Irrigation with fibrinolytic agents versus saline for percutaneous drainage of abdominal abscesses: A meta‐analysis with trial sequential analysis of randomized trials
Introduction Fibrinolytic agents (FA) activate the fibrinolytic system, converting plasminogen into plasmin to break down fibrin. Their use for irrigation of abdominal abscesses is debated, and this meta‐analysis evaluates their efficacy. Methods We searched PubMed, Embase, and Cochrane Central for...
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| Veröffentlicht in: | World journal of surgery 2024-11, Vol.48 (11), p.2629-2636 |
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| creator | Graziani e Sousa, Augusto Godoi, Amanda Florêncio de Mesquita, Cynthia Prajiante Bertolino, Enrico Canizares Quisiguina, Stalin Isaias Mazzola Poli de Figueiredo, Sergio |
| description | Introduction
Fibrinolytic agents (FA) activate the fibrinolytic system, converting plasminogen into plasmin to break down fibrin. Their use for irrigation of abdominal abscesses is debated, and this meta‐analysis evaluates their efficacy.
Methods
We searched PubMed, Embase, and Cochrane Central for randomized controlled trials (RCTs) comparing FA and saline in percutaneous drainage of abdominal abscesses. Outcomes included length of hospitalization, duration of drainage, and drainage volume. We pooled mean differences (MD) and 95% confidence intervals (CI) using a random‐effects model. We also performed a trial sequential analysis (TSA).
Results
We included six RCTs encompassing 299 patients. In the overall analysis, FA increased drainage volume (MD 104.25 mL; 95% CI 35.72–172.77 mL; p = 0.003; I2 = 0%). In children, saline reduced hospitalization duration (MD −1.26 days; 95% CI −1.98 to −0.55 days; p = 0.0006; I2 = 0%), whereas FA increased drainage volume (MD 84.66 mL; 95% CI 5.77–153.54 mL; p = 0.04; I2 = 0%). In adults, FA significantly reduced hospitalization duration (MD −11.12 days; 95% CI −15.16 to −7.08 days; p |
| doi_str_mv | 10.1002/wjs.12377 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_3118471180</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3118471180</sourcerecordid><originalsourceid>FETCH-LOGICAL-c2157-c67f9dab30498fe779a5ce908200ecca6ed3d0062ab41462be1b93c63e51398b3</originalsourceid><addsrcrecordid>eNp1kUtOwzAQhi0EglJYcAHkJSwKfqRxw65CPFWJBSCWkeNMwCiP4kmpyoojcA2uxUmYksKOjee359M_Hv2M7UlxJIVQx_NnPJJKG7PGejLSaqC00uusJ3QckZZ6i20jPgshTSziTbalk0gNTaR77PMqBP9oW9_UfO7bJ174LPi6KRetd9w-Qt0if4WAM-RoS18DL5rApxDcrLU1NPSeB-trQnlTcJvlTUW3khQ6QAQ84WNeQWu_3j8sNRbosRvVBk8cwsuMpizlX5uMgq2XTm-QdxzusI2CCuyuap_dn5_dnV4OJjcXV6fjycApOTQDF5siyW2mRZSMCjAmsUMHiRgpIcA5G0OucyFiZbNIRrHKQGaJdrGGodTJKNN9dtD5TkNDP8M2rTxtUpbdtqmWchQZOgShhx3qQoMYoEinwVc2LFIp0mUyKSWT_iRD7P7KdpZVkP-Rv1EQcNwBc1_C4n-n9OH6trP8BmQfngg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3118471180</pqid></control><display><type>article</type><title>Irrigation with fibrinolytic agents versus saline for percutaneous drainage of abdominal abscesses: A meta‐analysis with trial sequential analysis of randomized trials</title><source>MEDLINE</source><source>Access via Wiley Online Library</source><creator>Graziani e Sousa, Augusto ; Godoi, Amanda ; Florêncio de Mesquita, Cynthia ; Prajiante Bertolino, Enrico ; Canizares Quisiguina, Stalin Isaias ; Mazzola Poli de Figueiredo, Sergio</creator><creatorcontrib>Graziani e Sousa, Augusto ; Godoi, Amanda ; Florêncio de Mesquita, Cynthia ; Prajiante Bertolino, Enrico ; Canizares Quisiguina, Stalin Isaias ; Mazzola Poli de Figueiredo, Sergio</creatorcontrib><description>Introduction
Fibrinolytic agents (FA) activate the fibrinolytic system, converting plasminogen into plasmin to break down fibrin. Their use for irrigation of abdominal abscesses is debated, and this meta‐analysis evaluates their efficacy.
