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Outcomes of robotic vs laparoscopic hepatectomy:A systematic review and meta-analysis

World Journal of Gastroenterology 2015年第27期21卷 8441-8451页

作者： Roberto Montalti giammauro berardi Alberto Patriti Marco Vivarelli Roberto Ivan Troisi Department of General and Hepato-Biliary Surgery Liver Transplantation Service Ghent University Hospital and Medical School Department of Gastroenterology and Transplantation Surgery Polytechnic University of Marche-Ospedali Riuniti Division of General Minimally Invasive and Robotic Surgery General Hospital of Spoleto

AIM: To perform a systematic review and metaanalysis on robotic-assisted vs laparoscopic liver ***: A systematic literature search was performed using Pub Med, Scopus and the Cochrane Library Central. Participants of any age and sex, who underwent robotic or laparoscopic liver resection were considered following these criteria:(1) studies comparing robotic and laparoscopic liver resection;(2) studies reporting at least one perioperative outcome; and(3) if more than one study was reported by the same institute, only the most recent was included. The primary outcome measures were set for estimated blood loss, operative time, conversion rate, R1 resection rate, morbidity and mortality rates, hospital stay and major hepatectomy ***: A total of 7 articles, published between 2010 and 2014, fulfilled the selection criteria. The laparoscopic approach was associated with a significant reduction in blood loss and lower operative time(MD = 83.96, 95%CI: 10.51-157.41, P = 0.03; MD = 68.43, 95%CI: 39.22-97.65, P < 0.00001, respectively). No differences were found with respect to conversion rate, R1 resection rate, morbidity and hospital ***: Laparoscopic liver resection resulted in reduced blood loss and shorter surgical times compared to robotic liver resections. There was no difference in conversion rate, R1 resection rate, morbidity and length of postoperative stay.

关键词： Laparoscopic liver resections Robotic liverresections Outcome Systematic review Meta-analysis

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Management of duodenal stump fistula after gastrectomy for gastric cancer: Systematic review

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World Journal of Gastroenterology 2015年第24期21卷 7571-7576页

作者： Paolo Aurello Dario Sirimarco Paolo Magistri NiccolòPetrucciani giammauro berardi Silvia Amato Marcello Gasparrini Francesco D’Angelo Giuseppe Nigri Giovanni Ramacciato Department of General Surgery Sant’Andrea HospitalSapienza University of Rome

AIM: To identify the most effective treatment of duodenalstump fistula(DSF) after gastrectomy for gastric ***: A systematic review of the literature was performed. Pub Med, EMBASE, Cochrane Library, CILEA Archive, BMJ Clinical Evidence and Up To Date databases were analyzed. Three hundred eighty-eight manuscripts were retrieved and analyzed and thirteen studies published between 1988 and 2014 were finally selected according to the inclusion criteria, for a total of 145 cases of DSF, which represented our group of study. Only patients with DSF after gastrectomy for malignancy were selected. Data about patients' characteristics, type of treatment, short and long-term outcomes were extracted and analyzed. RESULTS: In the 13 studies different types of treatment were proposed: conservative approach, surgical approach, percutaneous approach and endoscopic approach(3 cases). The overall mortality rate was 11.7% for the entire cohort. The more frequent complications were sepsis, abscesses, peritonitis, bleeding, pneumonia and multi-organ failure. Conservative approach was performed in 6 studies for a total of 79 patients, in patients with stable general condition, often associated with percutaneous approach. A complete resolution of the leakage was achieved in 92.3% of these patients, with a healing time ranging from 17 to 71 d. Surgical approach included duodenostomy, duodenojejunostomy, pancreatoduodenectomy and the use of rectus muscle flap. In-hospital stay of patients who underwent relaparotomy ranged from 1 to 1035 d. The percutaneous approach included drainage of abscesses or duodenostomy(32 cases) and percutaneous biliary diversion(13 cases). The median healing time in this group was 43 d. CONCLUSION: Conservative approach is the treatment of choice, eventually associated with percutaneus drainage. Surgical approach should be reserved for severe cases or when conservative approaches fail.

关键词： Duodenal stump leak Duodenal stumpfistula Gastric cancer Management Gastrectomy

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