Database : MEDLINE
Search on : Primary and Graft and Dysfunction [Words]
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[PMID]: 29509585
[Au] Autor:Golse N; Guglielmo N; El Metni A; Frosio F; Cosse C; Naili S; Ichaï P; Ciacio O; Pittau G; Allard MA; Castaing D; S A Cunha A; Cherqui D; Adam R; Vibert E
[Ad] Address:Department of Surgery, AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Villejuif, France.
[Ti] Title:Arterial Lactate Concentration at the End of Liver Transplantation is an Early Predictor of Primary Graft Dysfunction.
[So] Source:Ann Surg;, 2018 Mar 05.
[Is] ISSN:1528-1140
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Although many prognostic factors of primary graft dysfunction after liver transplantation (LT) are available, it remains difficult to predict failure in a given recipient. OBJECTIVE: We aimed to determine whether the intraoperative assay of arterial lactate concentration at the end of LT (LCEOT) might constitute a reliable biological test to predict early outcomes [primary nonfunction (PNF), early graft dysfunction (EAD)]. METHODS: We reviewed data from a prospective database in a single center concerning patients transplanted between January 2015 and December 2016 (n = 296). RESULTS: There was no statistical imbalance between the training (year 2015) and validation groups (year 2016) for epidemiological and perioperative feature. Ten patients (3.4%) presented with PNF, and EAD occurred in 62 patients (20.9%); 9 patients died before postoperative day (POD) 90. LCEOT ≥5 mmol/L was the best cut-off point to predict PNF (Se=83.3%, SP=74.3%, positive likelihood ratio (LR+)=3.65, negative likelihood ratio (LR-)=0.25, diagnostic odds ratio (DOR)=14.44) and was predictive of PNF (P = 0.02), EAD (P = 0.05), and death ≤ POD90 (P = 0.06). Added to the validated BAR-score, LCEOT improved its predictive value regarding POD 90 survival with a better AUC (0.87) than BAR score (0.74). The predictive value of LCEOT was confirmed in the validation cohort. CONCLUSION: As a reflection of both hypoperfusion and tissue damage, the assay of arterial LCEOT ≥5 mmol/L appears to be a strong predictor of early graft outcomes and may be used as an endpoint in studies assessing the impact of perioperative management. Its accessibility and low cost could impose it as a reliable parameter to anticipate postoperative management and help clinicians for decision-making in the first PODs.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:Publisher
[do] DOI:10.1097/SLA.0000000000002726

  2 / 5137 MEDLINE  
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[PMID]: 29519311
[Au] Autor:Warren WA; Franco-Palacios D; King CS; Shlobin OA; Nathan SD; Katugaha SB; Mani H; Brown AW
[Ad] Address:Walter Reed National Military Medical Center Department of Pulmonary and Critical Care, Walter Reed Military Medical Center, Bethesda, MD. Electronic address: Whittney.Warren@gmail.com.
[Ti] Title:A 24-Year-Old Woman With Precipitous Respiratory Failure After Lung Transplantation.
[So] Source:Chest;153(3):e53-e56, 2018 Mar.
[Is] ISSN:1931-3543
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:CASE PRESENTATION: A 24-year-old woman with ΔF508/Y1092X cystic fibrosis (CF) complicated by severe obstructive lung disease (FEV of 30% predicted) was admitted for IV antibiotics for planned sinus surgery resulting from severe chronic sinusitis causing frequent exacerbations and declining lung function. She had persistent airway infection with multidrug-resistant Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus, and growth of a fungus presumed to be an airway colonizer, identified as Stephanoascus ciferrii 1 year before presentation. Two days after surgery, she developed acute respiratory failure requiring mechanical ventilation. On day 4 of mechanical ventilation, venovenous-extracorporeal membrane oxygenation (VV-ECMO) was initiated for refractory respiratory failure. The following day, she was listed for bilateral lung transplant and was transplanted 4 days later. Following transplantation, she was decannulated from ECMO; however, over the next 12 hours, oxygenation deteriorated requiring reinstitution of VV-ECMO for presumed severe primary graft dysfunction. Despite treatment with broad spectrum antimicrobial coverage with piperacillin/tazobactam, ciprofloxacin, linezolid, micafungin, voriconazole, and ganciclovir, she failed to improve and developed complex bilateral pleural effusions.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:In-Data-Review

  3 / 5137 MEDLINE  
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[PMID]: 29367464
[Au] Autor:Shaver CM; Wickersham N; McNeil JB; Nagata H; Miller A; Landstreet SR; Kuck JL; Diamond JM; Lederer DJ; Kawut SM; Palmer SM; Wille KM; Weinacker A; Lama VN; Crespo MM; Orens JB; Shah PD; Hage CA; Cantu E; Porteous MK; Dhillon G; McDyer J; Bastarache JA; Christie JD; Ware LB; Lung Transplant Outcomes Group (LTOG)
[Ad] Address:Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
[Ti] Title:Cell-free hemoglobin promotes primary graft dysfunction through oxidative lung endothelial injury.
