Four Surgical Strategies for the Treatment of Cesarean Scar Defect: A Systematic Review and Network Meta-analysis

He, Yunan; Zhong, Jiaojiao; Zhou, Wei; Zeng, Sha; Li, Hui; Yang, Hui; Shan, Nianchun

doi:10.1016/j.jmig.2019.03.027

Cited by 24 publications

(18 citation statements)

References 18 publications

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“…The layered suture of the myometrium is easier to form a diverticulum than the full-thickness suture of the myometrium (12,27,28). A previous meta-analysis showed a similar incidence of uterine scar diverticulum in the uterus with single-and double-layer sutures (29). In addition, the incidence of double-suture uterine scar diverticulum is lower than that with a single suture (30).…”

Section: Discussionmentioning

confidence: 94%

A systematic review and meta-analysis of the efficacy and safety of hysteroscopic electric resection versus vaginal surgery in the treatment of uterine scar defects after cesarean section

Yuan¹,

Gao²,

Wang³

et al. 2022

Ann Transl Med

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Background: Cesarean sections are increasingly likely to be applied; however, uterine scar defects (USD) often remain after delivery. The two existing treatment methods, hysteroscopic electric resection and vaginal surgery, are still controversial in terms of efficacy and safety. So, this paper to compares the effectiveness and safety of hysteroscopic electric resection and vaginal surgery in the treatment of USD after cesarean section.Methods: We performed a related literature search from main databases. According to the PICOS principles inclusion criteria were adult female USD patients to evaluate the efficacy of hysteroscopic resection and vaginal surgery for the treatment of USD, outcome data could be extracted to compare the efficacy and safety of the two procedures. Subsequently, according to the titles, abstracts, and full texts of the retrieved articles, studies that did not meet the inclusion criteria were eliminated. The RevMan 5.20 software was used for meta-analysis and Cochrane Risk of Bias 2 (RoB 2.0) was used to assess the risk of bias. The effectiveness and safety of hysteroscopic resection and vaginal surgery in the treatment of USD patients after cesarean section were compared.Results: Eight articles were finally included, with a total of 191 patients in the hysteroscopic electric resection group and 212 patients in the vaginal surgery group. Compared with hysteroscopic resection and vaginal surgery, there is less intraoperative blood loss [mean difference (MD) is −25.23, P<0.00001], shorter operation time (MD is −29.45, P<0.00001), and shorter hospital stay (MD is −1.87, P<0.00001), but menstrual improvement risk ratio (RR) is 0.71 (P=0.51) and diverticulum recovery RR is 0.60 (P=0.43) there were no significant differences.Discussion: Hysteroscopic electric resection provides a more satisfactory outcome than vaginal surgery in terms of intraoperative blood loss, operation time, and hospital stay. However, the sample size of the study was not large enough and some studies had high risk of bias, more large-sample multi-center high quality studies are needed for further comprehensive comparative analysis.

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Section: Discussionmentioning

confidence: 94%

A systematic review and meta-analysis of the efficacy and safety of hysteroscopic electric resection versus vaginal surgery in the treatment of uterine scar defects after cesarean section

Yuan¹,

Gao²,

Wang³

et al. 2022

Ann Transl Med

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“…Because of the limited number of included studies, it was not feasible to use funnel plots to detect publication bias. 29 Instead, we chose the Egger linear regression test, which quantitatively assesses bias with high detection efficacy for small samples and continuous variables. 30 We used comprehensive meta-analysis software (version 3; BioStat) for meta-regression and the assessment of publication bias.…”

Section: Discussionmentioning

confidence: 99%

Hippocampal subfield alterations in schizophrenia and major depressive disorder: a systematic review and network meta-analysis of anatomic MRI studies

