The Role of Pre-emptive Control of Vascular Pedicle in Laparoscopic Splenectomy: An Experience with 19 Consecutive Patients

Golash, Vishwanath

doi:10.5001/omj.2011.34

Cited by 1 publication

(4 citation statements)

References 37 publications

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“…There were 768 articles after removal of duplicates. A total of 29 articles were included in the final analysis 9,22–49 Figure 1. shows the PRISMA diagram for the study selection process.…”

Section: Resultsmentioning

confidence: 99%

“…shows the PRISMA diagram for the study selection process. Of the 29 studies included, there were 9 studies that did not have open conversion, 9,22,25,28–30,36,42,43 12 studies that were analyzed with intention-to-treat analysis, 23,31,32,34,35,38–40,44–47 2 studies analyzed with per-protocol analysis, 26,33 3 studies that separately analyzed LOPR with open conversion, 27,37,41 1 study that did not mention whether studies were analyzed based on intention-to-treat or per-protocol analysis, 24 1 study that excluded open conversions in their analysis, 49 and 1 study that did not report on open conversion 48 . For the three studies that analyzed LOPR with open conversion separately, 27,37,41 we analyzed them using per-protocol analysis.…”

Section: Resultsmentioning

confidence: 99%

“…There were 19 studies (65.5%) that reported on the expertise of surgeons involved in LOPR 9,22–24,27–32,34,37–40,42–44,46 and 10 studies (34.5%) that reported on the expertise of surgeons involved in OOPR 23,24,27,28,30,31,34,38,42,44 . Of patients who underwent LOPR, there were only three studies that analyzed the proportion of attending surgeons to trainees 23,27,34 and one study that analyzed the impact of seniority of performing surgeon on OT 37 .…”

Section: Resultsmentioning

confidence: 99%

“…Another plausible explanation for this difference in results may be due to the heterogeneity of definitions used to define ileus. Studies have used varying definitions such as “presence of colicky abdominal pain with abdominal distension,” “absence of flatus and vomiting,” or “prolonged ileus,” without specification of the definition of prolonged 25,30 . To add on, the study by Alhaj Saleh et al, 41 which found higher incidence of ileus in LOPR compared with OOPR (42% vs. 18%, p < 0.001), contributed to the highest weight (48.5%) in analysis of postoperative ileus.…”

Section: Discussionmentioning

confidence: 99%

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A systematic review and meta-analysis comparing postoperative outcomes of laparoscopic versus open omental patch repair of perforated peptic ulcer

Chan

TAN

et al. 2022

J Trauma Acute Care Surg

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BACKGROUND:The mainstay of surgical management of perforated peptic ulcer is omental patch repair. Advances in minimally invasive techniques have shown feasibility of laparoscopic omental patch repair (LOPR). Laparoscopic omental patch repair is limited by learning curve (LC), but there is a lack of reporting of LC in LOPR. This study aims to compare outcomes following LOPR versus open omental patch repair (OOPR) with reporting of LC. METHODS: PubMed, Embase, The Cochrane Library, and Scopus were systematically searched from inception till January 2022 for randomized controlled trials (RCTs) and non-RCTs comparing LOPR and OOPR in perforated peptic ulcer. Exclusion criteria were primary repair without use of omental patch repair. Primary outcomes were 30-day mortality, postoperative leak, and LC analysis. RESULTS: There were a total of 29 studies including 5,311 patients (LOPR, n = 1,687; OOPR, n = 3,624), with 4 RCTs with 238 patients (LOPR, n = 118; OOPR, n = 120). Majority of ulcers were located in the duodenum (57.0%) followed by stomach (30.7%). Mean ulcer size ranged from 5 to 16.2 mm in LOPR and 4.7 to 15.8 mm in OOPR. Laparoscopic omental patch repair was associated with lower 30-day mortality (odds ratio [OR], 0.57; 95% confidence interval [CI], 0.35-0.92; p = 0.02), overall morbidity (OR, 0.31; 95% CI, 0.18-0.53; p < 0.0001), surgical site infection (OR, 0.27; 95% CI, 0.18-0.42; p < 0.00001), and length of stay (mean difference, −2.84 days; 95% CI, −3.63 to −2.06; p < 0.00001). Postoperative leakage (OR, 1.06; 95% CI, 0.43-2.61; p = 0.90) was comparable between LOPR and OOPR. Only three studies analyzed the proportion of consultants to trainees; LOPR was performed mainly by consultants (range, 82.4-91.4%), while OOPR was mainly performed by trainees (range, 52.8-96.8%). One study showed that consultants who performed open conversion had shorter operating time compared with chief residents (85 vs. 186.6 minutes, p < 0.003). CONCLUSION:Laparoscopic omental patch repair has lower mortality, overall morbidity, length of stay, intraoperative blood loss, and postoperative pain compared with OOPR. More prospective studies should be conducted to evaluate LC in LOPR. (

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Section: Resultsmentioning

confidence: 99%