Aims Acute diverticulitis (AD) is one of the major acute surgical conditions which need either hospital admission or a dedicated ambulatory care services in order to provide conventional antibiotics therapy. Regular use of antibiotics for all cases of acute diverticulitis has recently been challenged. The aim is to evaluate the necessity of antibiotics in patients presenting with CT proven uncomplicated AD. Method A systematic search was undertaken and relevant published randomized controlled trials (RCT) were shortlisted according to the inclusion criteria. Summated outcomes, including failure to response to intervention, recurrence rates and surgery during the acute admission, were analyzed using the principles of meta-analysis on RevMan 5 statistical software. Result Four RCTs on 1756 patients who presented with CT-proven uncomplicated diverticulitis were included in this review. There were 879 patients in the antibiotics group (AG) and 877 patients in the no-antibiotics group (NAG). The failure to response to intervention (use of intravenous antibiotics) was not statistically significant between the two groups, however slight statistical favour was observed in AG [OR 0.49, 95% CI (0.22–1.06), z=1.81, p=0.07]. There was no statistical difference related to recurrence rates of acute diverticulitis between the two groups. Finally, the need of surgical intervention following both interventions was also statistically similar [OR 0.63, 95% CI (0.29–1.36), z=1.18, p=0.24]. Conclusion The use of antibiotics in patients with CT proven uncomplicated AD does not seem to improve the short-term outcomes; therefore it can be carefully omitted in selected patients. More RCTs of robust quality are required to validate these findings.
Objective The objective of this article is to evaluate the role of synthetic mesh versus biological mesh in repair of potentially contaminated and contaminated abdominal wall hernias/defects. Method Analysis was conducted according to PRISMA guidelines. Systematic search of medical databases like MEBASE, MEDLINE and pubmed was performed to find studies exclusively comparing the use of synthetic mesh versus biological mesh in repairing the potentially contaminated and contaminated complex abdominal wall hernia/defects. Standard medical electronic databases were searched with the help of local librarian and relevant published randomized controlled trials (RCT) were shortlisted according to the inclusion criteria. The analysis of the pooled data was done using RevMan statistical software. Result Three RCTs and 10 comparative studies on 1138 fulfilled the inclusion criteria. In the random effects model analysis, the use synthetic mesh for complex abdominal wall hernia/defect repair in contaminated or potentially contaminated zones reduce the risk of hernia recurrence [odds ratio 0.44, 95% CI (0.33–0.60), z= 5.37, p=0.00001] compared to implantation of biological mesh. Moreover, risk of surgical site infection was statistically higher [odds ratio 0.66, 95% CI (0.47–0.92), z=2.44, p=0.01] following the use of biological mesh. There was no heterogeneity (Tau2 = 0.10; Chi2= 16.15, df = 9 (p=0.06; I2 = 44%) among included studies. Conclusion Use of biological mesh for complex abdominal wall hernia/defect repair in potentially contaminated and contaminated situations failed to demonstrate any superiority over conventional synthetic mesh in both benchmark variables of surgical site infection and hernia recurrence.
Objective Metronidazole has been proven an effective proctological analgesic and antimicrobial agent in patients undergoing excisional haemorrhoidectomy. The aim of this article is to evaluate the efficacy of topical versus oral administration of metronidazole to in controlling the post-operative pain following excisional haemorrhoidectomy. Method A comprehensive systematic search was undertaken with the help of local librarian and relevant published randomized controlled trials (RCT) were shortlisted according to the inclusion criteria. Summated outcomes of the poste-operative pain on day one and day seven were analyzed using the principles of meta-analysis on RevMan 5 statistical software. Result Two RCTs on 286 patients undergoing excisional haemorrhoidectomy were included in this review. There were 143 patients in topical metronidazole group and same number of patients were in oral metronidazole group. the antibiotics group (AG) and 877 patients in the no-antibiotics group (NAG). In the random effects model analysis, day 1 [standardized mean difference -0.06, 95% CI (-0.30–0.17), z = 0.55, p = 0.59] and day 7 [standardized mean difference 0.09, 95% CI (-1.29–1.47), z = 0.12, p = 0.90] post-operative pain score was statistically similar in both groups. There was significant heterogeneity [Tau2 = 0.96, chi2 = 32.49, df = 1; p = 0.00001, I2= 97%] between included trials. Conclusion Both topical and oral administration of metronidazole as post-haemorrhoidectomy proctological analgesic is an effective modality. However, this evidence is based upon the findings of two RCTs on 286 patients and should be taken cautiously. A major, high quality RCT is mandatory to validate these findings.
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