Endoscopy-assisted versus open tissue expander placement in plastic and reconstructive surgery: a meta-analysis

Abstract

Tissue expansion can be used to overcome challenges due to tissue deficiency in plastic and reconstructive surgery; however, the long expansion process is often accompanied by numerous complications. This meta-analysis aimed to determine whether endoscopy-assisted expander placement could decrease complications and shorten treatment time. This study followed the principles of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and was registered in PROSPERO (CRD42021226116). A literature search was performed in eight databases from their inception dates up to 25 August 2021, to identify clinical studies on endoscopy-assisted and/or open tissue expander placement in plastic and reconstructive surgery. Seven studies met the inclusion criteria. In seven studies, 194 underwent endoscopy-assisted expander placement, and 565 underwent open expander placement. The overall complication rate in the endoscopy-assisted group was significantly lower than that in the open group (risk difference (RD) −0.28, 95% confidence interval (CI), −0.38, −0.18, p < .001). Subgroup analysis showed significantly lower incidence rates of hematoma, infection and dehiscence in the endoscopy-assisted group. The complication rate in the head/neck was lower with low heterogeneity (RD, −0.18; 95% CI, −0.26 to −0.09, p < .001; I² = 0%). The endoscopy-assisted group had shorter surgery time, hospital stay and time to full expansion (weighted mean difference (WMD), −13.97 min, −16.88 h, −27.54 days; 95% CI, −15.85, −12.08 min, −24.36, −9.40 h, −38.85, −16.24 days; both p < .001, respectively). Endoscopy-assisted expander placement may help lower the risk of complications, especially in the head/neck, and reduce surgery time, hospital stay, and time to full expansion. Abbreviations: CI: confidence interval; CNKI: China National Knowledge Infrastructure Database; CSTJ, China Science and Technology Journal Database; NOS: the Newcastle–Ottawa Scale; PRISMA: preferred reporting items for systematic reviews and meta-analyses; RCT: randomized controlled trial; RoB: the cochrane risk-of-bias; RD: risk difference; WMD: weighted mean difference; SE: standard error; SND: standard normal deviate

Keywords:

• Tissue expansion
• tissue expansion devices
• endoscopes
• plastic surgery
• meta-analysis

Acknowledgements

The first author thanks Qian He from Qujiang New Area Administrative Committee, Xi'an, China, and her baby, Keke, for their support.

Disclosure statement

The authors have no financial interests or commercial associations related to this research.

Additional information

Funding

This work was supported by the National Natural Science Foundation of China under Grant Nos. 82172229 and 81971851.