[So] Source:JCI Insight;3(2), 2018 Jan 25.
[Is] ISSN:2379-3708
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Primary graft dysfunction (PGD) is acute lung injury within 72 hours of lung transplantation. We hypothesized that cell-free hemoglobin (CFH) contributes to PGD by increasing lung microvascular permeability and tested this in patients, ex vivo human lungs, and cultured human lung microvascular endothelial cells. In a nested case control study of 40 patients with severe PGD at 72 hours and 80 matched controls without PGD, elevated preoperative CFH was independently associated with increased PGD risk (odds ratio [OR] 2.75, 95%CI, 1.23-6.16, P = 0.014). The effect of CFH on PGD was magnified by reperfusion fraction of inspired oxygen (FiO2) ≥ 0.40 (OR 3.41, P = 0.031). Isolated perfused human lungs exposed to intravascular CFH (100 mg/dl) developed increased vascular permeability as measured by lung weight (CFH 14.4% vs. control 0.65%, P = 0.047) and extravasation of Evans blue-labeled albumin dye (EBD) into the airspace (P = 0.027). CFH (1 mg/dl) also increased paracellular permeability of human pulmonary microvascular endothelial cell monolayers (hPMVECs). Hyperoxia (FiO2 = 0.95) increased human lung and hPMVEC permeability compared with normoxia (FiO2 = 0.21). Treatment with acetaminophen (15 µg/ml), a specific hemoprotein reductant, prevented CFH-dependent permeability in human lungs (P = 0.046) and hPMVECs (P = 0.037). In summary, CFH may mediate PGD through oxidative effects on microvascular permeability, which are augmented by hyperoxia and abrogated by acetaminophen.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1801
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:Publisher

  4 / 5137 MEDLINE  
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[PMID]: 29514222
[Au] Autor:Hulman M; Artemiou P; Ondrusek M; Hudec V; Gasparovic I; Bena M; Glonek I
[Ad] Address:Department of Cardiac Surgery, Medical Faculty of the Slovak Medical University, National Institute of Cardiovascular Diseases, Clinic of Cardiac Surgery, Bratislava, Slovakia.
[Ti] Title:Short-term mechanical circulatory support for severe primary graft dysfunction following orthotopic heart transplant.
[So] Source:Interact Cardiovasc Thorac Surg;, 2018 Mar 05.
[Is] ISSN:1569-9285
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:OBJECTIVES: Primary graft dysfunction (PGD) is a devastating complication and the most common cause of early death following a heart transplant. The goal of this study was to report our experience of using mechanical circulatory support to manage severe PGD. METHODS: Following 208 heart transplants performed between January 2007 and May 2017, 14 (6.7%) patients presented with severe PGD. We provided haemodynamic support using the following approaches: a venoarterial extracorporeal membrane oxygenation device, left ventricular assist device, right ventricular assist device and biventricular assist device. Primary complications included severe PGD, which resulted in hospital deaths and late survival. The mean follow-up was 3.7 ± 2.7 years. RESULTS: Fourteen (6.7%) heart transplant recipients presented with severe PGD. Seven patients received a venoarterial extracorporeal membrane oxygenation device; 1 patient received a left ventricular assist device; 4 patients received a right ventricular assist device; and 2 patients received a biventricular assist device. Mean device support and explantation times were 4.7 ± 2 and 6.3 ± 2 days, respectively. Weaning with cardiac recovery was successful in 57.1% of the patients. The hospital mortality rate was 50%. Postoperative causes of morbidity included renal failure that necessitated dialysis in 28.5%, surgical re-exploration due to postoperative bleeding in 57.1%, pneumonia in 28.5%, sepsis in 14.2%, sternal wound infection in 14.2% and mediastinitis in 7.1% of the patients, respectively. There were no deaths following hospital discharge or later follow-up appointments. CONCLUSIONS: Mechanical support devices such as venoarterial extracorporeal membrane oxygenation specifically offer a reliable therapeutic approach. Recognizing the relatively high number of deaths in-hospital, patients who have cardiac recovery and a successful hospital discharge can expect a favourable late outcome.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180307
[Lr] Last revision date:180307
[St] Status:Publisher
[do] DOI:10.1093/icvts/ivy050

  5 / 5137 MEDLINE  
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[PMID]: 29444290
[Au] Autor:Lin J; Wang R; Xu Y; Chen J
[Ad] Address:Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
[Ti] Title:Impact of renal allograft nephrectomy on graft and patient survival following retransplantation: a systematic review and meta-analysis.
