Michael E Chua, Kay Rivera, Rodrigo Romao, Jin Kyu Kim, Abby Varghese, Mandy Rickard, Pippi Salle, Joana Dos Santos, Jessie Cunningham, Barbara Pannozzo, Armando Lorenzo
{"title":"Mitrofanoff complications: time-to-event analysis of split versus intact appendix and meta-analysis.","authors":"Michael E Chua, Kay Rivera, Rodrigo Romao, Jin Kyu Kim, Abby Varghese, Mandy Rickard, Pippi Salle, Joana Dos Santos, Jessie Cunningham, Barbara Pannozzo, Armando Lorenzo","doi":"10.1007/s00345-024-05434-y","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>To assess the complication rates associated with split versus intact appendix Mitrofanoff procedures using a single-center retrospective analysis and a systematic review with meta-analysis.</p><p><strong>Subjects and methods: </strong>The study comprised a retrospective cohort analysis at a single institution, analyzing patients who underwent a laparoscopic-assisted Mitrofanoff with or without splitting the appendix from 2005 to 2016. The focus was on complications related to both Mitrofanoff and ACE channels. Kaplan-Meier survival analysis, log-rank tests, and Cox regression were utilized to determine hazard ratios. Additionally, a PROSPERO (CRD42023481627)-registered systematic review and meta-analysis were conducted, evaluating complication rates across diverse patient populations using the Mantel-Haenszel method with a random-effects model.</p><p><strong>Results: </strong>A total of 22 patients with intact appendix Mitrofanoff and 10 with split appendix for both Mitrofanoff and ACE creation were compared. The time to complications did not differ significantly, with a log-rank p-value of 0.72. The adjusted hazard ratio for the split appendix group was 1.26 (95% CI: 0.32-4.99). The systematic review and meta-analysis included 565 patients and indicated a higher, albeit non-significant, complication rate in the split appendix group (29.2%) compared to the intact group (20.4%), with an odds ratio of 1.49 (95% CI: 0.82-2.73).</p><p><strong>Conclusion: </strong>The analysis showed that, compared to appendicovesicostomy performed in isolation, the split appendix technique may be associated with slightly higher complication rates, though not statistically significant. The choice of surgical technique should be tailored to the individual anatomical and functional needs of patients, emphasizing the importance of personalized surgical planning and skilled execution.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"90"},"PeriodicalIF":2.8000,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"World Journal of Urology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00345-024-05434-y","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Objectives: To assess the complication rates associated with split versus intact appendix Mitrofanoff procedures using a single-center retrospective analysis and a systematic review with meta-analysis.
Subjects and methods: The study comprised a retrospective cohort analysis at a single institution, analyzing patients who underwent a laparoscopic-assisted Mitrofanoff with or without splitting the appendix from 2005 to 2016. The focus was on complications related to both Mitrofanoff and ACE channels. Kaplan-Meier survival analysis, log-rank tests, and Cox regression were utilized to determine hazard ratios. Additionally, a PROSPERO (CRD42023481627)-registered systematic review and meta-analysis were conducted, evaluating complication rates across diverse patient populations using the Mantel-Haenszel method with a random-effects model.
Results: A total of 22 patients with intact appendix Mitrofanoff and 10 with split appendix for both Mitrofanoff and ACE creation were compared. The time to complications did not differ significantly, with a log-rank p-value of 0.72. The adjusted hazard ratio for the split appendix group was 1.26 (95% CI: 0.32-4.99). The systematic review and meta-analysis included 565 patients and indicated a higher, albeit non-significant, complication rate in the split appendix group (29.2%) compared to the intact group (20.4%), with an odds ratio of 1.49 (95% CI: 0.82-2.73).
Conclusion: The analysis showed that, compared to appendicovesicostomy performed in isolation, the split appendix technique may be associated with slightly higher complication rates, though not statistically significant. The choice of surgical technique should be tailored to the individual anatomical and functional needs of patients, emphasizing the importance of personalized surgical planning and skilled execution.
期刊介绍:
The WORLD JOURNAL OF UROLOGY conveys regularly the essential results of urological research and their practical and clinical relevance to a broad audience of urologists in research and clinical practice. In order to guarantee a balanced program, articles are published to reflect the developments in all fields of urology on an internationally advanced level. Each issue treats a main topic in review articles of invited international experts. Free papers are unrelated articles to the main topic.