Comparison of safety between endoscopic and open carpal tunnel release .
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OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2016;4(6):21 PLoS One. 2015 Dec 16;10(12):e014368327 randomized and quasi-randomized trials that investigated safety outcomes in patients undergoing either endoscopic or open carpal tunnel release for carpal tunnel syndrome were included in this meta-analysis. The study was conducted to determine whether earlier concerns regarding the safety of endoscopic release in comparison to an open approach were still applicable presently. The study found that previous drawbacks of an endoscopic release such as high reoccurrence and reoperation rates have been gradually lessened to where they are now comparable with rates in an open approach. Total and major complications are also comparable between groups, whereas minor occurrences were significantly less frequent following endoscopic release. Return to activity was significantly earlier following endoscopic release compared to open release.
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Was the bias in the selection of studies avoided?
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Was the validity of all of the studies referred to in the text assessed with use of appropriate criteria (either in selecting the studies for inclusion or in analyzing the studies that were cited)?
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Incierto = 0,5
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Introduction
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Accessing Data
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Discussion
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
El Índice de Fragilidad es una herramienta que ayuda en la interpretación de hallazgos significativos, proporcionando una medida de fuerza para un resultado. El Índice de Fragilidad representa el número de eventos consecutivos que es necesario añadir a un resultado dicotómico para que el hallazgo deje de ser significativo. Un número pequeño representa un hallazgo más débil y un número grande un hallazgo más fuerte.
¿Por qué se necesitaba ahora este estudio?
Open surgery was traditionally used for carpal tunnel ligament (TCL) release, though more recently, the use of endoscopic release has gained popularity. While the reduced invasiveness of endoscopic carpal tunnel release (ECTR) offers theoretical advantages related to morbidity, early studies suggested that complication rate was in fact increased following ECTR compared to open carpal tunnel release (OCTR), which was largely attributed by authors to the reduced operative field through which surgeons were working. More recent randomized controlled trials have found similar complications rates between the two approaches though there is still considerable debate regarding the comparative efficacy and safety between the two.
¿Cuál era la pregunta principal de la investigación?
How safe is endoscopic carpal tunnel release as compared to open carpal tunnel release for treatment of carpal tunnel syndrome?
- The pooled results from 15 studies found no significant difference between carpal tunnel release approaches for data on recurrence (ECTR=24/878; OCTR=19/806; OR=1.02 [95%CI 0.55, 1.90]).
- Pooled incidence of reoperation from 11 studies demonstrated no significant difference between ETCR (20/869) and OTCR (8/727) (OR=1.36 [95%CI 0.61, 3.00]).
- From 25 studies, the incidence of major complications was both infrequent and similar between ECTR (12/1366) and OCTR (12/1199) (OR=1.00 [95%CI 0.44, 2.27]).
- From 24 studies, the incidence of minor complications was significantly lower following ECTR (63/1275) versus OCTR (120/1167) (OR=0.50; [95%CI 0.31, 0.82]). Sub-analysis of specific types of minor complications demonstrated a significantly higher rate of transient neuropraxia following ECTR compared to OCTR (OR=0.242 [95%CI 1.22, 4.80]), and a significantly lower rate of wound healing or scar problems with ECTR compared to OCTR (OR=0.24 [95%CI 0.15, 0.40]).
- In terms of total complications, results were comparable between the two groups (24 studies; ECRT=119/OCRT=159; OR=0.82; 95% CI 0.52, 1.51), however heterogeneity was high among studies.
- Patients who underwent ECTR returned to work significantly sooner than those OCTR (6 studies; MD=-9.56; 95% CI -12.51, -6.60), however there was high heterogeneity among studies.
- Outcomes were consistent in a post hoc sensitivity analysis that excluded studies with a high risk of bias for allocation concealment.
¿Qué es lo que más debo recordar?
In patients with carpal tunnel syndrome undergoing surgical release with either an open or endoscopic approach, no significant differences in pooled incidences of reoccurrence or reoperation were observed. Total and major complications were also comparable between open and endoscopic release, whereas minor complications occurred less frequently following endoscopic release. Nevertheless, within minor complications, an endoscopic release was associated with a significantly higher risk of transient neuropraxia, whereas open release was associated with a high risk of wound healing and scarring problems. A significantly earlier return to work was also noted following endoscopic release compared to open release.
¿Cómo afectará esto al cuidado de mis pacientes?
This analysis suggests that previous drawback of endoscopic carpal tunnel release being unsafe in comparison to open release in carpal tunnel syndrome may no longer be a concern. Rates of reoperation, reoccurrence, and complications were comparable between techniques and endoscopic release patients additionally exhibited a significantly faster return to activity. Studies with smaller populations tended to favour OCTR; however, these were generally studies published in the earlier years, and effect sizes could potentially be explained by a learning curve. As concerns of low study quality are expressed throughout this report, a further analysis with inclusion being limited to only high-quality trials is warranted.
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