The Clinical Effectiveness of Cognitive Behavioral Therapy for Patients with Insomnia and Depression: A Systematic Review and Meta-Analysis

Background. Insomnia and depression often co-occurr. However, there is lack of effective treatment for such comorbidity. CBT-I has been recommended as the first-line treatment for insomnia; whether it is also effective for comorbidity of insomnia and depression is still unknown. Therefore, we conducted this meta-analysis of randomized controlled trials to assess the clinical effectiveness and safety of CBT-I for insomnia comorbid with depression. Data Sources. Seven electronic databases, including China National Knowledge Infrastructure (CNKI), Wanfang Database, China Science Technology Journal Database, SinoMed Database, PubMed, the Cochrane Library, and EMBASE, as well as grey literature, were searched from the beginning of each database to July 1, 2019. Study Eligibility Criteria. Randomized controlled trials that compared CBT-I to no treatment or hypnotics (zopiclone, estazolam, and benzodiazepine agonist) for insomnia comorbid with depression and reported both insomnia scales and depression scales. Study Assessment and Synthesis Methods. Cochrane Reviewer’s Handbook was used for evaluating the risk of bias of included studies. Review Manager 5.3 software was used for meta-analysis. Online GRADEpro was used to assess the quality of evidence. Results. The pooled data showed that CBT-I was superior to no treatment for insomnia, while it was unsure whether CBT-I was better than no treatment for depression. And the effectiveness of CBT-I was comparable to hypnotics for both insomnia and depression. CBT-I was likely to be safe due to its noninvasive nature. The methodological quality varied across these trials. The evidence quality varied from moderate to very low, and the recommendation level was low. Conclusions. Currently, findings support that CBT-I seems to be effective and safe for insomnia comorbid with depression to improve the insomnia condition, while it is unsure whether CBT-I could improve depression condition. More rigorous trials are needed to confirm our findings.

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The Long-Lasting Effects of “Placebo Injections” in Knee Osteoarthritis: A Meta-Analysis

Cartilage ◽

10.1177/1947603520906597 ◽

2020 ◽

pp. 194760352090659 ◽

Cited By ~ 7

Author(s):

Davide Previtali ◽

Giulia Merli ◽

Giorgio Di Laura Frattura ◽

Christian Candrian ◽

Stefano Zaffagnini ◽

...

Keyword(s):

Knee Osteoarthritis ◽

Randomized Controlled Trials ◽

Placebo Effect ◽

Meta Analysis ◽

Grey Literature ◽

Cochrane Library ◽

Controlled Trials ◽

Level Of Evidence ◽

Randomized Controlled ◽

The Impact

Objectives To quantify the placebo effect of intraarticular injections for knee osteoarthritis in terms of pain, function, and objective outcomes. Factors influencing placebo effect were investigated. Design Meta-analysis of randomized controlled trials; Level of evidence, 2. PubMed, Web of Science, Cochrane Library, and grey literature databases were searched on January 8, 2020, using the string: (knee) AND (osteoarthritis OR OA) AND (injections OR intra-articular) AND (saline OR placebo). The following inclusion criteria were used: double-blind, randomized controlled trials on knee osteoarthritis, including a placebo arm on saline injections. The primary outcome was pain variation. Risk of bias was assessed using the RoB 2.0 tool, and quality of evidence was graded following the GRADE (Grading of Recommendations Assessment, Development and Evaluation) guidelines. Results Out of 2,363 records, 50 articles on 4,076 patients were included. The meta-analysis showed significant improvements up to the 6-month follow-up: Visual Analogue Scale (VAS)-pain −13.4 mean difference (MD) (95% confidence interval [CI]: −21.7/−5.1; P < 0.001), Western Ontario and McMaster Osteoarthritis Index (WOMAC)-pain −3.3 MD (95% CI: −3.9/−2.7; P < 0.001). Other significant improvements were WOMAC-stiffness −1.1 MD (95% CI: −1.6/−0.6; P < 0.001), WOMAC-function −10.1 MD (95% CI: −12.2/−8.0; P < 0.001), and Evaluator Global Assessment −21.4 MD (95% CI: −29.2/−13.6; P < 0.001). The responder rate was 52% (95% CI: 40% to 63%). Improvements were greater than the “minimal clinically important difference” for all outcomes (except 6-month VAS-pain). The level of evidence was moderate for almost all outcomes. Conclusions The placebo effect of knee injections is significant, with functional improvements lasting even longer than those reported for pain perception. The high, long-lasting, and heterogeneous effects on the scales commonly used in clinical trials further highlight that the impact of placebo should not be overlooked in the research on and management of knee osteoarthritis.

