and bibliographic reference lists were conducted, and a combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators and limits in electronic databases were applied. Intraoperative and post-operative complications, wound infection, haematoma, conversion to open procedure, return to theatre, volume of blood loss, procedure time and length of hospital stay were the evaluated outcome parameters. We identified 8 comparative studies reporting a total of 560 patients comparing outcomes of robotic ( = 202) and laparoscopic ( = 258) splenectomies. The robotic approach was associated with significantly lower volume of blood loss (MD: -82.53 mls, 95% CI -161.91 to -3.16, = .04) than the laparoscopic approach. There was no significant difference in intraoperative complications (OR: 0.68, 95% CI .21-2.01, = .51), post-operative complications (OR: .91, 95% CI .40-2.06, = .82), wound infection (RD: -.01, 95% CI -.04-.03, = .78), haematoma (OR: 0.40, 95% CI .04-4.03, = .44), conversion to open (OR: 0.63; 95% CI, .24-1.70, = .36), return to theatre (RD: -.04, 95% CI -.09-.02, = .16), procedure time (MD: 3.63; 95% CI -16.99-24.25, = .73) and length of hospital stay (MD: -.21; 95% CI -1.17 - .75, = .67) between 2 groups. In conclusion, robotic and laparoscopic splenectomies seem to have comparable perioperative outcomes with similar rate of conversion to an open procedure, procedure time and length of hospital stay. The former may potentially reduce the volume of intraoperative blood loss. Future higher level research is required to evaluate the cost-effectiveness and clinical outcomes

Robot-assisted laparoscopic pyeloplasty laparoscopic pyeloplasty for pelvi-ureteric junction obstruction in the paediatric population: a systematic review and meta-analysis

Background: Owing to the improved vision and instrument manipulation in robot-assisted procedures, we sought to evaluate the comparative outcomes of robot-assisted laparoscopic pyeloplasty (RALP) and laparoscopic pyeloplasty (LP) in a paediatric patients with pelvi-ureteric junction obstruction (PUJO). Methods: We conducted a systemic literature search of online sources, including PubMed, MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials, and respective bibliographic reference lists. Success rate, operative time, hospital length of stay, postoperative complication rate and re-intervention rate were our primary outcomes. Combined overall effect sizes were calculated using fixed-effect or random-effects models. Results: We identified 14 observational studies reporting a total of 2254 paediatric patients with PUJO, who underwent LP ( n = 1021) or RALP ( n = 1233). Our analysis demonstrated that RALP was associated with a significantly higher success rate [odds ratio (OR) 2.51; 95% confidence interval (CI) 1.08–5.83, p = 0.03] and shorter length of hospital stay [mean difference (MD) −1.49; 95% CI −2.22 to −077; p < 0.0001] compared with LP. Moreover, nonsignificant reductions in postoperative complications (OR 0.61; 95% CI 0.36–1.02; p = 0.06) and re-intervention (OR 0.43; 95% CI 0.15–1.21; p = 0.11) were found in favour of RALP. There was no difference in procedure time between the two approaches (MD −0.15; 95% CI −30.22 to 29.93, p = 0.99). Conclusions: Our meta-analysis of observational studies demonstrated that RALP is safe and may have higher success rate compared with the more traditional laparoscopic approach in a paediatric population. Moreover, it may be associated with lower postoperative complications and re-intervention rates. Evidence from randomized trials is required