[So] Source:Nephrol Dial Transplant;, 2018 Feb 12.
[Is] ISSN:1460-2385
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:Background: It is not clear whether renal allograft removal affects the outcome of renal retransplantation. This study aimed to determine the effect of allograft nephrectomy (AN) and no-AN (No AN) on renal retransplantation. Methods: A systematic review and meta-analysis were conducted using MEDLINE, Embase and the Cochrane Library. Observational studies or randomized controlled trials including renal retransplantation recipients with AN or No-AN were included. The primary outcomes were graft survival, patient survival, acute rejection (AR) and delayed graft dysfunction; the secondary outcomes were positive panel reactive antibody rate and serum creatinine level at 1 year after retransplantation, cold ischemia time and time of hemodialysis before recent transplantation. Pooled estimates of odds ratios (ORs) and the weighted mean difference for outcomes were calculated. Results: A total of 13 studies divided into 20 trials including 1923 patients were analyzed. The No-AN group had a significantly higher 3-year graft survival rate {OR 0.48 [95% confidence interval (CI) 0.34-0.69], 10 studies, n = 1030} and 5-year graft survival rate [OR 0.65 (95% CI 0.44-0.97), 16 studies, n = 1878] than the AN group. The rates of 5-year patient survival [OR 1.82 (95% CI 1.14-2.90), 5 studies, n = 749], positive panel reactive antibody [OR 3.08 (95% CI 2.08-4.56), 12 studies, n = 1225], AR [OR 1.59 (95% CI 1.21-2.09), 15 studies, n = 1388] and delayed graft dysfunction [OR 1.66 (95% CI 1.20-2.03), 8 studies, n = 879] were all significantly higher in the AN group. Compared with the No-AN group, cold ischemia time was longer in the AN group [weighted mean difference 1.84 (95% CI 0.90-2.79), 7 studies, n = 919]. The rate of 1-year graft survival and 10-year graft survival, serum creatinine levels at 1 year after retransplantation and the time of hemodialysis before recent transplantation were similar between the AN and No-AN groups. Conclusions: We recommend allowing the failed graft to remain unless symptoms dictate the need for surgery. We also suggest donor-specific antibody dynamic monitoring and better human leukocyte antigen matching for improved long-term outcome of retransplantation.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[St] Status:Publisher
[do] DOI:10.1093/ndt/gfx360

  6 / 5137 MEDLINE  
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[PMID]: 28449046
[Au] Autor:Riera J; Maldonado C; Mazo C; Martínez M; Baldirà J; Lagunes L; Augustin S; Roman A; Due M; Rello J; Levine DJ
[Ad] Address:Department of Critical Care, Vall d'Hebron University Hospital, Barcelona, Spain.
[Ti] Title:Prone positioning as a bridge to recovery from refractory hypoxaemia following lung transplantation.
[So] Source:Interact Cardiovasc Thorac Surg;25(2):292-296, 2017 08 01.
[Is] ISSN:1569-9285
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:OBJECTIVES: Refractory hypoxaemia is the leading cause of mortality in the postoperative period after lung transplantation. The role of prone positioning as a rescue therapy in this setting has not been assessed. We evaluated its effects in lung transplant recipients presenting refractory hypoxaemia following the surgery. METHODS: Prospectively collected data from 131 consecutive adult patients undergoing lung transplantation between January 2013 and December 2014 were evaluated. Twenty-two patients received prone position therapy. Indications, associated complications, time to initiation and duration of the manoeuvre were analysed and the effects of prone position on gas exchange were evaluated. Finally, outcomes in this cohort were compared against the rest of lung transplant recipients. RESULTS: Prone positioning was more frequently implemented within the first 72 h (68.2%) and its main indication was primary graft dysfunction. The manoeuvre was maintained during a median of 21 h. After prone position, the pressure of arterial oxygen/fraction of inspired oxygen ratio significantly increased from 81.0 mmHg [interquartile range (IQR) 71.5-104.0] to 220.0 (IQR 160.0-288.0) (P < 0.001). No complications related with the technique were reported. Patients who underwent the manoeuvre had longer hospital stay [50.0 days (IQR 36.0-67.0) vs 30.0 (IQR 23.0-56.0), P = 0.006] than the rest of the population. No differences were found comparing either 1-year mortality (9.1% vs 15.6%; P = 0.740) or 1-year graft function [forced expiratory volume in 1 second of 70.0 (IQR 53.0-83.0) vs 68.0 (IQR 53.5-80.5), P = 0.469]. CONCLUSIONS: Prone positioning is safe and significantly improves gas exchange in patients with refractory hypoxaemia after lung transplantation. It should be considered as a possible treatment in these patients.
