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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
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Αντωνίου, Σταύρος Αθανάσιος
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Thesis advisor
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Φιλαλήθης, Αναστάσιος
Μαυρίδης, Δημήτριος
Φραγκιαδάκης, Γεώργιος
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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.
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Language |
English, Greek |
Subject |
Postoperative abscess |
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Wound infection |
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Λοίμωξη τραύματος |
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Μετεγχειρητικό απόστημα |
Issue date |
2017-03-29 |
Collection
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School/Department--School of Medicine--Department of Medicine--Post-graduate theses
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Type of Work--Post-graduate theses
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Permanent Link |
https://elocus.lib.uoc.gr//dlib/c/6/b/metadata-dlib-1493134988-444309-24864.tkl
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Views |
235 |