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master's thesis
Sustavni pregled i meta-analiza randomiziranih studija za usporedbu laparoskopske kolecistektomije kroz jedan rez i standardne laparoskopske kolecistektomije
Zagreb: University of Zagreb, School of Medicine, 2014. urn:nbn:hr:105:439829
Milas, Mate
University of Zagreb
School of Medicine
Department of Pharmacology

Institutional repository: Dr Med - University of Zagreb School of Medicine Digital Repository

Cite this document

Milas, M. (2014). Sustavni pregled i meta-analiza randomiziranih studija za usporedbu laparoskopske kolecistektomije kroz jedan rez i standardne laparoskopske kolecistektomije (Master's thesis). Zagreb: University of Zagreb, School of Medicine. Retrieved from https://urn.nsk.hr/urn:nbn:hr:105:439829

Milas, Mate. "Sustavni pregled i meta-analiza randomiziranih studija za usporedbu laparoskopske kolecistektomije kroz jedan rez i standardne laparoskopske kolecistektomije." Master's thesis, University of Zagreb, School of Medicine, 2014. https://urn.nsk.hr/urn:nbn:hr:105:439829

Milas, Mate. "Sustavni pregled i meta-analiza randomiziranih studija za usporedbu laparoskopske kolecistektomije kroz jedan rez i standardne laparoskopske kolecistektomije." Master's thesis, University of Zagreb, School of Medicine, 2014. https://urn.nsk.hr/urn:nbn:hr:105:439829

Milas, M. (2014). 'Sustavni pregled i meta-analiza randomiziranih studija za usporedbu laparoskopske kolecistektomije kroz jedan rez i standardne laparoskopske kolecistektomije', Master's thesis, University of Zagreb, School of Medicine, accessed 23 November 2024, https://urn.nsk.hr/urn:nbn:hr:105:439829

Milas M. Sustavni pregled i meta-analiza randomiziranih studija za usporedbu laparoskopske kolecistektomije kroz jedan rez i standardne laparoskopske kolecistektomije [Master's thesis]. Zagreb: University of Zagreb, School of Medicine; 2014 [cited 2024 November 23] Available at: https://urn.nsk.hr/urn:nbn:hr:105:439829

M. Milas, "Sustavni pregled i meta-analiza randomiziranih studija za usporedbu laparoskopske kolecistektomije kroz jedan rez i standardne laparoskopske kolecistektomije", Master's thesis, University of Zagreb, School of Medicine, Zagreb, 2014. Available at: https://urn.nsk.hr/urn:nbn:hr:105:439829

