Chirurgie
zur Übersicht der bisher erschienen Ausgaben
Neuerscheinungen Ausgabe 2/2010 der Cochrane Library
Medical versus surgical management for gastro-oesophageal reflux disease (GORD) in adults
4 Studien (n=1.232)
There is evidence that laparoscopic fundoplication surgery is more effective than medical management for the treatment of GORD at least in the short to medium term. Surgery does carry some risk and whether the benefits of surgery are sustained in the long term remains uncertain. Treatment decisions for GORD should be based on patient and surgeon preference.
Interventions for the treatment of fractures of the mandibular condyle
No high quality evidence is available in relation to this review question and no conclusions could be reached about the effectiveness or otherwise of the two interventions considered in this review. A need for further well designed randomised controlled trials exists. The trialists should account for all losses to follow-up and assess patient related outcomes. They should also report the direct and indirect costs associated with the interventions.
Miniport versus standard ports for laparoscopic cholecystectomy
13 Studien (n=803)
Miniport laparoscopic cholecystectomy can be completed successfully in more than 85% of patients. Patients, in whom elective miniport laparoscopic cholecystectomy was completed successfully, had lower pain than those who underwent standard laparoscopic cholecystectomy. However, because of the lack of information on its safety, miniport laparoscopic cholecystectomy cannot be recommended outside well-designed, randomised clinical trials.
Surgical intervention for anorectal fistula
10 RCTs
There are very few randomized controlled trials comparing the various modalities of surgery for fistula in ano. While post operative pain, time to healing and discharge from hospital affect quality of life, recurrence and incontinence are the most important. As it turns out, there seems to be no major difference between the various techniques used as far as recurrence rates are concerned.
The use of Fibrin glue and advancement flaps are associated with low incontinence rates.
There is a crying need for well powered, well conducted randomised controlled trials comparing various modes of treatment of fistula in ano. Newer operations like the anal fistula plug and the LIFT procedure need to be evaluated by randomised clinical trials.
Staples versus sutures for closing leg wounds after vein graft harvesting for coronary artery bypass surgery.
3 Studien (n=423)
These results suggest that there is no evidence of a difference in the risk of surgical site infection (SSI) and wound dehiscence when staples rather than sutures are used to close leg wounds after vein graft harvesting during CABG, however more research is needed.
Perianal injectable bulking agents as treatment for faecal incontinence in adults
4 Studien (n= 176)
A definitive conclusion cannot be drawn regarding the effectiveness of perianal injection of bulking agents for faecal incontinence due to the limited number of identified trials together with methodological weaknesses. Within the available data, however, we found no reliable evidence for effectiveness of one treatment over another in improving faecal incontinence. Larger well-designed trials with adequate numbers of subjects using reliable validated outcome measures are needed to allow definitive assessment of the treatment for both effectiveness and safety.
Joint lavage for osteoarthritis of the knee
7 Studien (n=567)
Joint lavage does not result in a relevant benefit for patients with knee osteoarthritis in terms of pain relief or improvement of function.
Covering ileo- or colostomy in anterior resection for rectal carcinoma
6 RCTs
Covering stoma seems to be useful to prevent anastomotic leakage and urgent re-operations in patients receiving low anterior resection for rectal cancer. However, covering stoma does not seems to offer advantage in term of 30 days or long term mortality.
Embolisation therapy for pulmonary arteriovenous malformations
Keine geeigneten Studien
Currently there are no randomised controlled trials to support or refute embolisation therapy for treatment of pulmonary arteriovenous malformations. However, randomised controlled trials are not always feasible on ethical grounds. Observational studies suggest that embolisation therapy reduces mortality and morbidity compared to no treatment in patients. A standardised approach to reporting with long-term follow up through registry studies can help to strengthen the evidence base for embolisation therapy in the absence of randomised controlled trials. Future viable randomised controlled trials may compare different embolisation devices against each other.
