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What do systematic reviews say?

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Evidence found and GRADE certainty

1,938 questions · 1,994 findings · 246 reviews · Headline outcomes only

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No studies found 490 · 24.6%GRADE not reported 71 · 3.6%Very low 669 · 33.6%Low 446 · 22.4%Moderate 264 · 13.2%High 54 · 2.7%

Surgery vs preoperative pharmacological therapy and surgery

Adverse events · adults with growth‐hormone secreting pituitary adenomas

It is very uncertain whether surgery alone changes adverse events compared with preoperative pharmacological therapy and surgery (very low certainty).

1 finding from 1 review

Surgery vs preoperative pharmacological therapy and surgery

Surgery for recurrent or persistent disease · adults with growth‐hormone secreting pituitary adenomas

It is very uncertain whether surgery alone changes surgery for recurrent or persistent disease compared with preoperative pharmacological therapy and surgery (very low certainty).

1 finding from 1 review

Surgery vs Pharmacological therapy

Health‐related quality of life Mean AcroQoL score (0‐100) · adults with growth‐hormone secreting pituitary adenomas

Surgery alone showed no clear difference in health‐related quality of life Mean AcroQoL score (0‐100) compared with pharmacological therapy alone (low certainty).

1 finding from 1 review

Surgery vs preoperative pharmacological therapy and surgery

Disease‐related complications Intubation difficulties requiring postponement of surgery · adults with growth‐hormone secreting pituitary adenomas

It is very uncertain whether surgery alone changes disease‐related complications Intubation difficulties requiring… compared with preoperative pharmacological therapy and surgery (very low certainty).

1 finding from 1 review

Summary of findings table ‐ Off‐midline closure vs tension‐free midline closure

Wound infection · pilonidal sinus

It is very uncertain whether summary of findings table ‐ Off‐midline closure changes wound infection compared with tension‐free midline closure (very low certainty).

1 finding from 1 review

Summary of findings table ‐ Off‐midline closure vs tension‐free midline closure

Wound dehiscence · pilonidal sinus

It is very uncertain whether summary of findings table ‐ Off‐midline closure changes wound dehiscence compared with tension‐free midline closure (very low certainty).

1 finding from 1 review

Summary of findings table ‐ Off‐midline closure (Karydakis flap) vs off‐midline closure (Limberg flap)

Proportion of wounds healed · pilonidal sinus

Summary of findings table ‐ Off‐midline closure (Karydakis flap) showed no clear difference in proportion of wounds healed compared with off‐midline closure (Limberg flap) (low certainty).

1 finding from 1 review