Metadata
TitleSustavni pregled i meta-analiza randomiziranih studija za usporedbu laparoskopske kolecistektomije kroz jedan rez i standardne laparoskopske kolecistektomije
Title (english)Single incision versus standard multiport laparoscopic cholecystectomy : up-dated systematic review and meta-analysis of randomized trials
AuthorMate Milas
MentorVLADIMIR TRKULJA (mentor)
Committee memberJelka Petrak (predsjednik povjerenstva)
Committee memberTomislav Meštrović (član povjerenstva)
Committee memberVLADIMIR TRKULJA (član povjerenstva)
GranterUniversity of Zagreb
School of Medicine
(Department of Pharmacology)
Zagreb
Defense date and country2014-05-30, Croatia
Scientific / art field,
discipline and subdiscipline		BIOMEDICINE AND HEALTHCARE
Clinical Medical Sciences
Clinical Pharmacology and Toxicology
Abstract
Cilj: Usporedba klinički relevantnih ishoda u odraslih nakon laparoskopske kolecistektomije kroz jedan rez (SILC) u odnosu na standardnu multiport tehniku (MLC). ---- Metode: Sustavni pregled i meta-analiza randomiziranih kliničkih pokusa. ---- Rezultati: Identificirano je 30 studija (SILC N=1209, MLC N=1202) većinom umjerene do niske kvalitete. Trajanje operacije (30 studija): duže u SILC skupini (WMD=12.4 min, 95% CI=9.3-15.5 min; p<0.001), međutim razlika se smanjuje s iskustvom – u 10 velikih studija (1321 pacijent) WMD=5,9 min (-1.3, 13.1; p=0.105). Intraoperativni gubitak krvi (12 studija, 1201 pacijent): veći u SILC skupini, ali je razlika praktički beznačajna (WMD=1.29 mL, 95% CI=0.24-2.35 mL; p=0.017). Stopa konverzije (27 studija, 2277 pacijenata): češća u SILC skupini (OR=13.9, 95% CI=4.34-44.7; p<0.001), ali općenito rijetka (ukupna incidencija u SILC skupini 4.39%) i gotovo se isključivo odnosi na dodatni troakar. Jačina postoperativne boli (29 studija) i duljina boravka u bolnici (22 studije): nema razlike. Komplikacije (30 studija): rijetke (ukupna incidencija u SILC skupini 5.35%) i bez razlike u učestalosti između SILC i MLC skupina. Incizijska hernija (19 studija, 1676 pacijenata): vrlo mala učestalost (SILC N=15, MLC N=4), ali statistički značajno veća u SILC skupini (OR=4.94, 95% CI=1.26- 19.4; p=0.025). Zadovoljstvo kozmetskim ishodom (16 studija, 11 s podacima od 1-3 mjeseca): u 5 studija sa nezaslijepljenim pacijentima (N=513) u korist SILC-a (SMD=1.83, 95% CI=0.13-3.52; p=0.037), ali u 6 studija sa zaslijepljenim pacijentima (N=719) razlika je mala i beznačajna (SMD=0.42, 95% CI=-1.12-1.96; p=0.548). ---- Rasprava: Ishodi SILC-a jako ovise o vještini operatera, ali bez obzira na to, kad se usporedi sa MLC-om, SILC traje nešto duže, rizik incizijske hernije je veći (ali sveukupno jako nizak) te je rana kozmetska korist umjerena. ---- Zaključak: Sa stajališta (ne)pogodnosti i sigurnosti, SILC je prihvatljiva alternativa MLC-u sa umjerenom kozmetskom koristi.
Abstract (english)
Background and purpose: We aimed to compare single incision laparoscopic cholecystectomy (SILC) to the standard multiport technique (MLC) for clinically relevant outcomes in adults. ---- Methods: Systematic review and random-effects meta-analysis of randomized trials. ---- Results: We identified 30 trials (SILC N=1209, MLC N=1202) mostly of moderate to low quality. Operating time (30 trials): longer with SILC (WMD=12.4 min, 95%CI 9.3, 15.5; p<0.001), but difference reduced with experience – in 10 large trials (1321 patients) WMD=5.9 (-1.3, 13.1; p=0.105). Intra-operative blood loss (12 trials, 1201 patients): greater with SILC, but difference practically irrelevant (WMD=1.29 mL, 0.24-2.35; p=0.017). Procedure failure (27 trials, 2277 patients): more common with SILC (OR=13.9, 4.34-44.7; p<0.001), but overall infrequent (SILC pooled incidence 4.39%) and almost exclusively addition of a trocar. Post-operative pain (29 trials) and hospital stay (22 trials): no difference. Complications (30 trials): infrequent (SILC pooled incidence 5.35%) with no overall SILC vs. MLC difference. Incisional hernia (19 trials, 1676 patients): very rare (15 vs. 4 cases), but odds significantly higher with SILC (OR=4.94, 1.26-19.4; p=0.025). Cosmetic satisfaction (16 trials, 11 with data at 1-3 months): in 5 trials with non-blinded patients (N=513) in favour of SILC (SMD=1.83, 0.13, 3.52; p=0.037), but in 6 trials with blinded patients (N=719) difference small and insignificant (SMD=0.42, -1.12, 1.96; p=0.548). ---- Discussion: SILC outcomes largely depend on surgeon’s skill, but regardless of it, when compared to MLC, SILC requires somewhat longer operating time, risk of incisional hernia is higher (but overall very low) and early cosmetic benefit is modest. ----- Conclusion: From the (in)convenience and safety standpoint, SILC is an acceptable alternative to MLC with a modest cosmetic benefit.
Keywords
Keywords (english)
Languagecroatian
URN:NBNurn:nbn:hr:105:439829
Study programmeTitle: Medicine
Study programme type: university
Study level: integrated undergraduate and graduate
Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
Type of resourceText
File originBorn digital
Access conditionsAccess restricted to students and staff of home institution
Terms of useLicence In copyright icon
Created on2015-12-16 08:57:50