[Mh] MeSH terms primary: Hypoxia/rehabilitation
Lung Transplantation/adverse effects
Patient Positioning/methods
Physical Therapy Modalities
Primary Graft Dysfunction/rehabilitation
Prone Position
Recovery of Function
[Mh] MeSH terms secundary: Female
Follow-Up Studies
Humans
Hypoxia/etiology
Hypoxia/physiopathology
Male
Middle Aged
Primary Graft Dysfunction/complications
Prospective Studies
Respiratory Distress Syndrome, Adult/etiology
Time Factors
Treatment Outcome
[Pt] Publication type:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Entry month:1712
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[Js] Journal subset:IM
[Da] Date of entry for processing:170428
[St] Status:MEDLINE
[do] DOI:10.1093/icvts/ivx073

  7 / 5137 MEDLINE  
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[PMID]: 29377268
[Au] Autor:Hamilton BCS; Dincheva GR; Zhuo H; Golden JA; Brzezinski M; Singer JP; Matthay MA; Kukreja J
[Ad] Address:Department of Surgery, University of California, San Francisco, CA, USA.
[Ti] Title:Elevated donor plasminogen activator inhibitor-1 levels and the risk of primary graft dysfunction.
[So] Source:Clin Transplant;, 2018 Jan 29.
[Is] ISSN:1399-0012
[Cp] Country of publication:Denmark
[La] Language:eng
[Ab] Abstract:Primary graft dysfunction (PGD) following lung transplantation is associated with elevated recipient plasma levels of plasminogen activator inhibitor-1 (PAI-1) and the receptor for advanced glycation end products (RAGE). However, the significance of these biomarkers in the donor plasma is uncertain. We hypothesized that elevated donor plasma levels of PAI-1 and RAGE would be associated with recipient PGD. We carried out a prospective unmatched case-control study of double-lung transplant recipients between May 2014 and September 2015. We compared donor plasma levels of PAI-1 and RAGE using rank-sum tests and t tests, in 12 recipients who developed PGD grade 2 or 3 within 72 hours postoperatively with 13 recipients who did not. Recipients who developed PGD had higher donor plasma levels of PAI-1 than recipients who did not (median 2.7 ng/mL vs 1.4; P = .03). Recipients with PGD also had numerically higher donor plasma levels of RAGE than recipients without PGD, although this difference did not achieve statistical significance (median 1061 pg/mL vs 679; P = .12). Systemic inflammatory responses in the donor, as reflected by elevated plasma levels of PAI-1, may contribute to the risk of developing PGD. Rapid biomarker assessment of easily available plasma samples may assist in donor lung selection and risk stratification.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1801
[Cu] Class update date: 180307
[Lr] Last revision date:180307
[St] Status:Publisher
[do] DOI:10.1111/ctr.13210

  8 / 5137 MEDLINE  
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[PMID]: 28469087
[Au] Autor:Lama VN; Belperio JA; Christie JD; El-Chemaly S; Fishbein MC; Gelman AE; Hancock WW; Keshavjee S; Kreisel D; Laubach VE; Looney MR; McDyer JF; Mohanakumar T; Shilling RA; Panoskaltsis-Mortari A; Wilkes DS; Eu JP; Nicolls MR
[Ti] Title:Models of Lung Transplant Research: a consensus statement from the National Heart, Lung, and Blood Institute workshop.
[So] Source:JCI Insight;2(9), 2017 May 04.
