Endoscopy-Assisted Versus Open Tissue Expander Placement in Plastic and Reconstructive Surgery: A Meta-Analysis

Abstract Background Tissue expansion can solve the problem of tissue deficiency in plastic and reconstructive surgery, but it is a lengthy process with many possible complications. This meta-analysis aimed to determine whether endoscopy-assisted expander placement could decrease complications and shorten treatment time. Methods A literature search was performed in eight databases from their inception dates up to November 22, 2020, to identify clinical studies on endoscopy-assisted and/or open tissue expander placement in plastic and reconstructive surgery. Risk difference (RD) and weighted mean difference (WMD), along with the 95% confidence intervals (95% CI), were calculated to compare the pooled results. Results Seven studies met the inclusion criteria. Of the 759 patients, 194 received endoscopy-assisted expander placement and 565 patients received open expander placement. Overall complication rate was significantly lower in the endoscopy-assisted group than in the open expander group (pooled RD − 0.28, 95% CI, − 0.38 to − 0.18, p < 0.001). Subgroup analysis showed significantly lower incidence rates for haemotoma, infection, and dehiscence, but not for extrusion and deflation. The endoscopy-assisted group also had significantly shorter surgery time (WMD, − 13.97 min; 95% CI, − 15.85 to − 12.08 minutes, p < 0.001), hospital stay (WMD, − 16.88 hours; 95% CI, − 24.36 to − 9.40 hours, p < 0.001), and time to full expansion (WMD, − 27.54 days; 95% CI, − 38.85 to − 16.24 days, p < 0.001). Conclusions Endoscopy-assisted expander placement may help lower the risk of complications such as haemotoma, infection, and dehiscence, and also reduce surgery time, hospital stay, and time to full expansion. (PROSPERO: CRD42021226116)