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Purpose Completion lymph node dissection (CLND) following a positive sentinel lymph node biopsy (SLNB) has been reported to be less morbid than lymphadenectomy for palpable disease (therapeutic lymph node dissection; TLND). The reporting of morbidity data can be heterogeneous, and hence no ‘average’ surgical complication rates of these procedures has been reported. This review aims to determine complications rates to inform patients undergoing surgery for metastatic melanoma. Methods A systematic review of English-language literature from 2000 to 2017, reporting morbidity information about CLND and TLND for melanoma, was performed. The methodological quality of the included studies was performed using the methodological index for non-randomised studies (MINORS) instrument and Detsky score. Pooled proportions of post-operative complications were constructed using a random effects statistical model. Results After application of inclusion and exclusion criteria, 18 articles progressed to the final analysis. In relation to TLND (1627 patients), the overall incidence of surgical complications was 39.3% (95% CI 32.6–46.2); including wound infection/breakdown 25.4% (95% CI: 20.9–30.3); lymphoedema 20.9% (95% CI: 13.8–29.1); and seroma 20.4% (95% CI: 15.9–25.2). For CLND (1929 patients), the overall incidence of surgical complications was 37.2% (95% CI 27.6–47.4); including wound infection/breakdown 21.6% (95% CI: 13.8–30.6); lymphoedema 18% (95% CI: 12.5–24.2); and seroma 17.9% (95% CI: 10.3–27). The complication rate was marginally lower for CLND but not to statistical significance. Discussion This study provides information about the incidence of complications after CLND and TLND. It can be used to counsel patients about the procedures and it sets a benchmark against which surgeons can audit their practice. [ABSTRACT FROM AUTHOR]

Summary Background There is great diversity in reported post-operative outcomes for otoplasty, with the incidence of haematoma or infection ranging from 0% to 15.6% and 0%–10%, respectively. With such variability, it is difficult to determine an overall ‘average’ incidence of common post-operative complications. Methods A systematic review of the most relevant medical databases was conducted for studies available in English published between January 1, 2000, and December 31, 2015. Using the dataset, pooled estimates for the incidence of the primary and secondary outcomes were calculated for all included studies. The primary outcome was haematoma and/or bleeding incidence, and the secondary outcomes included infection, skin/wound healing problems, suture-related problems, scarring, pain and itching, and revision surgeries/recurrence. Comparable sub-group analysis of studies was also performed using calculated pooled proportions. Results After screening, 28 articles involving 3493 patients were included in the study. Pooled proportions revealed that haematoma and/or bleeding incidence was 2.5% (95% CI: 1.4–3.8%), infection 0.8% (95% CI: 0.4–1.3%), skin/wound healing problems 3% (95% CI: 1.4–5.1%), suture-related problems 1.8% (95% CI: 0.8–3.2%), scarring 1.6% (95% CI: 0.8–2.6%), pain and itching 13% (95% CI: 5.4–23.1%) and revision surgeries/recurrence 5% (95% CI: 2.9–7.7%). Conclusions By pooling proportions of reported complications, the results of this study could be useful in the personal audit of practice and will be a point of reference for comparing novel surgical techniques in the future. [ABSTRACT FROM AUTHOR]

Purpose The complications reported after sentinel lymph node biopsy (SLNB) for melanoma is highly variable in the worldwide literature; the overall complication rate varies between 1.8% and 29.9%. With heterogeneous reporting of morbidity data, no ‘average’ complication rates of this procedure have been reported. This systematic review aims to determine the complications rates associated with SLNB. Methods A systematic review of English-language literature from 2000 to 2015, which reported morbidity information about SLNB for melanoma, was performed. The methodological quality of the included studies was performed using the methodological index for non-randomised studies (MINORS) instrument and Detsky score. Pooled proportions of specific post-operative complications were constructed using a random effects statistical model, and subgroups including lymph node basin and continent of origin of the study were compared. Results After application of inclusion and exclusion criteria, 21 articles progressed to the final analysis. 9047 patients were included. The overall complication rate was 11.3% (95% CI: 8.1–15.0). The incidence of infection was 2.9% (95% CI 1.5–4.6); seroma 5.1% (95% CI: 2.5–8.6); haematoma 0.5% (95% CI: 0.3–0.9) lymphoedema 1.3% (95% CI: 0.5–2.6) and nerve injury 0.3% (95% CI: 0.1–0.6). There was no statistically significant difference in morbidity between the sites of SLNB or between continents. Discussion This study provides information about the incidence of complications after SLNB. It can be used to counsel patients about the procedure and it sets a benchmark against which surgeons can audit their practice. [ABSTRACT FROM AUTHOR]

