Laparoscopic bilateral inguinal hernia repair: Should it be the preferred technique?

Inguinal hernias are amongst the most common conditions requiring general surgical intervention. For decades, the preferred approach was the open repair. As laparoscopy became more popular and available and more surgeons became familiarized with this modality, laparoscopic inguinal hernia repair became an alternative. The aim of this study is to assess the effectiveness of laparoscopic inguinal repair, with a focus on bilateral inguinal hernias. Initial reports have shown promising clinical outcomes compared to those of conventional repair of bilateral hernias. However, there are only a few studies concerning laparoscopic repair of bilateral hernias. It is yet to be proven that laparoscopy is the “gold standard” in the treatment of bilateral inguinal hernias. So far, the choice of an inguinal hernia repair technique has been up to each surgeon, depending on their expertise and available resources after taking into consideration each patient’s needs.     

An analysis of the ergonomic risk of surgical trainees and experienced surgeons during laparoscopic procedures

BackgroundWork-related musculoskeletal injuries have been increasingly recognized to affect surgeons. It is unknown whether such injuries also affect surgical trainees. The purpose of this study was to assess the ergonomic risk of surgical trainees as compared with that of experienced surgeons.MethodsErgonomic data were recorded from 9 surgeons and 11 trainees. Biomechanical loads during surgery were assessed using motion tracking sensors and electromyography sensors. Demanding and static positions of the trunk, neck, right/left shoulder, as well as activity from the deltoid and trapezius muscles bilaterally were recorded. In addition, participants reported their perceived discomfort on validated questionnaires.ResultsA total of 87 laparoscopic general surgery cases (48 attendings and 39 trainees) were observed. Both trainees and attendings spent a similarly high percentage of each case in static (>60%) and demanding positions (>5%). Even though residents reported overall more discomfort, all participants shared similar ergonomic risk with the exception of trainees’ trunk being more static (odds ratio: –11.42, P = .006).ConclusionSurgeons are prone to ergonomic risk. Trainees are exposed to similar postural ergonomic risk as surgeons but report more discomfort and, given that musculoskeletal injuries are cumulative over time, the focus should be on interventions to reduce ergonomic risk in the operating room.     

Integrin expression in correlation to clinicopathological features and prognosis of prostate cancer: A systematic review and meta-analysis

Background: The prompt identification of patients with poor prognosis is essential in order to improve the treatment outcomes in prostate cancer (CaP); as a novel approach, several molecular markers, including integrins, have been discussed as prognostic biomarkers. Our aim was to comprehensively examine aberrant expression of integrins in correlation with clinicopathological features and prognosis in CaP by synthesizing all available evidence, in a systematic review and meta-analysis. Methods: A systematic review and meta-analysis was performed in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Scientific literature databases (Pubmed, Embase, and Scopus) were systematically searched until May 10, 2020. Random-effects (DerSimonian-Laird) models were used to estimate pooled odds ratios (ORs) for cross-sectional correlations with clinicopathological characteristics and relative risks for longitudinal associations with prognosis. Results: Fourteen studies were included with a total number of 3,194 CaP cases examined (13 cross-sectional and four longitudinal cohort study arms). Correlation of low expression of α₆ (pooled OR = 0.10, 95% confidence interval [CI]: 0.04–0.28, P < 0.001) and β₁ (pooled OR = 0.45; 95% CI: 0.21–1.00, P = 0.049) integrin with high Gleason score was noted. A borderline trend between reduced expression of α₆ integrin and an advanced clinical stage of CaP (pooled OR = 0.48; 95% CI: 0.22-1.03, P = 0.06) was observed. No associations with biochemical recurrence and survival were documented. Conclusions: Evidence on the association of low expression of integrins α₆ and β₁ and more advanced CaP exist, whereas significant results on survival were not documented; further studies are warranted.     

How are bariatric patients coping during the coronavirus disease 2019 (COVID-19) pandemic? Analysis of factors known to cause weight regain among postoperative bariatric patients

BackgroundThe global coronavirus disease 2019 (COVID-19) pandemic is wreaking havoc on society. Bariatric patients are more prone to severe infection due to their high body mass index (BMI) and are more vulnerable to the effects of isolation, such as depression or disruption of their health habits.ObjectivesTo quantify the impact of self-quarantine on bariatric patients and self-quarantine’s relationship with weight gain.SettingAcademic hospital, United States.MethodsA 30-item survey examining several known contributors to weight regain was distributed among the postoperative bariatric patients of our clinic. Changes in eating habits, exercise, depression, social support, loneliness, and anxiety were studied, among others.ResultsA total of 208 patients completed the survey (29.3% response rate). A large percentage of patients reported increases in their depression (44.2%), loneliness (36.2%), nervousness (54.7%), snacking (62.6%), loss of control when eating (48.2%), and binge eating (19.5%) and decreases in their social support (23.2%), healthy food eating (45.5%), and activity (55.2%). Difficulty in accessing vitamins was reported by 13%. Patients more than 18 months out of surgery regained more than 2 kg during an average of 47 days. Risk factors for weight regain were found to be loss of control when eating, increases in snacking and binge eating, reduced consumption of healthy food, and reduced physical activity.ConclusionBariatric patients are negatively affected by the COVID-19 pandemic and subsequent social isolation on many levels. This patient population is vulnerable to crisis situations; thus, additional intervention is needed to address behaviors that lead to weight regain.     

