Does Omental Plugging Provide a Better Surgical Treatment Outcome than the Omentopexy Technique in the Management of Giant Peptic Ulcer Perforation? A Meta-analysis of Comparative Studies.

Objectives: Giant perforation (size > 2 cm) is a catastrophic complication of peptic ulcer disease, which is difficult to repair and leads to postoperative leakage and 60% morbidity and 48.2% mortality rates. The objective of this meta-analysis was to compare the postoperative outcomes of omental plugging and omentopexy in the treatment of giant ulcer perforation. Methods: The dataset was defined by searching for articles published until December 2020 from PubMed, Embase, Google Scholar, and the Cochrane database. The search terms included were giant peptic ulcer, peptic ulcer perforation, omentopexy, and omental plug. The data analysis included a study published in English that evaluated the surgical outcomes of omental plugging and omentopexy in the management of giant peptic ulcer perforation patients. Meta-analysis was performed using Review Manager software version 5.4.1. Results: A total of 175 articles were identified during the initial search. After review, eight articles were suitable for inclusion in the meta-analysis. A total of 367 patients were included in the final analysis. The findings demonstrate that when compared to the omentopexy group, the omental plugging technique significantly reduced overall postoperative complications (odds ratio (OR) = 0.29, 95% CI: 0.18-0.47, p =0.0001) and bile leakage rate (OR = 0.18, 95% CI: 0.07-0.46, p =0.0003), resulting in a significantly lower postoperative mortality rate (OR = 0.35, 95% CI: 0.17-0.69, p =0.003). However, there was no significant difference in intraabdominal collection, respiratory tract, and wound infection rates between each surgical treatment group. Conclusions: Omental plugging is a simple surgical procedure associated with fewer postoperative complications and mortality than omentopexy. This technique is a safe surgical treatment option for peptic ulcer perforations > 2 cm.

Meta-analysis of total versus partial graft excision: Which is the better choice to manage arteriovenous dialysis graft infection?

BACKGROUND: Arteriovenous graft infection (AVGI) is a major cause of hemodialysis access failure. Delayed diagnosis and inappropriate treatment may lead to increased morbidity (3-35%) and mortality up to 12%. OBJECTIVES: Compare the postoperative outcomes of total graft excision (TGE) and partial graft excision (PGE) in the treatment of AVGI. DESIGNS: Systematic review and meta-analysis METHODS: The dataset was defined by searching PubMed, EMBASE, Google Scholar, and the Cochrane database for articles outlining the terms arteriovenous graft infection, infected dialysis graft, TGE and PGE published between 1995-2020. The data analysis evaluated the outcomes of TGE and PGE in the management of AVGI. The meta-analysis was performed using Review Manager Software version 5.4.1. MAIN OUTCOME MEASURES: 30-day mortality, recurrent infection, and reoperation rate. SAMPLE SIZE: Eight studies, including 555 AVGI, and 528 patients. RESULTS: PGE showed a significant increase in recurrent graft infection rate (OR=0.23,95% CI=0.13-0.41, P<.00001) and re-operation rate for control of infection (OR=0.14,95% CI=0.03-0.58, P<.007). However, the 30-day mortality rate did not differ significantly between the groups (OR=0.92,95% CI=0.39-2.17, P=.85). CONCLUSIONS: TGE remains a safe and effective surgical method for the management of AVGI. PGE is associated with a higher risk of graft infection and need for re-operation. As a result, PGE should only be considered in carefully selected patients. LIMITATION: Risk of bias due to the differences in patient characteristics. CONFLICT OF INTEREST: None.

Role of platelet indices as a biomarker for the diagnosis of acute appendicitis and as a predictor of complicated appendicitis: A meta-analysis.

INTRODUCTION: Acute appendicitis is one of the most common surgical emergencies worldwide. Clinical scoring system systems have been developed to diagnose acute appendicitis, but insufficient to predict the complication. The amount of serum biomarkers elevates in response to acute inflammation, which could be beneficial for diagnostic tools. Accordingly, a meta-analysis was conducted to evaluate the efficacy of platelet indices, including mean platelet volume (MVP) and platelet distribution width (PDW) as potential biomarkers for the diagnosis of a diagnosis of acute appendicitis. MATERIAL AND METHODS: The dataset was defined by searching for articles published until December 2020 from PubMed, EMBASE, Google Scholar and the Cochrane database. The meta-analysis was performed using Review Manager Software version 5.4.1. RESULTS: The final analysis was made from 9 studies, including 3124 patients. The results demonstrated that lower MPV values was significantly associated with acute appendicitis (odds ratio (OR) = 0.81, 95% confidence interval (CI) = -1.51 to -0.11, P = 0.02), but not associated with complicated appendicitis by comparing it with the control (OR = -0.13,95% CI = -0.33 to -0.07, P = 0.19) and non-complicated appendicitis groups (OR = -0.13,95% CI = -0.30 to -0.04, P = 0.14). The present study failed to demonstrate the diagnostic value of PDW for the prediction of appendicitis and its complication. CONCLUSION: The results of the meta-analysis strongly indicate that a lower MVP values could function as a marker for predicting the acute appendicitis.