Thermal Welding Tonsillectomy versus Monopolar Electrocautery Tonsillectomy: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

Objective: In hopes of contributing to the decision about the best surgical option in tonsillectomy, we performed this work to compare the effectiveness of the thermal welding system (TW) and monopolar electrocautery (ME) tonsillectomy in terms of postoperative pain, postoperative bleeding, and operation time in patients undergoing tonsillectomy, to determine which procedure is most expected to enhance the postoperative quality of life. Methods: Digital databases, including PubMed, Scopus, Cochrane, Web of Science, and Google Scholar, were systematically screened from inception up to October 2022. The included randomized controlled trials (RCTs) were evaluated for risk of bias via the Cochrane tool (version 2). The outcomes were summarized as risk ratio (RR) or mean difference/standardized mean difference (MD/SMD) with a 95% confidence interval (CI) in a random-effects model. Results: The three RCTs that met our criteria were included in the study. Overall, 151 patients had been enrolled in these three RCTs, in which 75 and 76 were allocated to the TW and ME groups, respectively. The postoperative pain levels were substantially reduced, favoring the TW arm over the ME arm [n=2 RCTs, SMD=-0.39, 95% CI (-0.67, -0.12), p=0.005]. Also, the analysis revealed a substantial variation between the TW and ME arms in terms of operation time [n=2 RCTs, MD=3.29 minutes, 95% CI (1.42, 5.17), p=0.0006]. However, the analysis revealed no substantial variation between the TW and ME arms in term of postoperative bleeding [n=3 RCTs, RR=0.40, 95% CI (0.06, 2.62), p=0.34]. Conclusion: This meta-analysis revealed that postoperative bleeding for tonsillectomy were similar between the ME and TW techniques. However, TW showed lower postoperative pain levels than ME statistically but without achieving significant clinical advantage.

Efficacy of gelfoam middle ear packing in type-1 tympanoplasty: systematic review and meta-analysis.

PURPOSE: To conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) that evaluated the surgical outcomes of type-1 tympanoplasty with and without gelfoam middle ear packing. METHODS: PubMed, CENTRAL, Scopus, Web of Science, and Google Scholar databases were screened from inception until October 2022. The included RCTs were evaluated for risk of bias, and the quality of each outcome was assessed according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. RESULTS: Nine RCTs with 773 participants (gelfoam = 381 and non-gelfoam = 392) were analyzed. The overall study quality varied: low risk (n = 4 RCTs), some concerns (n = 3 RCTs), and high risk (n = 2 RCTs). There were no significant differences between both arms regarding the graft uptake rate (moderate certainty), hearing improvement rate (moderate certainty), type of impedance audiometry (moderate certainty), and ear discharge (low certainty). The mean change in air-bone gap was significantly higher in the non-gelfoam arm compared with the gelfoam arm (low certainty). However, the non-gelfoam group had superior hearing improvement in only the early postoperative period (i.e., one month); however, after two, three, and six months, there were no significant differences between both arms. The rate of ear fullness was significantly higher in the gelfoam arm compared with the non-gelfoam arm (moderate certainty). CONCLUSION: Among patients undergoing type-1 tympanoplasty, the surgical outcomes did not significantly differ between both arms. The practice of middle ear packing with gelfoam needs to be standardized.

Coblation tonsillectomy versus laser tonsillectomy: a systematic review and meta-analysis of randomized controlled trials.

AIM: This systematic review and meta-analysis of randomized controlled trials (RCTs) evaluated coblation versus laser (carbon dioxide and diode) tonsillectomy, with regard to various surgical and clinical outcomes. METHODS: We searched PubMed, CENTRAL, Scopus, and Web of Science for relevant from inception until March 2021. We evaluated risk of bias using the Cochrane Collaboration Tool. We summarized the outcomes as risk ratio (RR) or mean difference/standardized mean difference (MD/SMD) with 95% confidence interval (CI). We conducted subgroup analysis based on the day of postoperative pain (day 1, day 7, and day 14) and type of postoperative hemorrhage (reactionary and secondary). In addition, we conducted subgroup analysis according to the type of laser. RESULTS: Five RCTs were analyzed. Three and two RCTs were evaluated as having "some concerns" and "low risk of bias", respectively. Coblation tonsillectomy correlated with lower intraoperative blood loss (MD = -5.08 ml, 95% CI [- 7.33 to - 2.84], P < 0.0001) and lower operative time (MD = - 4.50 min, 95% CI [- 6.10 to - 2.90], P < 0.0001) compared with the laser tonsillectomy. However, there was no significant difference between both groups regarding the postoperative pain score (SMD = - 0.27, 95% CI [- 0.72 to 0.17], P = 0.27) and rate of postoperative hemorrhage (RR = 0.95, 95% CI [0.27-3.40], P = 0.23). Subgroup analysis reported similar insignificant difference between both groups according to the day of postoperative pain and type of postoperative hemorrhage. CONCLUSIONS: Coblation tonsillectomy correlated with a significant reduction in intraoperative blood loss and operative time compared with the laser technique. Nevertheless, these effects do not seem clinically meaningful in surgical practice.

Colonoscopy completion rates and reasons for incompletion.

OBJECTIVES: Colonoscopy is one of the major procedures in gastroenterology. Since the procedure is operator dependant, Quality of each procedure is the main element of reliable outcome. One of the elements is the completion rate. Completion rate of endoscopy unit is a reliable measure to improve the quality of the procedure. METHODOLOGY: We here reviewed retrospectively our endoscopy database from the main tertiary hospital in Qassim province, central part of Saudi Arabia. The recommended completion based on several professional societies range from 90 - 95 % completion rate according to the indication. We retrospectively reviewed our endoscopy database over the period from 2005 to 2008 in King Fahad Specialist Hospital. RESULTS: Our adjusted completion rate was 85.3 %. The main reason of incompletion was poor preparation. Our completion rate was comparable throughout the study period. CONCLUSION: our completion rate is below recommended range. We think this result will stimulate the efforts to incorporate more quality measures in the endoscopy unit.