Ausgabe 1/2010 der Cochrane Library
Bariatric surgery for non-alcoholic steatohepatitis in obese patients
Keine geeigneten Studien
The lack of randomised clinical trials and quasi-randomised clinical studies precludes us to assess the benefits and harms of bariatric surgery as a therapeutic approach for patients with NASH. Limitations of all other studies with inferior design did not allow us to draw any unbiased conclusion on bariatric surgery for treatment of NASH.
Damage control surgery for abdominal trauma
Keine geeigneten Studien
Evidence that supports the efficacy of DCS with respect to traditional laparotomy in patients with major abdominal trauma is limited.
Hypertonic saline for peri-operative fluid management
15 Studien (n= 614)
HS reduces the volume of intravenous fluid required to maintain patients undergoing surgery but transiently increases serum sodium. It is not known if HS effects patient survival and morbidity but it should be tested in randomized clinical trials that are designed and powered to test these outcomes.
Neuraxial anaesthesia for lower-limb revascularization
4 Studien (n=696)
There was insufficient evidence available from the included trials that compared neuraxial anaesthesia with general anaesthesia to rule out clinically important differences for most clinical outcomes. Neuraxial anaesthesia may reduce pneumonia. No conclusions can be drawn with regard to mortality, myocardial infarction and rate of lower-limb amputation or less common outcomes.
An overview of Cochrane Hepato-Biliary Group reviews
56 Studien (n=5246)
No statistically significant differences in the outcome measures of mortality and complications have been found among open, small-incision, and laparoscopic cholecystectomy. There were no data on symptom relief. Complications in elective cholecystectomy are high. The quicker recovery of both laparoscopic and small-incision cholecystectomy patients compared with patients on open cholecystectomy justifies the existing preferences for both minimal invasive techniques over open cholecystectomy. Laparoscopic and small-incision cholecystectomies seem to be comparable, but the latter has a significantly shorter operative time, and seems to be less costly.
Oral rinses, mouthwashes and sprays for improving recovery following tonsillectomy
6 Studien (n=528)
The risk of bias was high in most of the included trials and poor reporting quality and inadequate data did not permit comprehensive and reliable conclusions to be made. Future trials should be well-constructed and pay more attention to the methods used to assess outcomes, the timing of the assessments and the quality of reporting and subsequent analysis of the data.
Surgery for Ménière's disease
2 Studien (n=59)
The two trials included in this review provide insufficient evidence of the beneficial effect of endolymphatic sac surgery in Ménière's disease.
Surgical interventions for the rheumatoid shoulder
1 RCT
The effects of surgical treatment in the management of the shoulder in people with rheumatoid arthritis are largely unknown due to the paucity of randomised controlled trials
Surgical resection versus non-surgical treatment for hepatic node positive patients with colorectal liver metastases
There is no evidence in the literature to assess the role of surgery versus other treatments for patients with colorectal liver metastases with hepatic node involvement. High quality randomised clinical trials are feasible and are necessary to determine the optimal management of patients with colorectal liver metastases with hepatic node involvement.
Treatment for thoracic outlet syndrome
This review was complicated by a lack of generally accepted diagnostic criteria for the diagnosis of TOS. There was very low quality evidence that transaxillary first rib resection decreased pain more than supraclavicular neuroplasty but no randomized evidence that either is better than no treatment. There is no randomized evidence to support the use of other currently used treatments. There is a need for an agreed definition for the diagnosis of TOS, especially the disputed form, agreed outcome measures and high quality randomized trials that compare the outcome of interventions with no treatment and with each other.
Infraclavicular brachial plexus block for regional anaesthesia of the lower arm
15 Studien (n=1020)
ICB is a safe and simple technique for providing surgical anaesthesia of the lower arm, with an efficacy comparable to other BPBs. The advantages of ICB include a lower likelihood of tourniquet pain during surgery, and more reliable blockade of the musculocutaneous and axillary nerves when compared to a single-injection axillary block.
