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.
Were the search methods used to find evidence (original research) on the primary question or questions stated?
Was the search for evidence reasonably comprehensive?
Were the criteria used for deciding which studies to include in the overview reported?
Was the bias in the selection of studies avoided?
Were the criteria used for assessing the validity of the included studies reported?
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)?
Were the methods used to combine the findings of the relevant studies (to reach a conclusion) reported?
Were the findings of the relevant studies combined appropriately relative to the primary question that the overview addresses?
Were the conclusions made by the author or authors supported by the data and or analysis reported in the overview?
How would you rate the scientific quality of this evidence?
Sim = 1
Incerto = 0,5
Não relevante = 0
Não = 0
A Avaliação dos Critérios de Relato avalia a transparência com que os autores relatam as caraterísticas metodológicas e do ensaio na publicação. A avaliação está dividida em cinco categorias que são apresentadas de seguida.
4/4
Introduction
3/4
Accessing Data
2/4
Analysing Data
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Results
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Discussion
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
O Índice de Fragilidade é uma ferramenta que auxilia na interpretação de achados significativos, fornecendo uma medida de força para um resultado. O Índice de Fragilidade representa o número de eventos consecutivos que precisam de ser adicionados a um resultado dicotómico para que o resultado deixe de ser significativo. Um número pequeno representa um resultado mais fraco e um número grande representa um resultado mais forte.
Porque é que este estudo era necessário agora?
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.
Qual era a principal questão de investigação?
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.
De que é que me devo lembrar mais?
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.
Como é que isto afectará o tratamento dos meus doentes?
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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