Summary Background The reporting of fistula after hypospadias repair varies greatly in the worldwide literature, with incidence ranging from 0% to over 35%. With multiple techniques employed within a heterogeneous patient cohort, to date, no “average” incidence of fistula has been reported. Methods A systematic review of the contemporary English-language literature from 2005 to 2015 identifying articles reporting complications after primary, single-stage hypospadias repair (the most commonly performed hypospadias operation) was performed. Identified reports were reviewed according to the Consolidated Standards of Reporting Trials (CONSORT) and the Methodological Index or Non-Randomized Studies (MINORS). A random effects analysis model was produced, in order to calculate a pooled outcome rates across the included studies. Separate models were then produced for subgroups of studies, with the resulting pooled rates compared. Results After application of inclusion and exclusion criteria, 44 articles progressed to the final analysis. A total of 6603 patients were included. The incidence of fistula was 7.5% (95% CI: 5.8–9.4), stricture or stenosis 4.4% (95% CI: 3.1–5.8) and dehiscence 2.1% (95% CI: 1.3–3.1). Conclusions With pooled proportions of complications from over 6600 patients over a 10-year period, a standard may be set for outcomes after single-stage primary hypospadias repair for surgeons to audit their own outcomes against. [ABSTRACT FROM AUTHOR]

Abstract: Objective: We have experienced difficulty with the removal of all-silicone Foley catheters after hypospadias repair, relating to the formation of a ‘cuff’ of residual balloon material that fails to deflate, after aspiration of the instilled volume of water. This could potentially lead to both short- and long-term complications (stenosis, fistula). In all-silicone paediatric catheters, we investigated the production of such ‘cuffs’, and any other significant deformity which may be associated with deformation of the catheter balloon mechanism, in vitro. Materials and methods: Catheters were inflated with 0 (control) to 7mL of sterile water. The catheter balloon dimensions were measured before and after incubation of the catheters for 168h in a solution simulating human urine. The aspiration volumes were recorded. Results: At volumes greater than 40% of the manufacturer''s advised inflation volume, a significant increase in the transverse diameter of the catheter occurred after deflation, compared to controls (P <0.001). Conclusion: We advise the maximum instillation of 2mL of water into a 5-mL paediatric catheter balloon to avoid cuff formation. Using this technique allows all of the advantages of a stent, in combination with the security of a catheter, but with a reduced risk of trauma and complications associated with catheter removal. [Copyright &y& Elsevier]

Summary: Novagold™ breast implants were withdrawn from use in the UK in December 2000 due to concerns about the metabolic fate of the implant filler material, the hydrogels polyvinylpyrrolidine (PVP) and guar gum. A total of 250 women in the UK had these implants, 66 of which were performed in our unit. A total of 44% of cases needed further surgery for complications. Capsular contracture requiring surgical intervention occurred in 32%. Symptomatic ruptures occurred in 10.5%. Infection was recorded in 1.5%. From comparison with published data, the incidence of capsular contracture is comparable, but the occurrence of rupture is almost twice that of saline-filled implants. It is hypothesised that an osmotic gradient occurs due to the hydrogel filler causing the implants to swell and weaken the elastomer shell. When the PVP/guar gum filler is released into the subcutis, a vigorous tissue reaction occurs causing pain and swelling. These results show that this composition of implant poses potential risks, which should be considered by manufacturers in the future. We advise removal of symptomatic implants, as rupture is likely to have occurred. [Copyright &y& Elsevier]

Summary: An audit of the hypospadias repair service provided in the county of Warwickshire has shown that centralising all referrals to a single surgeon who uses limited, well-practiced techniques, greatly improves outcome. Comparison to previous audit of the service, when provided by a number of surgeons in the region, shows complication rates dropping – fistulae occurrence reducing from 35.8% to 6.7% and urethral stricture rates showing similar improvement from 4.4% to 0%. Overall productivity increased, and referral out of region dropped from 13% to 0%. This provides definitive evidence that restructuring of a service already in place has decreased morbidity and increased efficiency to give results comparable to published data. [Copyright &y& Elsevier]