Identification of a new genotype H wild-type mumps virus strain and its molecular relatedness to other virulent and attenuated strains

A single clinical isolate of mumps virus designated 88-1961 was obtained from a patient hospitalized with a clinical history of upper respiratory tract infection, parotitis, severe headache, fever and lymphadenopathy. We have sequenced the full-length genome of 88-1961 and compared it against all available full-length sequences of mumps virus. Based upon its nucleotide sequence of the SH gene 88-1961 was identified as a genotype H mumps strain. The overall extent of nucleotide and amino acid differences between each individual gene and protein of 88-1961 and the full-length mumps samples showed that the missense to silent ratios were unevenly distributed. Upon evaluation of the consensus sequence of 88-1961, four positions were found to be clearly heterogeneous at the nucleotide level (NP 315C/T, NP 318C/T, F 271A/C, and HN 855C/T). Sequence analysis revealed that the amino acid sequences for the NP, M, and the L protein were the most conserved, whereas the SH protein exhibited the highest variability among the compared mumps genotypes A, B, and G. No identifying molecular patterns in the non-coding (intergenic) or coding regions of 88-1961 were found when we compared it against relatively virulent (Urabe AM9 B, Glouc1/UK96, 87-1004 and 87-1005) and non-virulent mumps strains (Jeryl Lynn and all Urabe Am9 A substrains).     

Transanaler rektaler Verschiebelappen (rectal advancement flap) versus mukosaflap mit internusnaht im management komplizierter fisteln des anorektums Eine prospektive klinische und manometrische studie

A prospective study was carried out on 55 patients with complicated anal fistulas (41 transsphincteric, 5 suprasphincteric and 9 rectovaginal) to evaluate the value of two sphincter-conserving techniques with primary occlusion of the internal ostium and endorectal advancement flap (group A, n=34) or mucosal flap (group B, n=21). Ten of the patients had Crohn's disease. Both techniques consist in one-stage fistulectomy without drainage of the intersphincteric space. The inflamed proctodeal and granulation tissue was carefully cleared. The site of the former primary orifice of the fistula was adapted by means of two or three peranally performed single stitches. The peranally applied suture included the layers of the internal anal sphincter muscle only. A mobilized flap of rectal wall (group A) and rectal mucosa and submucosa (group B) about 4 cm × 3 cm in size was stitched below the muscular sphincter. The perianal part of the wound was left to heal by second intention. Postoperatively there were 16 cases of suture leakage (23.5% in group A, and 38% in group B), and 19 patients (26% or 47% in both groups) had to have revision surgery because of recurrent fistula or sutur leakage; 2 patients (3.6%) developed incontinence with intermittent fecal soiling. Complete incontinence was not observed in any patient. No significant difference in clinical and functional results was determined between the two groups.

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Transanaler rektaler Verschiebelappen (rectal advancement flap) versus mukosaflap mit internusnaht im management komplizierter fisteln des anorektums Eine prospektive klinische und manometrische studie

Zusammenfassung Bei 55 Patienten mit komplizierten Analfisteln (41 transsphinktere, 5 suprasphinktere, 9 rektovaginale Fisteln) wurde eine prospektive Studie zur Bewertung von 2 sphinktererhaltenden Techniken mit primärem Verschlu des inneren Fistelostiums and anschlieender Deckung durch einen endorektalen Verschiebelappen (Gruppe A, n=34) oder Mukosalappen (Gruppe B, n=21) durchgeführt. Zehn Patienten hatten M. Crohn. Beide Techniken bestehen aus einer einzeitigen Fistulektomie ohne Drainage des Intersphinkterraumes. Das entzündlich veränderte Procdodealdrüsen- und Granulationsgewebe wurde vorsichtig mit dem scharfen Löffel entfernt. Der Ort der früeren Primäröffnung der Fistel wurde mit zwei bzw. drei peranal angelegten Einzelknopfnähten verschlossen. Die peranal gelegte Naht umfate die Schichten des M. spincter ani internus. Ein mobilisierter Rektumwandlappen (Gruppe A) oder ein Mukosa-Submukosalappen (Gruppe B), in einer Gröe von ca. 4×3 cm wurde versetzt und über den muskulären Verschlu gedeckt. Der perianale Teil der Wunde heilte sekundär. Postoperativ trat bei 16 Fällen eitle Nahtinsuffizienz auf (23,5% in Gruppe A, 38% in Gruppe B). Neunzehn Patienten (26% gegenüber 47% in beiden Gruppen) erforderten eine erneute Operation aufgrund von wiederkehrenden Fisteln oder Nahtinsuffizienzen. Zwei Patienten (3,6%) entwickelten eine Inkontinenz in Hinblick auf intermittierendes Stuhlschmieren. Eine völlige Störung der Kontinenz wurde in keinem Fall beobachtet. Ein signifikanter Unterschied zwischen beiden Gruppen war weder in klinischen noch in den funktionellen Ergebnissen zu ermitteln.