Methods
We searched PubMed, Embase, and Cochrane Central for randomized controlled trials (RCTs) comparing FA and saline in percutaneous drainage of abdominal abscesses. Outcomes included length of hospitalization, duration of drainage, and drainage volume. We pooled mean differences (MD) and 95% confidence intervals (CI) using a random‐effects model. We also performed a trial sequential analysis (TSA).
Results
We included six RCTs encompassing 299 patients. In the overall analysis, FA increased drainage volume (MD 104.25 mL; 95% CI 35.72–172.77 mL; p = 0.003; I2 = 0%). In children, saline reduced hospitalization duration (MD −1.26 days; 95% CI −1.98 to −0.55 days; p = 0.0006; I2 = 0%), whereas FA increased drainage volume (MD 84.66 mL; 95% CI 5.77–153.54 mL; p = 0.04; I2 = 0%). In adults, FA significantly reduced hospitalization duration (MD −11.12 days; 95% CI −15.16 to −7.08 days; p < 0.00001; I2 = 0%) and duration of drainage (MD −6.53 days; 95% CI −9.25 to −3.81 days; p < 0.00001; I2 = 0%) while increasing drainage volume (MD 164.47 mL; 95% CI 26.16–302.78 mL; p = 0.02; I2 = 0%). On TSA, the required information size was achieved only for the adult subgroup's hospitalization and drainage duration.
Conclusion
In adults, FA reduce hospitalization and drainage duration and increase drainage volume. In children, saline seems more effective in reducing hospitalization duration, while FA increase drainage volume. These findings underscore the need for age‐specific treatments and further research, especially in the pediatric population.</description><identifier>ISSN: 0364-2313</identifier><identifier>ISSN: 1432-2323</identifier><identifier>EISSN: 1432-2323</identifier><identifier>DOI: 10.1002/wjs.12377</identifier><identifier>PMID: 39425743</identifier><language>eng</language><publisher>United States</publisher><subject>abdominal abscess ; Abdominal Abscess - therapy ; drainage ; Drainage - methods ; duration of drainage ; duration of hospitalization ; fibrinolytic agents ; Fibrinolytic Agents - administration & dosage ; Fibrinolytic Agents - therapeutic use ; Humans ; Length of Stay - statistics & numerical data ; percutaneous ; Randomized Controlled Trials as Topic ; saline irrigation ; Saline Solution - administration & dosage ; Saline Solution - therapeutic use ; Therapeutic Irrigation - methods ; Treatment Outcome ; volume of drainage</subject><ispartof>World journal of surgery, 2024-11, Vol.48 (11), p.2629-2636</ispartof><rights>2024 International Society of Surgery/Société Internationale de Chirurgie (ISS/SIC).</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c2157-c67f9dab30498fe779a5ce908200ecca6ed3d0062ab41462be1b93c63e51398b3</cites><orcidid>0000-0003-4706-862X ; 0009-0003-1254-0565 ; 0000-0002-4146-2098 ; 0000-0003-2986-8164 ; 0009-0006-2838-1978 ; 0000-0001-8666-7786</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fwjs.12377$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fwjs.12377$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>315,781,785,1418,27928,27929,45578,45579</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39425743$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Graziani e Sousa, Augusto</creatorcontrib><creatorcontrib>Godoi, Amanda</creatorcontrib><creatorcontrib>Florêncio de Mesquita, Cynthia</creatorcontrib><creatorcontrib>Prajiante Bertolino, Enrico</creatorcontrib><creatorcontrib>Canizares Quisiguina, Stalin Isaias</creatorcontrib><creatorcontrib>Mazzola Poli de Figueiredo, Sergio</creatorcontrib><title>Irrigation with fibrinolytic agents versus saline for percutaneous drainage of abdominal abscesses: A meta‐analysis with trial sequential analysis of randomized trials</title><title>World journal of surgery</title><addtitle>World J Surg</addtitle><description>Introduction
Fibrinolytic agents (FA) activate the fibrinolytic system, converting plasminogen into plasmin to break down fibrin. Their use for irrigation of abdominal abscesses is debated, and this meta‐analysis evaluates their efficacy.
Methods
We searched PubMed, Embase, and Cochrane Central for randomized controlled trials (RCTs) comparing FA and saline in percutaneous drainage of abdominal abscesses. Outcomes included length of hospitalization, duration of drainage, and drainage volume. We pooled mean differences (MD) and 95% confidence intervals (CI) using a random‐effects model. We also performed a trial sequential analysis (TSA).