[Is] ISSN:2379-3708
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Lung transplantation, a cure for a number of end-stage lung diseases, continues to have the worst long-term outcomes when compared with other solid organ transplants. Preclinical modeling of the most common and serious lung transplantation complications are essential to better understand and mitigate the pathophysiological processes that lead to these complications. Various animal and in vitro models of lung transplant complications now exist and each of these models has unique strengths. However, significant issues, such as the required technical expertise as well as the robustness and clinical usefulness of these models, remain to be overcome or clarified. The National Heart, Lung, and Blood Institute (NHLBI) convened a workshop in March 2016 to review the state of preclinical science addressing the three most important complications of lung transplantation: primary graft dysfunction (PGD), acute rejection (AR), and chronic lung allograft dysfunction (CLAD). In addition, the participants of the workshop were tasked to make consensus recommendations on the best use of these complimentary models to close our knowledge gaps in PGD, AR, and CLAD. Their reviews and recommendations are summarized in this report. Furthermore, the participants outlined opportunities to collaborate and directions to accelerate research using these preclinical models.
[Pt] Publication type:JOURNAL ARTICLE; REVIEW
[Em] Entry month:1705
[Cu] Class update date: 180307
[Lr] Last revision date:180307
[St] Status:Publisher

  9 / 5137 MEDLINE  
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[PMID]: 29503377
[Au] Autor:Masuda T; Hata M; Yamaya K; Suzuki T; Terao N
[Ad] Address:Department of Cardiovascular Surgery, Sendai Kosei Hospital, Sendai, Miyagi, Japan.
[Ti] Title:Two Cases of Endovascular Repair with the Stent Graft for Retrograde Type A Acute Aortic Dissection with Complications.
[So] Source:Ann Thorac Cardiovasc Surg;, 2018 Mar 03.
[Is] ISSN:2186-1005
[Cp] Country of publication:Japan
[La] Language:eng
[Ab] Abstract:Thoracic endovascular aortic repair (TEVAR) is used to treat retrograde type A acute aortic dissection (RTAAD). In case 1, a 52-year-old man, who was conservatively managed, reported worsening back pain. Emergency TEVAR was performed 7 days after onset. After deploying two GORE Conformable TAG (CTAG) in the descending aorta, his symptoms disappeared. In case 2, a 52-year-old man with progressive worsening resistant hypertension, renal dysfunction, and respiratory failure despite maximal medical therapy underwent TEVAR 8 days after onset. A CTAG was deployed from the left subclavian artery under rapid pacing, and two Zenith Dissection stents were placed, which resolved complications. In both cases, after 6 months, computed tomography (CT) scan showed complete resorption of the false lumen in the ascending aorta. TEVAR for RTAAD with complete thrombosis of false lumen in the ascending aorta can be an alternative to surgery when the primary tear is located in descending aorta.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180305
[Lr] Last revision date:180305
[St] Status:Publisher
[do] DOI:10.5761/atcs.cr.17-00200

  10 / 5137 MEDLINE  
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[PMID]: 29502352
[Au] Autor:Mowat A; Maher D; Baessler K; Christmann-Schmid C; Haya N; Maher C
[Ad] Address:Royal Brisbane and Women's Hospital, Brisbane, Australia.
[Ti] Title:Surgery for women with posterior compartment prolapse.
[So] Source:Cochrane Database Syst Rev;3:CD012975, 2018 Mar 05.
