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What the surgeons need to know about meta-analyses in 2023, beyond the simple Odds ratio

2022; Elsevier BV; Volume: 159; Issue: 6 Linguagem: Inglês

10.1016/j.jviscsurg.2022.10.003

1878-7886

Chadli Dziri, K. Slim,

Abdominal Surgery and Complications

To compare the safety and efficacy between Veress needle insertion and direct trocar insertion in laparoscopic surgeries.Relevant clinical trials were retrieved from major databases; Web of Science, Cochrane CENTRAL, PubMed, and SCOPUS. The following outcomes were pooled for analysis: failed entry, extraperitoneal insufflation, vascular lesion, omental lesion and visceral lesion, site bleeding, reintervention, subcutaneous emphysema, solid organ lesion, and infection of the trocar site. A fixed-effects model was used to analyze homogeneous outcomes, whereas random-effects models were used to analyze heterogeneous outcomes.We included a total of twelve clinical trials. The pooled analysis showed that the Veress needle was accompanied by a significant increase in the incidences of extraperitoneal insufflation (RR = 0.204; 95% Cl [0.136, 0.307], P = 0.001), omental lesion (RR = 0.444 95% Cl [0.239, 0.825], P = 0.01), and failed entry (RR = 0.169 95% Cl [0.101, 0.284], P = 0.001). There is no significant difference between both cohort regarding the vascular lesion (RR = 0.847 95% Cl [0.259, 2.777), P = 0.7), infection of the trocar site (RR = 0.583 95%Cl [0.106, 3.216], P = 0.5, and visceral lesion (RR = 1.308 95% Cl [0.314, 5.438], P = 0.7.The DTI was accompanied by a significantly lower incidence of complications such as extraperitoneal insufflation, failed entry, omental lesion, and subcutaneous emphysema. On the other hand, both cohorts showed similar results regarding; vascular lesions, visceral lesions, reintervention, site bleeding, and solid organ lesion.