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Identifier

000408472

Title

Απολίνωση κολοβώματος σκωληκοειδούς απόφυσης στη λαπαροσκοπική σκωληκοειδεκτομή : μετά-ανάλυση δικτύου από το minimally invasive surgery synthesis of interventions and outcomes network (mission)

Alternative Title

Optimal stump management in laparoscopic appendectomy

Author

Αντωνίου, Σταύρος Αθανάσιος

Thesis advisor

Φιλαλήθης, Αναστάσιος
Μαυρίδης, Δημήτριος
Φραγκιαδάκης, Γεώργιος

Abstract

Background Laparoscopic appendectomy is the predominant method of treatment of acute appendicitis. There is insufficient evidence on the most effective management of the appendix stump. Aim of this study was to investigate the relative effectiveness and provide a treatment ranking of different options for securing the appendix stump. Methods Electronic databases were searched to identify randomized controlled trials (RCTs) comparing ligation methods of the appendix. The primary outcomes were organ/space infection and superficial surgical site infection. We performed a network meta-analysis and we estimated the pairwise relative treatment effects of the competing interventions using the odds ratio (OR) and its 95% confidence interval (CI). We obtained a hierarchy of the competing interventions using rankograms and the surface under the cumulative ranking curve (SUCRA). Results Forty-three RCTs were eligible and provided data for more than 5000 patients. Suture ligation appeared to be the most effective treatment strategy, in terms of both organ/space infection and superficial surgical site infection. Statistical significance was reached for the comparisons of clip versus endoloop (OR 0.56, 95% CI 0.32 to 0.96) for organ/space infection; and suture versus clip (OR 0.20, 95% CI 0.08 to 0.55) and clip versus endoloop (OR 2.22, 95% CI 1.56 to 3.13) for superficial surgical site infection. The network was informed primarily by indirect treatment comparisons. Conclusions The use of suture ligation of the appendix in laparoscopic appendectomy seems to be superior to other methods for the composite parameters of organ/space and superficial surgical site infection.

Language

English, Greek

Subject

Postoperative abscess

Wound infection

Λοίμωξη τραύματος

Μετεγχειρητικό απόστημα

Issue date

2017-03-29

Collection

School/Department--School of Medicine--Department of Medicine--Post-graduate theses

Type of Work--Post-graduate theses