Magnetic sphincter augmentation device for gastroesophageal reflux disease: effective, but postoperative dysphagia and risk of erosion should not be underestimated. a systematic review and meta-analysis / Dispositivo magnético no esfincter para doença do refluxo gastroesofágico: eficaz, mas a disfagia pós-operatória e o risco de erosão não devem ser subestimados. uma revisão sistemática e meta-análise

ABSTRACT BACKGROUND: Magnetic ring (MSA) implantation in the esophagus is an alternative surgical procedure to fundoplication for the treatment of gastroesophageal reflux disease. AIMS: The aim of this study was to analyse the effectiveness and safety of magnetic sphincter augmentation (MSA) in patients with gastroesophageal reflux disease (GERD). METHODS: A systematic literature review of articles on MSA was performed using the Medical Literature Analysis and Retrieval System Online (Medline) database between 2008 and 2021, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A random-effect model was used to generate a pooled proportion with 95% confidence interval (CI) across all studies. RESULTS: A total of 22 studies comprising 4,663 patients with MSA were analysed. Mean follow-up was 27.3 (7-108) months. The weighted pooled proportion of symptom improvement and patient satisfaction were 93% (95%CI 83-98%) and 85% (95%CI 78-90%), respectively. The mean DeMeester score (pre-MSA: 34.6 vs. post-MSA: 8.9, p=0.03) and GERD-HRQL score (pre-MSA: 25.8 vs. post-MSA: 4.4, p<0.0001) improved significantly after MSA. The proportion of patients taking proton pump inhibitor (PPIs) decreased from 92.8 to 12.4% (p<0.0001). The weighted pooled proportions of dysphagia, endoscopic dilatation and gas-related symptoms were 18, 13, and 3%, respectively. Esophageal erosion occurred in 1% of patients, but its risk significantly increased for every year of MSA use (odds ratio — OR 1.40, 95%CI 1.11-1.77, p=0.004). Device removal was needed in 4% of patients. CONCLUSIONS: Although MSA is a very effective treatment modality for GERD, postoperative dysphagia is common and the risk of esophageal erosion increases over time. Further studies are needed to determine the long-term safety of MSA placement in patients with GERD.

RESUMO RACIONAL: A implantação de anel magnético (AM) no esôfago é um procedimento cirúrgico alternativo à fundoplicatulra, para o tratamento da doença do refluxo gastroesofágico. OBJETIVOS: O objetivo deste estudo foi analisar a eficácia e segurança do anel magnético em pacientes com doença do refluxo gastroesofágico (DRGE). MÉTODOS: Uma revisão sistemática da literatura de artigos sobre AM foi realizada usando o banco de dados Medline entre 2008 e 2021, seguindo as diretrizes PRISMA. Um modelo de efeito aleatório foi usado para gerar uma proporção agrupada com intervalo de confiança (IC) de 95% em todos os estudos. RESULTADOS: Um total de 22 estudos compreendendo 4.663 pacientes submetidos à colocação do AM foram analisados. O seguimento médio foi de 27,3 (7-108) meses. A proporção ponderada de melhora dos sintomas e satisfação do paciente foi de 93% (IC95% 83-98%) e 85% (IC95% 78-90%), respectivamente. A pontuação média de DeMeester (pré-AM: 34,6 versus pós-AM: 8,9, p=0,03) e pontuação GERD-HRQL (pré-AM: 25,8 versus pós-AM: 4,4, p<0,0001) melhoraram significativamente após a colocação do anel. A proporção de pacientes em uso de inbidor de bomba de prótons (IBP) diminuiu de 92,8% para 12,4% (p<0,0001). A erosão esofágica ocorreu em 1% dos pacientes, o risco aumentou significativamente para cada ano de uso do AM (OR 1,40; IC95% 1,11-1,77, p=0,004). A remoção do dispositivo foi necessária em 4% dos pacientes. CONCLUSÕES: O AM é uma modalidade de tratamento eficaz para a DRGE. A disfagia pós-operatória é comum, e o risco de erosão esofágica aumenta com o tempo.

Impacto de la subespecialización en los resultados de la sigmoidectomía laparoscópica por diverticulitis perforada Hinchey III / Outcomes of emergent laparoscopic sigmoid resection for Hinchey III diverticulitis: Does specialization matter?