Sun

Wang

et al. 2023

jpn

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Background: Hippocampal disturbances are important in the pathophysiology of both schizophrenia and major depressive disorder (MDD). Imaging studies have shown selective volume deficits across hippocampal subfields in both disorders. We aimed to investigate whether these volumetric alterations in hippocampal subfields are shared or divergent across disorders. Methods: We searched PubMed and Embase from database inception to May 8, 2021. We identified MRI studies in patients with schizophrenia, MDD or both, in which hippocampal subfield volumes were measured. We excluded nonoriginal, animal or postmortem studies, and studies that used other imaging modalities or overlapping data. We conducted a network meta-analysis to estimate and contrast alterations in subfield volumes in the 2 disorders. Results: We identified 45 studies that met the initial criteria for systematic review, of which 15 were eligible for network metaanalysis. Compared to healthy controls, patients with schizophrenia had reduced volumes in the bilateral cornu ammonis (CA) 1, granule cell layer of the dentate gyrus, subiculum, parasubiculum, molecular layer, hippocampal tail and hippocampus-amygdala transition area (HATA); in the left CA4 and presubiculum; and in the right fimbria. Patients with MDD had decreased volumes in the left CA3 and CA4 and increased volumes in the right HATA compared to healthy controls. The bilateral parasubiculum and right HATA were smaller in patients with schizophrenia than in patients with MDD. Limitations: We did not investigate medication effects because of limited information. Study heterogeneity was noteworthy in direct comparisons between patients with MDD and healthy controls. Conclusion: The volumes of multiple hippocampal subfields are selectively altered in patients with schizophrenia and MDD, with overlap and differentiation in subfield alterations across disorders. Rigorous head-to-head studies are needed to validate our findings.

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“…Group A used the method of general anesthesia extended with epidural anesthesia, GEA. Group B used the method of general intravenous anesthesia GA [ 16 ].…”

Section: Methodsmentioning

confidence: 99%

[Retracted] Application of Intravenous Anesthesia in Laparoscopic Hiatal Hernia Repair of Children

Zhu

Yang

et al. 2022

Contrast Media & Molecular Imaging

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In order to solve the stress problem in laparoscopic hiatal hernia repair of children, improve surgical safety, and reduce surgical risk, this study compared the perioperative changes of epinephrine, norepinephrine, IL-6, IL-10, and hemodynamics in children undergoing laparoscopic surgery under intravenous general anesthesia and general anesthesia combined with an epidural block. In this study, 40 children aged 1–3 years who planned to undergo laparoscopic ortopexy and those who planned to undergo laparoscopic high ligation of hernia sac, aged 23.84 1.6 months and weighed 14.9 1.1 kg, were randomly divided into general anesthesia combined with the epidural block group (group A) and a total intravenous anesthesia group (group B), with 20 subjects in each group. The results are as follows: There were no differences in age, gender, body weight, anesthesia time, pneumoperitoneum duration, and functional time between the two groups. Cytokines: Compared with T0, the levels of IL-6 in T2, T3, T4, and T5 groups were significantly increased ( P < 0.01). IL-10 levels: T2, T3, T4, and T5 groups were further increased, and the difference was statistically significant compared with T0 ( P < 0.01). There was no difference between groups ( P > 0.05). The recovery time in group B was shorter than that in group A ( P < 0.01), and the total amount of propofol and fentanyl in group B was less than that in group A ( P < 0.01). Through research on intravenous anesthesia treatment, it has been proved that total intravenous anesthesia can relieve perioperative pressure, reduce intravenous injection, and reduce the recovery time of children. However, its effect on cytokines is not obvious, so intravenous anesthesia is the most appropriate anesthesia mode in laparoscopic hiatal hernia repair surgery, which has practical significance.

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Four Surgical Strategies for the Treatment of Cesarean Scar Defect: A Systematic Review and Network Meta-analysis

Cited by 24 publications

References 18 publications

A systematic review and meta-analysis of the efficacy and safety of hysteroscopic electric resection versus vaginal surgery in the treatment of uterine scar defects after cesarean section

A systematic review and meta-analysis of the efficacy and safety of hysteroscopic electric resection versus vaginal surgery in the treatment of uterine scar defects after cesarean section

Hippocampal subfield alterations in schizophrenia and major depressive disorder: a systematic review and network meta-analysis of anatomic MRI studies

[Retracted] Application of Intravenous Anesthesia in Laparoscopic Hiatal Hernia Repair of Children

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