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Activity and Safety of Tegafur, Gimeracil, and Oteracil Potassium for Nasopharyngeal Carcinoma: A Systematic Review and Meta-Analysis

Journal of Oncology ◽

10.1155/2021/6690275 ◽

2021 ◽

Vol 2021 ◽

pp. 1-15

Author(s):

Ximing Zhang ◽

Xiumei Tian ◽

Yuezi Wei ◽

Hao Deng ◽

Lichun Ma ◽

...

Keyword(s):

Nasopharyngeal Carcinoma ◽

Randomized Controlled Trials ◽

Adverse Reactions ◽

Meta Analysis ◽

Cochrane Library ◽

Controlled Trials ◽

Efficacy And Safety ◽

China National Knowledge Infrastructure ◽

Randomized Controlled ◽

Significant Difference

In clinical practice, tegafur, gimeracil, and oteracil potassium (S-1) therapy is commonly administered to treat nasopharyngeal carcinoma (NPC). However, its efficacy and safety remain controversial in both randomized controlled trials (RCTs) and non-RCTs. We aimed to evaluate the efficacy and safety of S-1 treatment for NPC. We searched PubMed, Ovid, EMBASE, the Cochrane Library, China National Knowledge Infrastructure, Wanfang Database, and VIP databases for RCTs of chemotherapy with or without S-1 for NPC, from 2001 to 2020. A meta-analysis was performed using RevMan5.3 and Stata15. Randomized controlled trials published in journals were included irrespective of blinding and language used. Patients were diagnosed with NPC through a clinicopathological examination; patients of all cancer stages and ages were included. Overall, 25 trials and 1858 patients were included. There were significant differences in the complete remission (OR = 2.42, 95% CI (1.88–3.10), P < 0.05 ) and overall response rate (OR = 2.68, 95% CI (2.08–3.45), P < 0.05 ) between the S-1 and non-S-1 groups. However, there was no significant difference in partial remission (OR = 1.10, 95% CI (0.87–1.39), P = 0.42 ) and seven adverse reactions (leukopenia, thrombocytopenia, nausea and vomiting, diarrhea, dermatitis, oral mucositis, and anemia) between the S-1 and non-S-1 groups. Additionally, statistical analyses with six subgroups were performed. S-1 was found to be a satisfactory chemotherapeutic agent combined with radiotherapy, intravenous chemotherapy, or chemoradiotherapy for NPC. As an oral medicine, the adverse reactions of S-1, especially gastrointestinal reactions, can be tolerated by patients, thereby optimizing their quality of life. S-1 may be a better choice for the treatment of NPC. This trial is registered with CRD42019122041.

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Efficacy and Safety of Banxia Formulae for Insomnia: A Systematic Review and Meta-Analysis of High-Quality Randomized Controlled Trials

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2021/8833168 ◽

2021 ◽

Vol 2021 ◽

pp. 1-18

Author(s):

Yan-Hua Lin ◽

Cong Chen ◽

Xiu Zhao ◽

Yi-Fei Mao ◽

Guang-Xin Xiang ◽

...

Keyword(s):

