Abdominal binders after laparotomy: review of the literature and French survey of policies

Background and aim

The use of abdominal binders after laparotomy is a question of habit. Scientific evidence of their usefulness is limited. The aims of this work were to review the scientific literature and to depict the practices of French surgeons regarding the use of these devices.

Methods

A systematic review of the literature about the use of abdominal binders after laparotomy was conducted. In order to depict surgeons’ habits, an anonymous questionnaire was sent to all surgical departments affiliated to the FRENCH network (Federation of Surgical Research) and their surgical contacts. They were all asked about their use of binders, the type of binders they ordered, the expected benefit, the cost and the need for a randomized trial in this field.

Results

Only four trials have been published regarding the use of abdominal binders after laparotomy, all with a small number of patients. Some authors suggested that wearing binders procured a benefit in terms of postoperative comfort, but no significant difference was found. One study also suggested an improvement in respiratory volumes. No study focused on incisional hernia. Regarding the survey of practices, 50 questionnaires were retained for the final analysis (one questionnaire per department of surgery). The use of this device is really very frequent in France (94 % of surgeons order them), a habit usually acquired during the training in surgery. The main expected benefit is the prevention of abdominal wall dehiscence (83 %), but also an improvement in patients’ postoperative comfort and pain (66 %). Although some surgeons order an abdominal binder for all their patients, most use them in selected patients (according to the operation and the patients’ characteristics).

Conclusion

Abdominal binders are frequently ordered by French surgeons after laparotomy. The expected benefit is the prevention of abdominal-wall complications, even though no data actually support this practice. Binders might have a benefit in terms of postoperative pain relief, but this needs to be analyzed. A prospective randomized trial is warranted.     

Bevacizumab Efficacy in Metastatic Colorectal Cancer is Dependent on Primary Tumor Resection

Purpose

Bevacizumab plus fluoropyrimidine-based chemotherapy is standard treatment for first-line and second-line metastatic colorectal cancer (mCRC). However, to date, there is no current biomarker predictive for the benefit of bevacizumab use for these patients. Preclinical data suggest that the presence of the primary tumor could be involved in less efficient antitumor activity of antiangiogenic agents, but no clinical data currently support this hypothesis.

Methods

We performed a retrospective analysis of factors associated with overall survival (OS) in a study cohort of 409 mCRC patients. Univariate and multivariate Cox proportional hazard regression models were used to assess the influence of primary tumor resection and bevacizumab use on OS. We evaluated associations linking bevacizumab use and OS among patients who previously underwent or did not undergo primary tumor resection. Results were externally validated in a second independent cohort of 328 mCRC patients.

Results

In the study cohort, bevacizumab use and resection of the primary tumor were associated with improved OS. However, subgroup analyses indicate that bevacizumab did not influence survival of patients bearing a primary colorectal tumor (hazard ratio (HR) 0.98, 95 % confidence interval (CI) 0.60–1.61, log-rank test P = 0.6). By contrast, the survival benefit of bevacizumab was restricted to patients who previously underwent primary tumor resection (HR 0.71, 95 % CI 0.55–0.92, P = 0.009). Similar results were observed in the validation cohort.

Conclusions

Addition of bevacizumab to chemotherapy is associated with improvement of OS only in patients with primary tumor resection. These data support the rationale to validate prospectively the influence of primary tumor resection on bevacizumab antitumor effect in synchronous mCRC.     

Childbearing After Hyperthermic Intraperitoneal Chemotherapy: Results From an International Survey

Background  

Cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC) can improve survival in selected patients with primary or secondary peritoneal malignancies. With the opportunity for long-term survival, questions about the impact of those procedures in fertility in women of childbearing age can be raised.     

Closed Hyperthermic Intraperitoneal Chemotherapy with Open Abdomen: a Novel Technique to Reduce Exposure of the Surgical Team to Chemotherapy Drugs

Background Exposure of the surgical team to toxic drugs during hyperthermic intraperitoneal chemotherapy (HIPEC) remains a matter of great concern. During closed-abdomen HIPEC, operating room staff are not exposed to drugs, but the distribution of the heated liquid within the abdomen is not optimal. With open-abdomen HIPEC, the opposite is true. Although the open-abdomen method is potentially more effective, it has not become a standard procedure because of the risk of exposure of members of the team to drugs. Methods We present a new technique (closed HIPEC with open abdomen) which ensures protection against potentially contaminating exposure to liquids, vapours and aerosols, and allows permanent access to the whole abdominal cavity. Its principle is to extend the abdominal surgical wound upwards with a sort of “glove-box”. The cutaneous edges of the laparotomy are stapled to a latex “wall expander”. The expander is draped over a special L-section metal frame placed above the abdomen. A transparent cover containing a “hand-access” port, like those used in laparoscopic surgery, is fixed inside the frame. Results In 10 patients, this device proved to be hermetic for both liquids and vapours. Intra-abdominal temperature was maintained between 42 and 43°C during most of the procedure. The whole abdominal cavity was accessible to the surgeon, allowing optimal exposure of all peritoneal surfaces. Conclusion This technique allows optimal HIPEC, while limiting the potential toxic effects for the surgical, medical and paramedical teams. Authors’ Disclosures of Potential Conflicts of Interest: Patrick Rat, MD, has received lecture fees and grant support from Landanger. He conceived and patented the expander sheet in 2003 and then transferred the copyright to Landanger, who actually owns it for the entire device.     

Immunonutrition in surgical oncology: the French experience

Malnutrition is frequent among cancer patients and must be evaluated before the surgery. Immunonutrition is a nutritional support therapy focused on modulating the inflammatory response, stimulating the immunology, maintaining intestinal trophicity and reducing overall postoperative morbidity, particularly infectious complications. Immunonutrition is indicated in elective digestive surgical oncology, and the length of administration depends on the presence or not of malnutrition. This treatment is now a standard of care in France, because the recommendations of the French Society of Digestive Surgery (2005) and its reimbursement by the National Health System.     

Lactobacillus stress protein GroEL prevents colonic inflammation

Journal of Gastroenterology - We previously showed that supernatants of Lactobacillus biofilms induced an anti-inflammatory response by affecting the secretion of macrophage-derived cytokines,...     

Inflammatory markers as predictors of surgical site infection after elective colorectal cancer surgery

We raise some doubts regarding the methods, results and conclusions obtained by Takakura et al. in their article published in the August’s issue of the journal about the use of inflammatory markers as early predictors of surgical infection after colorectal cancer surgery.