Background:Previous meta-analyses have been conducted to compare outcomes of various treatment injections for lateral epicondylitis (LE), including corticosteroid injection (CSI) and autologous blood products such as autologous blood (AB) and platelet-rich plasma (PRP).Purpose:To conduct a systematic review of overlapping meta-analyses comparing different injection treatments (CSI, AB, PRP) for LE to determine which meta-analyses provide the best available evidence.Study Design:Systematic review; Level of evidence, 2.Methods:A systematic review was performed by searching PubMed, Embase, and the Cochrane Library to locate meta-analyses that compared clinical outcomes of CSI, AB, and PRP for the treatment of LE. Search terms included “injection,” “corticosteroid,” “platelet-rich plasma,” “autologous blood,” “tennis elbow,” “lateral epicondylitis,” and “meta-analysis.” Results were reviewed to determine study eligibility. Patient outcomes were extracted from these meta-analyses. Meta-analysis quality was assessed with the Oxman-Guyatt and Quality of Reporting of Meta-analyses (QUOROM) systems. The Jadad decision algorithm was then used to determine which meta-analyses provided the best level of evidence.Results:Nine meta-analyses (two level 1 studies, seven level 2 studies) containing 8656 patients met the eligibility criteria. Seven meta-analyses found that autologous blood products such as AB and PRP significantly improved pain and elbow function in the intermediate term (12-26 weeks), while 4 studies found that CSI effectively relieved pain and improved elbow function in the short term (<12 weeks). The study by Arirachakaran et al in 2016 received the highest QUOROM and Oxman-Guyatt scores; therefore, this meta-analysis appears to have the highest level of evidence. In addition, this study was rated the highest-quality study in this systematic review according to the Jadad decision algorithm. Lower-quality meta-analyses indicated that dosage, number of injections, and differences in therapeutic duration between CSI and autologous blood products may be essential factors in determining the appropriate treatment injection protocol for LE.Conclusion:The current best available evidence suggests that CSI improves functional outcomes and pain relief in the short term, while AB and PRP are the most effective treatments in the intermediate term.

Background Hiatal hernias (HH) are a known, yet poorly studied, post-surgical complication of esophagectomy. The aim of this study was to analyze in a retrospective fashion the MIE experience at our institution, in order to individuate factors associated with post-surgical HH development. Methods We reviewed data from MIE performed at University of Colorado from July 2013 to July 2017. Our most common approach of choice is Ivor Lewis MIE with circular stapled end to side anastomosis. We divided our patient population in two groups: those who developed a HH at any time post operatively and those who did not. We compared pre-, intra- and post-operative clinical variables of interest in the two groups using Pearson chi-squared and Fisher's exact test for binomial variables and Two-sample Wilcoxon rank-sum (Mann-Whitney) test for continuous variables. Results 91 patients underwent MIE in the study period: 11 developed HH in a time frame ranging from one week to two years post operatively. 8 patients had a HH involving one or more intra-abdominal organs other than the stomach; 3 patients had a HH interesting mostly the tubulized stomach. 7 patients required a reoperation. There were no statistically significant differences in the prevalence of pre-operative comorbidities between the two groups. Patient who developed a HH were significantly less likely to have had prior abdominal or thoracic surgery (Pr = 0.039). As expected, they were also significantly more likely to require a reoperation (Pr = 0.000). There were no statistically significant differences in intra-operative variables between the two groups, including operative time and anastomotic technique, nor where there differences in incidence of post operative complications other than HH. We did observe a trend towards higher rate of preoperative chemotherapy and radiation in the HH group. Of note, we did attempt to prevent HH by means of tacking abdominal organs to the abdominal wall, however this did not prove to significantly decrease HH incidence. Conclusion HH occurs in a non-negligible percentage of patients undergoing MIE. Lack of prior surgery appears to be significantly associated with HH, perhaps due to lesser adhesion burden acting as a mean of organ fixation. Disclosure All authors have declared no conflicts of interest.