Randomized Controlled Trials ◽

Assessment Tool ◽

Meta Analysis ◽

Effective Rate ◽

Cochrane Library ◽

Controlled Trials ◽

Efficacy And Safety ◽

China National Knowledge Infrastructure ◽

Randomized Controlled ◽

Bias Risk

Objective. To systematically evaluate the efficacy and safety of Banxia (Pinellia Tuber) formulae in the treatment of insomnia compared with those of conventional western medicines. Methods. Randomized controlled trials (RCTs) evaluating the efficacy and safety of Banxia formulae in the treatment of insomnia were searched from the following databases: PubMed, Cochrane Library, EMBASE, the China National Knowledge Infrastructure (CNKI), Chinese Scientific Journals Database (VIP), and Wanfang database. The literature collected was from the time when the databases were established to April 2020. Quality assessment and meta-analysis were conducted by using Cochrane bias risk assessment tool and RevMan 5.2, respectively. Publication bias was assessed by Egger’s test. Results. Fourteen RCTs with 910 participants were identified. A total of 46 traditional Chinese medicines involving 2 different dosage forms were used in the included studies. Meta-analysis indicated that Banxia formulae had more significant effects on improving the total effective rate (RR = 1.23, 95% CI 1.16 to 1.31), Pittsburgh Sleep Quality Index (PSQI, MD = −1.05, 95% CI −1.63 to −0.47), and the TCM syndrome score (SMD = −0.78, 95% CI −1.18 to −0.39). Meanwhile, on reducing adverse events, Banxia formulae also showed an advantage (RR = 0.48, 95% CI 0.24 to 0.93). Conclusion. According to the current studies, the efficacy of Banxia formulae in the treatment of insomnia is better than that of the conventional western medicines, and its safety is relatively stable. However, due to the limitations of this study, further research and evaluation are needed.

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Effectiveness of Acupuncture for Poststroke Aphasia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Complementary Medicine Research ◽

10.1159/000512672 ◽

2021 ◽

pp. 1-11

Author(s):

Yu Zhang ◽

Zhijie Wang ◽

Xudong Jiang ◽

Zimeng Lv ◽

Lin Wang ◽

...

Keyword(s):

Systematic Review ◽

Randomized Controlled Trials ◽

Reading Ability ◽

Meta Analysis ◽

Reporting Quality ◽

Cochrane Library ◽

Controlled Trials ◽

Therapeutic Effects ◽

China National Knowledge Infrastructure ◽

Randomized Controlled

Background: Aphasia is one of the common complications of stroke, and it considerably influences the quality of life of patients. Acupuncture, a therapy used in traditional Chinese medicine for aphasia after stroke, has potential therapeutic effects. We aimed to investigate the therapeutic effect of acupuncture on individuals with poststroke aphasia. Methods: Randomized controlled trials (RCTs) on acupuncture for poststroke aphasia (either alone or combined with other therapies) were included and compared. We conducted a systematic review and meta-analysis by searching databases, such as MEDLINE, Cochrane Library, Embase, China National Knowledge Infrastructure, VIP, and Wanfang, from inception to July 15, 2019. No language restrictions were applied in this study. Results: Fourteen trials involving 936 participants had poor reporting and methodological quality. Our meta-analysis showed that compared to the speech and language therapy (SLT) group, acupuncture combined with SLT could improve the rate of Boston Diagnostic Aphasia Examination (BDAE) (OR: 0.15, 95% confidence interval [CI]: 0.04–0.25, p = 0.005), scores of Aphasia Battery of Chinese (ABC) which includes repeating ability (SMD: 1.46, 95% CI: 1.24–1.69, p < 0.00001), reading ability (SMD: 1.57, 95% CI: 1.25–1.90, p < 0.00001), writing ability (SMD: 1.52, 95% CI: 1.19–1.86, p < 0.00001), naming ability (SMD: 1.40, 95% CI: 1.04–1.76, p < 0.00001), and listening comprehension ability (SMD: 0.57, 95% CI: 0.22–0.92, p = 0.001). All RCTs were considered at high risk of biased assessment. Conclusions: Acupuncture (either alone or combined with SLT) may be effective for poststroke aphasia. In the future, rigorous clinical trials with an accurate method design and high reporting quality are required to validate our results.

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Do Docosahexaenoic and Eicosapentaenoic Acids Have Similar Effects on Inflammation Markers? Pairwise and Network Meta-Analyses of Randomized Controlled Trials

Current Developments in Nutrition ◽

10.1093/cdn/nzaa045_118 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 485-485

Author(s):

Cécile Vors ◽

Janie Allaire ◽

Sonia Blanco Mejia ◽

Tauseef Khan ◽

John Sievenpiper ◽

...

