Safety and Efficacy of En Bloc Renal Hilar Vascular Staple Ligation: A Meta-Analysis

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• 作者：Win Shun Lai^a ; Soroush Rais-Bahrami^a ; ^b ; ^{sraisbahrami@uabmc.edu}
• 关键词：kidney ; nephrectomy ; arteriovenous fistula ; ligation ; surgical staplers
• 刊名：The Journal of Urology
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：197
• 期：1
• 页码：175-181
• 全文大小：898 K
• 卷排序：197

文摘

We reviewed the literature on the safety of en bloc ligation. We also performed a meta-analysis of the effect of using this technique with vascular staplers on perioperative factors compared to conventional renal pedicle dissection and isolated staple ligation of the renal artery and vein.Materials and MethodsA literature search was performed to include all primary studies related to the safety of en bloc ligation of the renal hilum. After exclusion criteria were applied 9 studies were identified for review, of which 4 included a control group and were used in the meta-analysis. The primary end point was the incidence of arteriovenous fistula. Secondary end points were procedure duration, blood loss and the number of perioperative complications.ResultsNone of the total population of 595 patients in whom en bloc ligation was performed for nephrectomy were diagnosed with arteriovenous fistula formation at an average postoperative followup of 26.5 months. When comparing en bloc and isolated ligation of the renal artery and vein, the meta-analysis showed a significant improvement in procedure duration for en bloc nephrectomy. There was no difference in estimated blood loss or the number of complications.ConclusionEn bloc ligation appears to be as safe as and potentially more beneficial in terms of perioperative factors than conventional renal pedicle dissection and isolated vascular ligation.