Laparoscopic versus open surgery in small bowel obstruction
Although data from retrospective clinical controlled trials suggest that laparoscopy seems feasible and better in terms of hospital stay and mortality reduction, high quality randomised controlled trials assessing all clinically relevant outcomes including overall mortality, morbidity, hospital stay and conversion are needed.
Somatostatin analogues for pancreatic surgery
17 Studien (n=2143)
Ausgabe 4/2009 der Cochrane Library
Cardiopulmonary interventions to decrease blood loss and blood transfusion requirements for liver resection
9 Studien (n= 587)
None of the interventions seem to decrease peri-operative morbidity or offer any long-term survival benefit.
Pharmacological interventions to decrease blood loss and blood transfusion requirements for liver resection
6 Studien (n= 849)
None of the interventions seem to decrease peri-operative morbidity or offer any long-term survival benefit.
Processed versus fresh frozen bone for impaction bone grafting in revision hip arthroplasty
Keine geeigneten Studien
Good quality randomised controlled trials are required in this area so that a surgeon’s choice of bone graft can be informed by evidence rather than personal preference.
Shouldice technique versus other open techniques for inguinal hernia repair
16 Studien (n= 2566)
Shouldice herniorrhaphy is the best non-mesh technique in terms of recurrence, though it is more time consuming and needs a slightly longer post-operative hospital stay. The use of mesh is associated with a lower rate of recurrence. The quality of included studies, assessed with jaded scale, were low.
Surgical interventions for anterior shoulder instability in adults
3 Studien (n= 184)
There is insufficient evidence from randomised trials comparing arthroscopic with open surgery for treating anterior shoulder instability.
Surgical interventions for treating acute fractures or non-union of the middle third of the clavicle
3 kleine Studien
There is limited evidence, from single trials only, regarding the effectiveness of different methods of surgical fixation of fractures and non-union of the middle third of the clavicle.
Tamponade in surgery for retinal detachment associated with proliferative vitreoretinopathy
2 kleine Studien
The use of either C3F8 or silicone oil appears reasonable for most patients with RD associated with PVR. Because there do not appear to be any major differences in outcomes between the two agents, the choice of a tamponade agent should be individualized for each patient.
Arthrocentesis and lavage for treating temporomandibular joint disorders
2 Studien (n= 81)
There is insufficient, consistent evidence to either support or refute the use of arthrocentesis and lavage for treating patients with temporomandibular joint disorders.
Supplemental perioperative steroids for surgical patients with adrenal insufficiency
2 Studien (n=37)
Owing to the small number of patients, the results may not be representative. Based on current available evidence, we are unable to support or refute the use of supplemental perioperative steroids for patients with adrenal insufficiency during surgery.
Ausgabe 3/2009 der Cochrane Library
11 Studien (n= 1754)
We found no evidence regarding the effectiveness of the use of incentive spirometry for prevention of postoperative pulmonary complications in upper abdominal surgery. This review underlines the urgent need to conduct well-designed trials in this field. There is a case for large randomized trials of high methodological rigour in order to define any benefit from the use of incentive spirometry regarding mortality.
5 Studien
There is insufficient evidence to support strict glycaemic control versus conventional management (maintenance of glucose < 200 mg/dL) for the prevention of SSIs. No trials were found that evaluated strict glycaemic control in the immediate pre-operative period or outside the setting of an intensive care unit. The trials were limited by small sample size, inconsistencies in the definitions of the outcome measures and methodological quality.
Ausgabe 2/2009 der Cochrane Library
Conservative interventions for treating middle third clavicle fractures in adolescents and adults
Drei Studien (n=354) mäßiger Qualität
There is insufficient evidence from randomised controlled trials to determine which methods of conservative treatment are the most appropriate for acute middle third clavicle fractures in adolescents and adults. Further research is warranted.