Keyword(s):

Randomized Controlled Trials ◽

Meta Analysis ◽

Outcome Data ◽

Cochrane Library ◽

Controlled Trials ◽

Eligibility Criteria ◽

Randomized Controlled ◽

Tnf Α ◽

Mean Differences ◽

Meta Analyses

Abstract Objectives The aim of this study was to compare the effect of DHA and EPA on several markers of systemic inflammation by pairwise and network meta-analyses of randomized controlled trials (RCTs). Methods MEDLINE, EMBASE and The Cochrane Library were searched through September 2019. We included RCTs of ≥ 7 days that directly compared the effects of DHA with EPA and RCTs of indirect comparisons, in which the effects of DHA or EPA were assessed individually compared with a control fatty acid. Differences in circulating concentrations of CRP, IL-6, TNF-α and adiponectin were the primary outcome. Data were pooled by pairwise and network meta-analysis and expressed as mean differences (MDs) with 95% confidence intervals (CIs). Heterogeneity was assessed (Cochran Q statistic) and quantified (I2 statistic) in the pairwise meta-analysis. Inconsistency and transitivity were evaluated in the network meta-analysis. The certainty of evidence was assessed using GRADE (Grading of Recommendations Assessment, Development, and Evaluation). Results Eligibility criteria were met by 5 RCTs (N = 411) for the pairwise meta-analysis and 20 RCTs (N = 1231) for the network meta-analysis. In the pairwise meta-analysis, DHA and EPA had similar effects on plasma CRP (MDDHA vs. EPA = 0.14 mg/L [95% CI −0.57, 0.85]; I2 = 61%), IL-6 (MDDHA vs. EPA = 0.10 pg/mL [−0.15, 0.34]; I2 = 40%) and TNF-α (MDDHA vs. EPA = −0.10 pg/mL [−0.37, 0.18]; I2 = 40%). The effects of DHA and EPA on plasma CRP (MDDHA vs. EPA = −0.33 mg/L [−0.75, 0.10]), IL-6 (MDDHA vs. EPA = 0.09 pg/mL [−0.12, 0.30]) and TNF-α (MDDHA vs. EPA = −0.02 pg/mL [−0.25, 0.20]) were also similar according to the network meta-analysis. DHA and EPA had similar effects on plasma adiponectin in the network meta-analysis. Conclusions The present pairwise and network meta-analyses comparing EPA to DHA suggest that DHA and EPA do not differentially modify systemic markers of subclinical inflammation. Funding Sources The authors have no funding to report.

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Vitamin C as a Supplementary Therapy in Relieving Symptoms of the Common Cold: A Meta-Analysis of 10 Randomized Controlled Trials

BioMed Research International ◽

10.1155/2020/8573742 ◽

2020 ◽

Vol 2020 ◽

pp. 1-9

Author(s):

Li Ran ◽

Wenli Zhao ◽

Hongwu Wang ◽

Ye Zhao ◽

Huaien Bu

Keyword(s):

Vitamin C ◽

Randomized Controlled Trials ◽

Antiviral Therapy ◽

Common Cold ◽

Meta Analysis ◽

Cochrane Library ◽

Controlled Trials ◽

China National Knowledge Infrastructure ◽

Randomized Controlled ◽

Vitamin C Supplementation

Aim. To investigate whether vitamin C performs well as a supplemental treatment for common cold. Method. After systematically searching through the National Library of Medicine (PubMed), Cochrane Library, Elsevier, China National Knowledge Infrastructure (CNKI), VIP databases, and Wanfang databases, 10 randomized controlled trials were selected for our meta-analysis with RevMan 5.3 software. Published in China, all 10 studies evaluated the effect of combined vitamin C and antiviral therapy for the treatment of common cold. Results. The total efficacy (RR=1.27, 95% CI (1.08, 1.48), P=0.003), the time for symptom amelioration (MD=−15.84, 95% CI (-17.02, -14.66), P<0.00001), and the time for healing (I, 95% CI (-14.98, -4.22), P=0.0005) were better with vitamin C supplementation than with antiviral therapy alone. Conclusions. Vitamin C could be used as a supplementary therapy along with antiviral regimens to relieve patients from the symptoms of common cold.

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Efficacy and Safety of Transcutaneous Electrical Acupoint Stimulation (TEAS) for Postoperative Pain in Laparoscopy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2022/9922879 ◽

2022 ◽

Vol 2022 ◽

pp. 1-17

Author(s):

Dan Meng ◽

Yifei Mao ◽

Quan-mei Song ◽

Chun-chun Yan ◽

Qin-yu Zhao ◽

...

