Robot-assisted radical cystectomy (RARC) has become a minimally invasive alternative to open radical cystectomy (ORC) for muscle-invasive bladder cancer, with potential advantages in perioperative outcomes and recovery times. However, their comparative effectiveness remains debatable, particularly when extracorporeal urinary diversion is employed in both approaches. This systematic review and meta-analysis integrated evidence from randomized controlled trial data comparing RARC with ORC using extracorporeal reconstruction, with novel subgroup analyses by neobladder utilization and GRADE certainty assessment. We systematically searched MEDLINE, Embase, CENTRAL, Web of Science, and Scopus from inception to November 2025 for randomized controlled trials comparing robot-assisted radical cystectomy (RARC) with open radical cystectomy (ORC) with extracorporeal urinary diversion in adults with bladder cancer. The primary outcomes included 90-day overall complications, major complications, operative time, blood loss, length of hospital stay, and positive surgical margins. Secondary outcomes included lymph node yield, venous thromboembolic events, postoperative ileus, and health-related quality of life (HRQoL). Random-effects meta-analyses were used to calculate risk ratios and mean differences with 95
Robotic-assisted laparoscopic hysterectomy has gained widespread adoption for benign gynecologic diseases despite its higher cost and ongoing debate over its clinical superiority compared to conventional laparoscopy. Although many comparative studies exist, no meta-analysis has exclusively synthesized randomized controlled trial evidence with a comprehensive GRADE certainty assessment of all clinically relevant, perioperative outcomes. This systematic review and meta-analysis was prospectively registered (PROSPERO ID: CRD420251183072). We systematically searched major databases from inception through November 1, 2025, for randomized controlled trials comparing robotic total laparoscopic hysterectomy (R-TLH) with conventional total laparoscopic hysterectomy (C-TLH) for benign indications. Two independent reviewers screened the studies, extracted the data, and assessed the risk of bias using the RoB 2 tool. Random-effects meta-analyses were performed for operative duration, estimated blood loss, conversion to laparotomy, length of hospital stay, and perioperative complications. Heterogeneity was quantified using I² statistics, and comprehensive sensitivity analyses were conducted to assess the robustness of the results. The certainty of the evidence for each outcome was evaluated using the GRADE approach. Four trials (N = 375 patients) met the inclusion criteria, with 185 and 190 patients in the R-TLH and C-TLH groups, respectively. The total operative time did not differ significantly between the R-TLH and C-TLH groups (mean difference [MD] 11.79 min, 95
Background: Listeria monocytogenes is a common foodborne organism identified as a causative agent of multiple clinical conditions in unique circumstances such as pregnancy and immunocompromise. It is a Gram-positive rod and a facultative anaerobic organism. This paper presents a study over a timeline of 5 years in retrospect and explores the incidence of listeriosis amongst patients of different age groups, along with its associated risk factors and clinical outcomes. Materials and methods: This study was conducted in retrospect from June 2019 to June 2024 at Shifa International Hospital, Islamabad. Ninety-seven cases of listeriosis were identified. These cases were culture-positive listeriosis where the pathogen was isolated from various samples such as blood and cerebrospinal fluid (CSF). Important risk factors associated with the clinical presentations were also documented, which included diabetes mellitus (DM), Chronic Kidney disease (CKD) and malignancy. The mean ± SD was calculated for the continuous variable. Frequency and percentage were calculated for categorical variables. Chi-square tests was performed to assess associations with mortality and fetal outcomes. Results: A total of 97 culture-confirmed listeriosis cases, comprising 44 (45.5%) males and 53 (54.6%) females, were obtained. 15 of the females were pregnant. Fever was the most common presenting symptom across all groups, with pregnant patients also reporting abdominal pain, vomiting, and fetal complications, while non-pregnant patients showed a wider range, including neurological, respiratory, and gastrointestinal complaints. Of the 97 patients, 86 had co-morbidities—most commonly hypertension and diabetes—while 15 total adult deaths occurred. Eight pregnancies resulted in fetal losses. Descriptive trends in pregnant patients suggested worse fetal outcomes with higher CRP, TLC and maternal comorbidities. Ampicillin-based regimens were the most frequently used treatments, and all isolates were sensitive to the tested antibiotics. Conclusion: This study highlights how listeriosis poses substantial morbidity and mortality risk, especially in pregnant cases. There is also a critical data gap, emphasizing the need for better diagnostic strategies, timely and targeted interventions, awareness of the clinical team, and public health surveillance to reduce the burden of this often-overlooked infection in Pakistan.
Postoperative pancreatic fistula (POPF) is the principal cause of morbidity after pancreatoduodenectomy (PD). Omental wrapping of the pancreaticojejunostomy (PJ) has been proposed to reduce fistula risk; however, prior syntheses often pooled arterial and anastomotic targets, obscuring the PJ-specific effect relevant to surgical decision-making. This systematic review and meta-analysis was registered in PROSPERO (ID: CRD420251176513) on October 26, 2025. We searched the PubMed, Embase, Web of Science, Cochrane CENTRAL, Scopus, and ClinicalTrials databases. gov, and WHO ICTRP from inception to October 24, 2025, for comparative studies evaluating omental wrapping of the PJ versus no wrap during PD. The primary outcome was clinically relevant POPF (CR-POPF; ISGPS grades B/C). Secondary outcomes included delayed gastric emptying, post-pancreatectomy hemorrhage, reoperation, length of stay (LOS), operative time, estimated blood loss (EBL), and time to oral intake. Random-effects meta-analyses were used to calculate risk ratios (RR) and mean differences (MD) with 95