[Is] ISSN:1469-493X
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:BACKGROUND: Posterior vaginal wall prolapse (also known as 'posterior compartment prolapse') can cause a sensation of bulge in the vagina along with symptoms of obstructed defecation and sexual dysfunction. Interventions for prevention and conservative management include lifestyle measures, pelvic floor muscle training, and pessary use. We conducted this review to assess the surgical management of posterior vaginal wall prolapse. OBJECTIVES: To evaluate the safety and effectiveness of any surgical intervention compared with another surgical intervention for management of posterior vaginal wall prolapse. SEARCH METHODS: We searched the Cochrane Incontinence Group Specialised Register of controlled trials, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) (searched April 2017). We also searched the reference lists of relevant articles, and we contacted researchers in the field. SELECTION CRITERIA: We included randomised controlled trials (RCTs) comparing different types of surgery for posterior vaginal wall prolapse. DATA COLLECTION AND ANALYSIS: We used Cochrane methods. Our primary outcomes were subjective awareness of prolapse, repeat surgery for any prolapse, and objectively determined recurrent posterior wall prolapse. MAIN RESULTS: We identified 10 RCTs evaluating 1099 women. Evidence quality ranged from very low to moderate. The main limitations of evidence quality were risk of bias (associated mainly with performance, detection, and attrition biases) and imprecision (associated with small overall sample sizes and low event rates).Transanal repair versus transvaginal repair (four RCTs; n = 191; six months' to four years' follow-up)Awareness of prolapse is probably more common after the transanal approach (risk ratio (RR) 2.78, 95% confidence interval (CI) 1.00 to 7.70; 2 RCTs; n = 87; I = 0%; low-quality evidence). If 10% of women are aware of prolapse after transvaginal repair, between 10% and 79% are likely to be aware after transanal repair.Repeat surgery for any prolapse: Evidence is insufficient to show whether there were any differences between groups (RR 2.42, 95% CI 0.75 to 7.88; 1 RCT; n = 57; low-quality evidence).Recurrent posterior vaginal wall prolapse is probably more likely after transanal repair (RR 4.12, 95% CI 1.56 to 10.88; 2 RCTs; n = 87; I = 35%; moderate-quality evidence). If 10% of women have recurrent prolapse on examination after transvaginal repair, between 16% and 100% are likely to have recurrent prolapse after transanal repair.Postoperative obstructed defecation is probably more likely with transanal repair (RR 1.67, 95% CI 1.00 to 2.79; 3 RCTs; n = 113; I = 10%; low-quality evidence).Postoperative dyspareunia: Evidence is insufficient to show whether there were any differences between groups (RR 0.32, 95% CI 0.09 to 1.15; 2 RCTs; n = 80; I = 5%; moderate-quality evidence).Postoperative complications: Trials have provided no conclusive evidence of any differences between groups (RR 3.57, 95% CI 0.94 to 13.54; 3 RCTs; n = 135; I = 37%; low-quality evidence). If 2% of women have complications after transvaginal repair, then between 2% and 21% are likely to have complications after transanal repair.Evidence shows no clear differences between groups in operating time (in minutes) (mean difference (MD) 1.49, 95% CI -11.83 to 8.84; 3 RCTs; n = 137; I = 90%; very low-quality evidence).Biological graft versus native tissue repairEvidence is insufficient to show whether there were any differences between groups in rates of awareness of prolapse (RR 1.09, 95% CI 0.45 to 2.62; 2 RCTs; n = 181; I = 13%; moderate-quality evidence) or repeat surgery for any prolapse (RR 0.60, 95% CI 0.18 to 1.97; 2 RCTs; n = 271; I = 0%; moderate-quality evidence). Trials have provided no conclusive evidence of a difference in rates of recurrent posterior vaginal wall prolapse (RR 0.55, 95% CI 0.30 to 1.01; 3 RCTs; n = 377; I = 6%; moderate-quality evidence); if 13% of women have recurrent prolapse on examination after native tissue repair, between 4% and 13% are likely to have recurrent prolapse after biological graft. Evidence is insufficient to show whether there were any differences between groups in rates of postoperative obstructed defecation (RR 0.96, 95% CI 0.50 to 1.86; 2 RCTs; n = 172; I = 42%; moderate-quality evidence) or postoperative dyspareunia (RR 1.27, 95% CI 0.26 to 6.25; 2 RCTs; n = 152; I = 74%; low-quality evidence). Postoperative complications were more common with biological repair (RR 1.82, 95% CI 1.22 to 2.72; 3 RCTs; n = 448; I = 0%; low-quality evidence).Other comparisonsSingle RCTs compared site-specific vaginal repair versus midline fascial plication (n = 74), absorbable graft versus native tissue repair (n = 132), synthetic graft versus native tissue repair (n = 191), and levator ani plication versus midline fascial plication (n = 52). Data were scanty, and evidence was insufficient to show any conclusions about the relative effectiveness or safety of any of these interventions. The mesh exposure rate in the synthetic group compared with the native tissue group was 7%. AUTHORS' CONCLUSIONS: Transvaginal repair may be more effective than transanal repair for posterior wall prolapse in preventing recurrence of prolapse, in the light of both objective and subjective measures. However, data on adverse effects were scanty. Evidence was insufficient to permit any conclusions about the relative effectiveness or safety of other types of surgery. Evidence does not support the utilisation of any mesh or graft materials at the time of posterior vaginal repair. Withdrawal of some commercial transvaginal mesh kits from the market may limit the generalisability of our findings.
[Pt] Publication type:JOURNAL ARTICLE; REVIEW
[Em] Entry month:1803
[Cu] Class update date: 180304
[Lr] Last revision date:180304
[St] Status:Publisher
[do] DOI:10.1002/14651858.CD012975


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