Keyword(s):

Postoperative Pain ◽

Randomized Controlled Trials ◽

Meta Analysis ◽

Cochrane Library ◽

Controlled Trials ◽

Efficacy And Safety ◽

China National Knowledge Infrastructure ◽

Serious Adverse Events ◽

Complementary And Alternative Therapy ◽

Randomized Controlled

Objectives. This meta-analysis aimed to assess the efficacy and safety of transcutaneous acupoint electrical stimulation (TEAS) for postoperative pain in laparoscopy. The review has been registered on the “INPLASY” website and the registration number is INPLASY202150101. Methods. Relevant randomized controlled trials are selected from seven electronic databases (PubMed, the Cochrane Library, Embase, China National Knowledge Infrastructure, Chongqing VIP Information, WanFang Data, and Chinese Biomedical Database) from their inception up to November 30, 2020. Twenty-eight studies were included in this meta-analysis, and the statistical analyses and the exploration of heterogeneity sources were conducted by Stata 15.0 software. Besides, the bias assessment of the included studies was evaluated using the Cochrane risk of bias tool. Results. In total, 28 RCTs covering 2787 participants were included. The meta-analysis suggested that TEAS can effectively relieve pain in the short term after laparoscopy, reduce the postoperative consumption of rescue analgesics, improve the quality of life of patients, and shorten the length of hospitalization. And no serious adverse events are related to TEAS. Therefore, TEAS is relatively safe and efficacy for clinical application. The most used acupoints were Hegu (LI14), Neiguan (PC6), and Zusanli (ST36). Conclusions. TEAS can be recommended as a complementary and alternative therapy for the treatment of postoperative pain after laparoscopy. However, the included RCTs had some methodological limitations. Therefore, larger-size, more rigorous, and higher-quality RCTs are needed in the future to further explore the efficacy and safety of TEAS for postoperative pain after laparoscopy.

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Adjuvant Transarterial Chemoembolization Following Curative-Intent Hepatectomy Versus Hepatectomy Alone for Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Cancers ◽

10.3390/cancers13122984 ◽

2021 ◽

Vol 13 (12) ◽

pp. 2984

Author(s):

Stepan M. Esagian ◽

Christos D. Kakos ◽

Emmanouil Giorgakis ◽

Lyle Burdine ◽

J. Camilo Barreto ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Systematic Review ◽

Randomized Controlled Trials ◽

Transarterial Chemoembolization ◽

Meta Analysis ◽

Risk Of Bias ◽

Cochrane Library ◽

Controlled Trials ◽

Curative Intent ◽

Randomized Controlled

The role of adjuvant transarterial chemoembolization (TACE) for patients with resectable hepatocellular carcinoma (HCC) undergoing hepatectomy is currently unclear. We performed a systematic review of the literature using the MEDLINE, Embase, and Cochrane Library databases. Random-effects meta-analysis was carried out to compare the overall survival (OS) and recurrence-free survival (RFS) of patients with resectable HCC undergoing hepatectomy followed by adjuvant TACE vs. hepatectomy alone in randomized controlled trials (RCTs). The risk of bias was assessed using the Risk of Bias 2.0 tool. Meta-regression analyses were performed to explore the effect of hepatitis B viral status, microvascular invasion, type of resection (anatomic vs. parenchymal-sparing), and tumor size on the outcomes. Ten eligible RCTs, reporting on 1216 patients in total, were identified. The combination of hepatectomy and adjuvant TACE was associated with superior OS (hazard ratio (HR): 0.66, 95% confidence interval (CI): 0.52 to 0.85; p < 0.001) and RFS (HR: 0.70, 95% CI: 0.56 to 0.88; p < 0.001) compared to hepatectomy alone. There were significant concerns regarding the risk of bias in most of the included studies. Overall, adjuvant TACE may be associated with an oncologic benefit in select HCC patients. However, the applicability of these findings may be limited to Eastern Asian populations, due to the geographically restricted sample. High-quality multinational RCTs, as well as predictive tools to optimize patient selection, are necessary before adjuvant TACE can be routinely implemented into standard practice. PROSPERO Registration ID: CRD42021245758.