Low pressure versus standard pressure pneumoperitoneum in laparoscopic cholecystectomy
15 RCTs (n=690)
Low pressure pneumoperitoneum appears effective in decreasing pain after laparoscopic cholecystectomy. The safety of low pressure pneumoperitoneum has to be established.
Mohs micrographic surgery versus surgical excision for periocular basal cell carcinoma
Keine Studien gefunden
No reliable conclusions could be reached regarding which method of treatment (SE or MMS) resulted in a lower recurrence or complication rate for periocular BCC. No studies were found comparing the cost of either method directly.
Surgery versus radical endotherapies for early cancer and high grade dysplasia in Barrett's oesophagus
Keine geeigneten RCTs
This Cochrane review has indicated that there are no randomised control trials to compare management options in this vital area, therefore trials should be undertaken as a matter of urgency. The problems with such randomised methods are standardising surgery and endotherapies in all sites; standardising histopathology in all centres; assessing which patients are fit or unfit for surgery; and making sure there are relevant outcomes for the study i.e. no progression of high grade dysplasia or long term survival i.e. over five years.
Ausgabe 1/2009 der Cochrane Library
Antimicrobial prophylaxis for colorectal surgery
182 Studien (n=30.880) mit 50 differenten Antibiotika
Antibiotics covering aerobic and aerobic bacteria should be delivered orally and intravenously prior to colorectal surgery. Antibiotics delivered within this framework will reduce the risk of postoperative SWI by at least 75%.
Conventional versus LigaSure hemorrhoidectomy for patients with symptomatic Hemorrhoids
12 Studien (n=1142)
A tendency for equal efficacy. Ligasure technique results in significantly less immediate postoperative pain
Open versus laparoscopic (assisted) ileo pouch anal anastomosis for ulcerative colitis and familial adenomatous polyposis
11 Studien (n=607)
The laparoscopic IPAA is a feasible and safe procedure. Short-term advantages of the laparoscopic approach seem to be limited and their clinical significance is arguable.
Vascular occlusion for elective liver resections
5 Studien (n=166), hohes Risiko für Bias
The blood loss was significantly lower in vascular occlusion compared with no vascular occlusion.
Methods of vascular occlusion for elective liver resections
10 Studien (n=657), hohes Risiko für Bias
In elective liver resection, hepatic vascular occlusion cannot be recommended over portal triad clamping.
Techniques for liver parenchymal transection in liver resection
7 Studien (n=556)
There was no clinically or statistically significant difference in the operating time between sharp dissection and clamp-crush techniques. Clamp-crush technique is two to six times cheaper than the other methods depending upon the number of surgeries performed each year.
Ischaemic pre-conditioning for elective liver resections performed under vascular occlusion
4 Studien (n=271)
Currently, there is no evidence to suggest a protective effect of ischaemic preconditioning in non-cirrhotic patients undergoing liver resection under continuous vascular occlusion.
Palliative cytoreductive surgery versus other palliative treatments in patients with unresectable liver metastases from gastro-entero-pancreatic neuroendocrine tumours
Keine RCTs zu finden
Virtual reality training for surgical trainees in laparoscopic surgery
23 trials mit 612 Patienten
Virtual reality training can supplement standard laparoscopic surgical training of apprenticeship and is at least as effective as video trainer training in supplementing standard laparoscopic training.
Robot assistant for laparoscopic cholecystectomy
5 trials (all of high risk of bias) mit 453 Patienten
Although robot-assisted laparoscopic cholecystectomy appears safe, there seems to be no significant advantages over human-assisted laparoscopic cholecystectomy. We were unable to identify trials comparing one type of robot assistant versus another.
Cholecystectomy for gallbladder polyp
Keine RCTs verfügbar
Cholecystectomy for suspected gallbladder dyskinesia
1 Studie mit 21 Patienten, 11 mit cholecystectomy und 10 ohne Op als kontrolle
Keine verlässliche Aussage möglich
Intra-peritoneal prophylactic agents for preventing adhesions and adhesive intestinal obstruction after non-gynaecological abdominal surgery
6 Studien zu hyaluronic acid/carboxymethyl membrane (HA/CMC)
Evidence that the use of HA/CMC membrane reduces incidence, extent and severity of adhesions. There is no evidence that the incidence of intestinal obstruction or need for operative intervention is reduced.
