Risultati per: Diagnosi e gestione dell’aneurisma aorta addominale (AAA)

Introduction
Incisional hernia (IH) is a prevalent and potentially dangerous complication of abdominal surgery, especially in high-risk groups. Mesh reinforcement of the abdominal wall has been studied as a potential intervention to prevent IHs. Randomised controlled trials (RCTs) have demonstrated that prophylactic mesh reinforcement after abdominal surgery, in general, is effective and safe. In patients with abdominal aortic aneurysm (AAA), prophylactic mesh reinforcement after open repair has not yet been recommended in official guidelines, because of relatively small sample sizes in individual trials. Furthermore, the identification of subgroups that benefit most from prophylactic mesh placement requires larger patient numbers. Our primary aim is to evaluate the efficacy and effectiveness of the use of a prophylactic mesh after open AAA surgery to prevent IH by performing an individual patient data meta-analysis (IPDMA). Secondary aims include the evaluation of postoperative complications, pain and quality of life, and the identification of potential subgroups that benefit most from prophylactic mesh reinforcement.

Methods and analysis
We will conduct a systematic review to identify RCTs that study prophylactic mesh placement after open AAA surgery. Cochrane Central Register of Controlled Trials, MEDLINE Ovid, Embase, Web of Science Core Collection and Google Scholar will be searched from the date of inception onwards. RCTs must directly compare primary sutured closure with mesh closure in adult patients who undergo open AAA surgery. Lead authors of eligible studies will be asked to share individual participant data (IPD). The risk of bias (ROB) for each included study will be assessed using the Cochrane ROB tool. An IPDMA will be performed to evaluate the efficacy, with the IH rate as the primary outcome. Any signs of heterogeneity will be evaluated by Forest plots. Time-to-event analyses are performed using Cox regression analysis to evaluate risk factors.

Ethics and dissemination
No new data will be collected in this study. We will adhere to institutional, national and international regulations regarding the secure and confidential sharing of IPD, addressing ethics as indicated. We will disseminate findings via international conferences, open-source publications in peer-reviewed journals and summaries posted online.

PROSPERO registration number
CRD42022347881.

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To the Editor A recent randomized clinical trial on REBOA showed that use of the technique may be detrimental to patients in some major trauma centers in the UK. However, I have some concerns about this study.

To the Editor One of the key issues that came to our attention in the recent UK-REBOA study was the high proportion of patients randomized to the REBOA and standard care group who did not have an aortic balloon inserted. In 8 cases (17%), it was reported that clinicians were unable to establish access to the femoral artery.

To the Editor We are concerned about the results and interpretation of the UK-REBOA randomized clinical trial. First, this study population may have included cases that were unsuited for resuscitative endovascular balloon occlusion of the aorta (REBOA). The median Abbreviated Injury Scale (AIS) score for the thorax was 4 in both groups, suggesting the presence of severe thoracic trauma. The use of REBOA in patients with thoracic injuries could potentially exacerbate bleeding, thereby raising concerns about the cases in which thoracic trauma was the primary source of severe bleeding.

To the Editor We would like to highlight some concerns surrounding the study design and findings of the UK-REBOA randomized clinical trial that evaluated the effectiveness of REBOA and standard care compared with standard care alone.

In Reply We thank the authors for the letters about our recently published randomized clinical trial of emergency department REBOA in trauma patients.

To the Editor The results of a recent randomized clinical trial demonstrated that the incorporation of REBOA into standard trauma care in the emergency department “does not reduce, and may increase, mortality compared with standard care alone.” Although these results are of high significance, they partially contradict previously published studies. We have some concerns about this study.

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