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Effect of Probiotic Consumption on Immune Response in Athletes: A Meta-analysis

International Journal of Sports Medicine ◽

10.1055/a-1463-3303 ◽

2021 ◽

Author(s):

Rahele Tavakoly ◽

Amir Hadi ◽

Nahid Rafie ◽

Behrouz Talaei ◽

Wolfgang Marx ◽

...

Keyword(s):

Randomized Controlled Trials ◽

Weighted Mean Difference ◽

Meta Analysis ◽

Cochrane Library ◽

Controlled Trials ◽

Monocyte Count ◽

Randomized Controlled ◽

Immunological Markers ◽

Online Databases ◽

Immunological Effects

AbstractThe possible effect of probiotic interventions on immunological markers in athletes is inconclusive. Therefore, to synthesize and quantitatively analyze the existing evidence on this topic, systematic literature searches of online databases PubMed, Scopus, Cochrane Library, and ISI Web of Sciences was carried out up to February 2021 to find all randomized controlled trials (RCTs) concerning the immunological effects of probiotics in athletes. In the random-effects model, weighted mean difference (WMD) and 95% confidence interval (CI) explained the net effect. The authors assessed the likelihood of publication bias via Egger’s and Begg’s statistics. A total of 13 RCTs (836 participants) were retrieved. Probiotic consumption reduced lymphocyte T cytotoxic count significantly (WMD=−0.08 cells×109/L; 95% CI: −0.15 to −0.01; p=0.022) with evidence of moderate heterogeneity (I 2=59.1%, p=0.044) and monocyte count when intervention duration was ≤ 4 weeks (WMD=−0.08 cells×109/L; 95% CI: −0.16 to −0.001; I 2=0.0%). Furthermore, leukocyte count was significantly elevated (WMD=0.48 cells×109/L; 95% CI: 0.02 to 0.93; I 2=0.0%) when multi-strain probiotics were used. Probiotic supplements may improve immunological markers, including lymphocyte T cytotoxic, monocyte, and leukocyte in athletes. Further randomized controlled trials using diverse strains of probiotics and consistent outcome measures are necessary to allow for evidence-based recommendations.

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Early Versus Routine Stoma Closure in Patients With Colorectal Resection: A Meta-Analysis of 7 Randomized Controlled Trials

Surgical Innovation ◽

10.1177/1553350620907812 ◽

2020 ◽

Vol 27 (3) ◽

pp. 291-298

Author(s):

Yinyin Guo ◽

Yanxin Luo ◽

Hui Zhao ◽

Liangliang Bai ◽

Juan Li ◽

...

Keyword(s):

Colorectal Surgery ◽

Randomized Controlled Trials ◽

Bowel Obstruction ◽

Meta Analysis ◽

Cochrane Library ◽

Wound Complications ◽

Controlled Trials ◽

Stoma Closure ◽

Randomized Controlled ◽

Significant Difference

Background. A substantial proportion of patients undergoing colorectal surgery receive a temporary stoma, and the timing for stoma closure remains unclear. The aim of this study was to evaluate the safety and feasibility of early stoma closure (ESC) compared with routine stoma closure (RSC) after colorectal surgery. Methods. We comprehensively searched PubMed, Embase, and the Cochrane Library for randomized controlled trials that compared ESC and RSC after colorectal surgery. Results. A total of 7 randomized controlled trials with 814 enrolled patients were identified for this meta-analysis. There were no significant differences between the ESC and RSC groups regarding the complications of stoma closure (26.8% and 16.6%, respectively; odds ratio [OR]: 1.30; 95% confidence interval [CI]: 0.89-1.90; P = .17). A subgroup analysis was conducted by Clavien-Dindo grade of complication, and no significant difference was observed in any subgroup ( P > .05). However, the ESC group had a significantly higher risk of wound complications than the RSC group (17.6% and 7.8%, respectively; OR: 2.61; 95% CI: 1.43-4.76; P = .002), and the RSC group had more cases of small bowel obstruction than the ESC group (3.1% and 8.4%, respectively; OR: 0.37; 95% CI: 0.15-0.87; P = .02). Conclusions. ESC is a safe and effective therapeutic approach in patients who have undergone colorectal surgery; it is associated with a reduced risk of bowel obstruction but a higher risk of wound complications.

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