Endoscopy-assisted versus open tissue expander placement in plastic and reconstructive surgery: a meta-analysis

Abstract

BackgroundTissue expansion can solve the problem of tissue de ciency in plastic and reconstructive surgery, but it is a lengthy process with many possible complications. This meta-analysis aimed to determine whether endoscopy-assisted expander placement could decrease complications and shorten treatment time. MethodsA literature search was performed in eight databases from their inception dates up to November 22, 2020, to identify clinical studies on endoscopy-assisted and/or open tissue expander placement in plastic and reconstructive surgery. Risk difference (RD) and weighted mean difference (WMD), along with the 95% con dence intervals (95% CI), were calculated to compare the pooled results. ResultsSeven studies met the inclusion criteria. Of the 759 patients, 194 received endoscopy-assisted expander placement and 565 patients received open expander placement. Overall complication rate was signi cantly lower in the endoscopy-assisted group than in the open expander group (pooled RD − 0.28, 95% CI, − 0.38 to − 0.18, p < 0.001). Subgroup analysis showed signi cantly lower incidence rates for haemotoma, infection, and dehiscence, but not for extrusion and de ation. The endoscopy-assisted group also had signi cantly shorter surgery time (WMD, − 13.97 min; 95% CI, − 15.85 to − 12.08 minutes, p < 0.001), hospital stay (WMD, − 16.88 hours; 95% CI, − 24.36 to − 9.40 hours, p < 0.001), and time to full expansion (WMD, − 27.54 days; 95% CI, − 38.85 to − 16.24 days, p < 0.001). ConclusionsEndoscopy-assisted expander placement may help lower the risk of complications such as haemotoma, infection, and dehiscence, and also reduce surgery time, hospital stay, and time to full expansion.