     

Laparoscopic Cholecystectomy in Obese and Nonobese Patients

Background: From November 1997 to November 1998, 145 cases of laparoscopic cholecystectomy (LC) have been attempted at the District General Hospital of Corfu. Methods: 23 (15.8%) were obese (Group I, BMI >30) and 122 (84.2%) were nonobese patients (Group II, BMI ≤30). One-fifth of these patients suffered from acute cholecystitis. Results: Operative time averaged 95 minutes in Group 1 and 78 minutes in Group II. There were no deaths. There were no significant differences between the obese and nonobese groups in conversion to open procedure (Group1: 0%, Group II: 2.4%), intraoperative and postoperative complications (Group I: 4.3%, Group II: 4.0%), operating time, and length of postoperative hospitalization. Conclusion: LC was a safe and effective treatment for obese patients with symptomatic cholelithiasis.     

Caffeine Pretreatment Enhances Clinical Efficacy and Reduces Cognitive Effects of Electroconvulsive Therapy

In an open clinical trial, depressed patients received age-dosed, brief-pulse electroconvulsive therapy (ECT) either with or without 500 mg i.v. caffeine sodium benzoate before each treatment. Caffeine-pretreated patients required fewer ECT treatments, and after three to four treatments, their Hamilton Depression Scale (HDS) scores were significantly lower. At the end of the ECT course, both groups reached the same reduction in HDS scores. Of five memory tests, one showed better performance at the end of the ECT course for the caffeine-pretreated compared with the non-caffeine-pretreated patients. The results argue that caffeine-modified ECT differs from unmodified ECT in speed of response and the effects on cognitive tests.     

Elektromyographische und funktionsanalytische Befunde bei obstruktiven Defäkationsstorungen

Zusammenfassung Zur Beurteilung der funktionellen Ergebnisse bei Patienten mit obstruktiven Defäkationsstö-rungen warden bei 27 Patienten (im Alter von 42–74 Jahren) elektromyographische, manometrische und radiologische Untersuchungen durchgeführt. Die Elektromyographie stellt eine dynamische Untersuchungstechnik dar und erlaubt eine Differenzierung zwischen neuro- und myogenen Störungen der willkürlichen Bekkenbodenmuskulatur. Patienten mit einer obstruktiven Defäkation lassen sich elektromyographisch in eine Gruppe mit neurogenen, eine Gruppe mit myogenen und eine weitere Gruppe mit neuromyogenen Veränderungen einteilen. Die Gruppen mit neurogenen bzw. myogenen Veränderungen zeigten statistisch signifikante Unterschiede gegenüber der Kontrollgruppe bei der mittleren Amplitude, der Entladungsfrequenz und dem Integral. Die neurogene Patientengruppe zeigte weiterhin Unterschiede hinsichtlich der Aktionspotentialdauer und die myogene hinsichtlich der Aktionspotentialhöhe. 77 % der untersuchten Patienten waren nicht in der Lage, während der Defakation den Beckenboden zu relaxieren.

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Einctromyographic and functional analytic findings in obstructed defecation. A contribution to discriminate between neurogenic and myogenous sphincter injuries

Summary The aim of this study was to get further information about functional results in patients with outlet obstruction. We investigated 27 patients (age between 42 and 74 years) by electromyography (EMG), manometry and radiology with contrast-solution. The electromyography, a dynamic investigation method, allows the differentiation between neuronal and muscular malfunctions of the voluntary controlled pelvis muscles. Patients with outlet obstruction should be divided into three groups by EMG diagnosis: One group with neuronal alterations, another group with muscular alterations and one group with neuro-muscular alterations. We obtained marked statistical differenceds between patients with neuronal or muscular malfunctions in the mean amplitude, the turns per second and the integration of the mean amplitude compared to the control group (14 patients). Patients with only neuronal alterations showed furthermore statistically significant distinctions of the action potential duration from control, whereas the data of patients with muscular malfunctions were significantly different from control in the peak amplitude of the action potentials. 77 % of all investigated patients were not able to relax the pelvis muscles during defecation.