Results
We included six RCTs encompassing 299 patients. In the overall analysis, FA increased drainage volume (MD 104.25 mL; 95% CI 35.72–172.77 mL; p = 0.003; I2 = 0%). In children, saline reduced hospitalization duration (MD −1.26 days; 95% CI −1.98 to −0.55 days; p = 0.0006; I2 = 0%), whereas FA increased drainage volume (MD 84.66 mL; 95% CI 5.77–153.54 mL; p = 0.04; I2 = 0%). In adults, FA significantly reduced hospitalization duration (MD −11.12 days; 95% CI −15.16 to −7.08 days; p < 0.00001; I2 = 0%) and duration of drainage (MD −6.53 days; 95% CI −9.25 to −3.81 days; p < 0.00001; I2 = 0%) while increasing drainage volume (MD 164.47 mL; 95% CI 26.16–302.78 mL; p = 0.02; I2 = 0%). On TSA, the required information size was achieved only for the adult subgroup's hospitalization and drainage duration.
Conclusion
In adults, FA reduce hospitalization and drainage duration and increase drainage volume. In children, saline seems more effective in reducing hospitalization duration, while FA increase drainage volume. These findings underscore the need for age‐specific treatments and further research, especially in the pediatric population.</description><subject>abdominal abscess</subject><subject>Abdominal Abscess - therapy</subject><subject>drainage</subject><subject>Drainage - methods</subject><subject>duration of drainage</subject><subject>duration of hospitalization</subject><subject>fibrinolytic agents</subject><subject>Fibrinolytic Agents - administration & dosage</subject><subject>Fibrinolytic Agents - therapeutic use</subject><subject>Humans</subject><subject>Length of Stay - statistics & numerical data</subject><subject>percutaneous</subject><subject>Randomized Controlled Trials as Topic</subject><subject>saline irrigation</subject><subject>Saline Solution - administration & dosage</subject><subject>Saline Solution - therapeutic use</subject><subject>Therapeutic Irrigation - methods</subject><subject>Treatment Outcome</subject><subject>volume of drainage</subject><issn>0364-2313</issn><issn>1432-2323</issn><issn>1432-2323</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kUtOwzAQhi0EglJYcAHkJSwKfqRxw65CPFWJBSCWkeNMwCiP4kmpyoojcA2uxUmYksKOjee359M_Hv2M7UlxJIVQx_NnPJJKG7PGejLSaqC00uusJ3QckZZ6i20jPgshTSziTbalk0gNTaR77PMqBP9oW9_UfO7bJ174LPi6KRetd9w-Qt0if4WAM-RoS18DL5rApxDcrLU1NPSeB-trQnlTcJvlTUW3khQ6QAQ84WNeQWu_3j8sNRbosRvVBk8cwsuMpizlX5uMgq2XTm-QdxzusI2CCuyuap_dn5_dnV4OJjcXV6fjycApOTQDF5siyW2mRZSMCjAmsUMHiRgpIcA5G0OucyFiZbNIRrHKQGaJdrGGodTJKNN9dtD5TkNDP8M2rTxtUpbdtqmWchQZOgShhx3qQoMYoEinwVc2LFIp0mUyKSWT_iRD7P7KdpZVkP-Rv1EQcNwBc1_C4n-n9OH6trP8BmQfngg</recordid><startdate>202411</startdate><enddate>202411</enddate><creator>Graziani e Sousa, Augusto</creator><creator>Godoi, Amanda</creator><creator>Florêncio de Mesquita, Cynthia</creator><creator>Prajiante Bertolino, Enrico</creator><creator>Canizares Quisiguina, Stalin Isaias</creator><creator>Mazzola Poli de Figueiredo, Sergio</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-4706-862X</orcidid><orcidid>https://orcid.org/0009-0003-1254-0565</orcidid><orcidid>https://orcid.org/0000-0002-4146-2098</orcidid><orcidid>https://orcid.org/0000-0003-2986-8164</orcidid><orcidid>https://orcid.org/0009-0006-2838-1978</orcidid><orcidid>https://orcid.org/0000-0001-8666-7786</orcidid></search><sort><creationdate>202411</creationdate><title>Irrigation with fibrinolytic agents versus saline for percutaneous drainage of abdominal abscesses: A meta‐analysis with trial sequential analysis of randomized trials</title><author>Graziani e Sousa, Augusto ; Godoi, Amanda ; Florêncio de Mesquita, Cynthia ; Prajiante Bertolino, Enrico ; Canizares Quisiguina, Stalin Isaias ; Mazzola Poli de Figueiredo, Sergio</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c2157-c67f9dab30498fe779a5ce908200ecca6ed3d0062ab41462be1b93c63e51398b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>abdominal abscess</topic><topic>Abdominal Abscess - therapy</topic><topic>drainage</topic><topic>Drainage - methods</topic><topic>duration of drainage</topic><topic>duration of hospitalization</topic><topic>fibrinolytic agents</topic><topic>Fibrinolytic Agents - administration & dosage</topic><topic>Fibrinolytic Agents - therapeutic use</topic><topic>Humans</topic><topic>Length of Stay - statistics & numerical data</topic><topic>percutaneous</topic><topic>Randomized Controlled Trials as Topic</topic><topic>saline irrigation</topic><topic>Saline Solution - administration & dosage</topic><topic>Saline Solution - therapeutic use</topic><topic>Therapeutic Irrigation - methods</topic><topic>Treatment Outcome</topic><topic>volume of drainage</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Graziani e Sousa, Augusto</creatorcontrib><creatorcontrib>Godoi, Amanda</creatorcontrib><creatorcontrib>Florêncio de Mesquita, Cynthia</creatorcontrib><creatorcontrib>Prajiante Bertolino, Enrico</creatorcontrib><creatorcontrib>Canizares Quisiguina, Stalin Isaias</creatorcontrib><creatorcontrib>Mazzola Poli de Figueiredo, Sergio</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>World journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Graziani e Sousa, Augusto</au><au>Godoi, Amanda</au><au>Florêncio de Mesquita, Cynthia</au><au>Prajiante Bertolino, Enrico</au><au>Canizares Quisiguina, Stalin Isaias</au><au>Mazzola Poli de Figueiredo, Sergio</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Irrigation with fibrinolytic agents versus saline for percutaneous drainage of abdominal abscesses: A meta‐analysis with trial sequential analysis of randomized trials</atitle><jtitle>World journal of surgery</jtitle><addtitle>World J Surg</addtitle><date>2024-11</date><risdate>2024</risdate><volume>48</volume><issue>11</issue><spage>2629</spage><epage>2636</epage><pages>2629-2636</pages><issn>0364-2313</issn><issn>1432-2323</issn><eissn>1432-2323</eissn><abstract>Introduction
Fibrinolytic agents (FA) activate the fibrinolytic system, converting plasminogen into plasmin to break down fibrin. Their use for irrigation of abdominal abscesses is debated, and this meta‐analysis evaluates their efficacy.
Methods
We searched PubMed, Embase, and Cochrane Central for randomized controlled trials (RCTs) comparing FA and saline in percutaneous drainage of abdominal abscesses. Outcomes included length of hospitalization, duration of drainage, and drainage volume. We pooled mean differences (MD) and 95% confidence intervals (CI) using a random‐effects model. We also performed a trial sequential analysis (TSA).
Results
We included six RCTs encompassing 299 patients. In the overall analysis, FA increased drainage volume (MD 104.25 mL; 95% CI 35.72–172.77 mL; p = 0.003; I2 = 0%). In children, saline reduced hospitalization duration (MD −1.26 days; 95% CI −1.98 to −0.55 days; p = 0.0006; I2 = 0%), whereas FA increased drainage volume (MD 84.66 mL; 95% CI 5.77–153.54 mL; p = 0.04; I2 = 0%). In adults, FA significantly reduced hospitalization duration (MD −11.12 days; 95% CI −15.16 to −7.08 days; p < 0.00001; I2 = 0%) and duration of drainage (MD −6.53 days; 95% CI −9.25 to −3.81 days; p < 0.00001; I2 = 0%) while increasing drainage volume (MD 164.47 mL; 95% CI 26.16–302.78 mL; p = 0.02; I2 = 0%). On TSA, the required information size was achieved only for the adult subgroup's hospitalization and drainage duration.
Conclusion
In adults, FA reduce hospitalization and drainage duration and increase drainage volume. In children, saline seems more effective in reducing hospitalization duration, while FA increase drainage volume. These findings underscore the need for age‐specific treatments and further research, especially in the pediatric population.</abstract><cop>United States</cop><pmid>39425743</pmid><doi>10.1002/wjs.12377</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0003-4706-862X</orcidid><orcidid>https://orcid.org/0009-0003-1254-0565</orcidid><orcidid>https://orcid.org/0000-0002-4146-2098</orcidid><orcidid>https://orcid.org/0000-0003-2986-8164</orcidid><orcidid>https://orcid.org/0009-0006-2838-1978</orcidid><orcidid>https://orcid.org/0000-0001-8666-7786</orcidid></addata></record> |
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| subjects | abdominal abscess Abdominal Abscess - therapy drainage Drainage - methods duration of drainage duration of hospitalization fibrinolytic agents Fibrinolytic Agents - administration & dosage Fibrinolytic Agents - therapeutic use Humans Length of Stay - statistics & numerical data percutaneous Randomized Controlled Trials as Topic saline irrigation Saline Solution - administration & dosage Saline Solution - therapeutic use Therapeutic Irrigation - methods Treatment Outcome volume of drainage |
| title | Irrigation with fibrinolytic agents versus saline for percutaneous drainage of abdominal abscesses: A meta‐analysis with trial sequential analysis of randomized trials |
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