Pre and peri-operative erythropoeitin for reducing allogeneic blood transfusions in colorectal cancer surgery.
4 Studien
There is no sufficient evidence to date to recommend pre and peri-operative erythropoietin use in colorectal cancer surgery.
Preoperative chemoradiation versus radiation alone for stage II and III resectable rectal cancer
4 Studien
The addition of chemotherapy to preoperative RT significantly increased grade III and IV acute toxicity (OR 1.68-10, P = 0.002) while no differences were observed in postoperative morbidity or mortality.
Prolonged thromboprophylaxis with Low Molecular Weight heparin for abdominal or pelvic surgery
4 Studien
Prolonged thromboprophylaxis with LMWH significantly reduces the risk of VTE compared to thromboprophylaxis during hospital admittance only, without increasing bleeding complications after major abdominal or pelvic surgery.
Resorbable versus titanium plates for facial fractures
Keine verwertbaren Studien, einige abgebrochen
The findings of this review, based on the results of the aborted trials, do not suggest that resorbable plates are as effective as titanium plates.
Steroid avoidance or withdrawal for kidney transplant recipients
30 Studien (n=5949)
This review confirms that steroid avoidance and steroid withdrawal strategies in kidney transplantation are not associated with increased mortality or graft loss despite an increase in acute rejection.
Thoracic stent graft versus surgery for thoracic aneurysm
Keine verwertbaren Studien
Decompressive surgery for treating nerve damage in leprosy
2 RCTs (n=88)
No significant added benefit of surgery over steroid treatment alone
Ausgabe 4/2008 der Cochrane Library
Absorbent products for moderate-heavy urinary and/or faecal incontinence in women and men
2 trials (n=185)
There is evidence that different designs are better for men and women. Diapers are the most cost-effective disposable design for men. Disposable pull-ups are most preferred for women but are expensive: disposable inserts are a cheaper alternative.
Evidence from small trials, many with methodological limitations, suggests that superficial and partial thickness burns may be managed with hydrocolloid, silicon nylon, antimicrobial (containing silver), polyurethane film and biosynthetic dressings. There was no evidence to support the use of silver sulphadiazine.
10 Studien
This review found that use of propofol for sedation during colonoscopy can lead to faster recovery after the procedure and higher patient satisfaction, without any increase in side-effects as compared to the use of drugs traditionally used (narcotics and/or benzodiazepines) for sedation during colonoscopy.
Ausgabe 3/2008 der Cochrane Library
Debridement for surgical wounds
5 RCTs
Enzyme treated wounds were cleaned more quickly. Lack of large, high quality published RCTs evaluating debridement.
Open surgical procedures for incisional hernias
8 Trials (n= 1141 Patienten)
Good evidence from three trials that open mesh repair is superior to suture repair in terms of recurrences, but inferior when considering wound infection.
Ausgabe 2/2008 der Cochrane Library
Abdominal lift for laparoscopic cholecystectomy
20 Studien, N=706
Nachteilig ist das Pneumoperitoneum nur bei Personen, die stark in ihrer cardiopulmonalen Funktion eingeschränkt sind.
Laparoscopic Entry Techniques
17 RCTs, N= 3040
Kein Vorteil einer speziellen Technik. Nichtanheben der Bauchdecke beim Eingehen mit der Verresnadel senkt die Zahl der nicht erfolgreichen Zugänge, ohne die Komplikationen zu erhöhen.
Es gibt nicht die „bessere Technik“. Zwischen den verschiedenen Techniken gibt es keine wichtigen Unterschiede.
Long-term results of laparoscopic colorectal cancer resection
33 Studien, N= 3346
Kein Nachtiel der laparoskopischen Resektion im long term outcome gegen open colectomy.
Bone grafts and bone substitutes for treating distal radial fractures in adults
7 Studien, N über 600
Bone scaffolding may improve anatomical outcome compared with plaster cast alone but there is insufficient evidence to conclude on functional outcome and safety; or for other comparisons.
Antacids for preventing oesophagogastric variceal bleeding and rebleeding in cirrhotic patients
Keine RCTS
Keine klinisch verwertbare Evidenz gefunden.
Interventions for treating wrist fractures in children
10 Studien, N= 827
Although surgery helped prevent redisplacement of some types of fractures, the long-term benefit was not confirmed. However, further trials on these three issues are needed to obtain more conclusive evidence.
Adjuvant treatment of anaplastic oligodendrogliomas and oligoastrocytomas
2 Studien
Anaplastische Oligodendrogliome und Oligoastrocytome werden traditionell nach der Chirurgie bestrahlt.
Chemotherapie: Two RCTs have found that, although the addition of procarbazine, lomustine, and vincristine (PCV) chemotherapy to standard treatment does not prolong survival, it does delay progression of these tumors.
Reconstructive Techniques After Rectal Resection for Rectal Cancer
9 RCTs, N= 473
In several randomized controlled trials, the CJP has been shown to be superior to the SCA in bowel function outcomes in patients with rectal cancer for at least 18 months after gastrointestinal continuity is re-established.
Antibiotics to reduce post-tonsillectomy morbidity
9 Studien
The review suggests that there is little or no evidence that antibiotics reduce the main morbid outcomes following tonsillectomy (i.e. pain, the need for analgesia or secondary haemorrhage rates).
Intravenous versus inhalation anaesthesia for one-lung ventilation
9 Studien, N= 291
Keine Studie berichtete zum Endpunkt.
Ausgabe 1/2008 der Cochrane Library
Hand washing for preventing diarrhoea
14 RCTs
Hand washing can reduce diarrhoea episodes by about 30%.
Surgical hand antisepsis to reduce surgical site infection
Ten trials
The evidence from comparisons of aqueous scrubs with alcohol rubs which contain additional active ingredients is mixed, there is evidence from studies in favour of both forms of antisepsis.
Day-case versus overnight stay in laparoscopic cholecystectomy
5 trials, N=429
Day-case elective laparoscopic cholecystectomy seems to be a safe and effective intervention in selected patients with symptomatic gallstones. Because of the decreased hospital stay, it is likely to save costs.
Different methods of external fixation for treating distal radial fractures in adults
9 trials, N=510
There is insufficient robust evidence to determine the relative effects of different methods of external fixation.
Infection control strategies for preventing the transmission of meticillin-resistant Staphylococcus aureus (MRSA) in nursing homes for older people
No studies met the selection criteria
Ischaemic preconditioning for liver transplantation
3 trials, N=162
There is currently no evidence to support or refute the use of ischaemic preconditioning in donor liver retrievals.
Spinal fixation surgery for acute traumatic spinal cord injury
No randomised controlled trials or controlled trials were identified.
Surgery for rotator cuff disease
14 RCTs, N=829
Effect of surgery for rotator cuff disease:
may not lead to any difference in pain compared with different exercise programs. Arthroscopic surgery may not lead to any difference in outcome in the long run compared with open surgery but people might recover sooner.
Systemic prokinetic pharmacologic treatment for postoperative adynamic ileus following abdominal surgery in adults
39 RCTs, N=4615
Six RCTs support the effect of Alvimopan
Treatment for peritoneal dialysis-associated peritonitis
36 studies, N=2089
Based on one study, IP administration of antibiotics is superior to IV dosing for treating PD peritonitis.
Tumor necrosis factor-alpha antibody for maintenace of remission in Crohn's disease
9 trials
Infliximab is effective for the maintenance of remission and maintenance of fistula healing in patients who have responded to infliximab induction therapy.