Introducción: La sigmoidectomía por diverticulitis perforada es una cirugía de urgencia comúnmente realizada por cirujanos generales. Está descripta la correlación positiva entre el volumen del cirujano y los mejores resultados postoperatorios. Sin embargo, existe escasa evidencia de la influencia de la especialización en cirugía colorrectal sobre los resultados de la sigmoidectomía laparoscópica por diverticulitis perforada. Objetivo: Evaluar el impacto de la especialización en cirugía colorrectal en los resultados postoperatorios de la sigmoidectomía laparoscópica por diverticulitis Hinchey III. Diseño: Estudio retrospectivo sobre una base de datos cargada de forma prospectiva. Material y métodos: Se incluyeron pacientes sometidos a sigmoidectomía laparoscópica por diverticulitis perforada Hinchey III. La muestra fue dividida en dos grupos: pacientes operados por un cirujano colorrectal (CC) y aquellos operados por un cirujano general (CG). Las variables demográficas, operatorias y postoperatorias fueron comparadas entre los grupos. El objetivo primario fue determinar si existían diferencias en la proporción de anastomosis primaria, morbilidad y mortalidad a 30 días entre los grupos. Resultados: Se incluyeron 101 pacientes en el análisis; 58 operados por CC y 43 por CG. Los pacientes operados por CC presentaron una mayor proporción de anastomosis primaria (CC: 98,3% vs. CG: 67,4%, p<0,001). Los CG realizaron más estomas (CC: 13,8% vs. CG: 46,5%, p<0,001), presentaron un mayor índice de conversión (CC: 20,6% vs. CG: 39,5%, p=0,03) y una mayor estadía hospitalaria (CC: 6,2 vs. CG: 10,8 días, p<0,001). La morbilidad global (CC: 34,4% vs. CG: 46,5%, p=0.22), dehiscencia anastomótica (CC: 3,5% vs. CG: 6,8%, p=0.48) y la mortalidad (CC: 1,7% vs. CG: 9,3 %, p=0,08) fueron similares entre ambos grupos. Conclusión: La sigmoidectomía laparoscópica de urgencia realizada por CG presenta similar morbilidad y mortalidad postoperatoria que la realizada por CC. Sin embargo, la participación del especialista se asoció a una mayor frecuencia de anastomosis primarias, menos estomas y una estadía hospitalaria más corta.

Background: Sigmoid resection for perforated diverticulitis is one of the most common emergency surgeries and often performed by general surgeons. Relationship between high-volume surgeons and improved postoperative outcomes is well established. However, the influence of colorectal specialization on outcomes after emergency laparoscopic sigmoidectomy for perforated diverticulitis is not well described. Aim: Evaluate the impact of colorectal surgery training on the outcomes after emergency laparoscopic sigmoid resection for Hinchey III diverticulitis. Design: Retrospective analysis of prospectively collected database.Method: Patients undergoing emergent laparoscopic sigmoid resection for perforated (Hinchey III) diverticulitis were identified and stratified by involvement of colorectal or general surgeon. This study was conducted from 2000 to 2018 at a teaching hospital. Primary outcome measures were primary anastomosis, postoperative morbidity and mortality.Results: A total of 101 patients were identified; 58 by colorectal and 43 by general surgeons. Patients in the colorectal surgeon group had higher rates of primary anastomosis (CS: 98, 2% vs. GS: 67, 4%, p<0.001). General surgeons performed more ostomies (CS: 13, 8% vs. GS: 46, 5%, p<0.001), had a higher conversion rate (CS: 20, 6% vs. GS: 39, 5%, p=0.03) and longer mean length of hospital stay (CS: 6, 2 vs. GS: 10, 8 days, p<0.001). Overall morbidity (CS: 34, 4% vs. GS: 46, 5%, p=0.22), anastomotic leak rate (CC: 3,5% vs. CG: 6,8%, p=0.48) and mortality (CS: 1, 7% vs. GS: 9,3 %, p=0.08) were similar between groups. Conclusion: Emergency laparoscopic sigmoid resection by general surgeons wasn ́t associated with higher rates of postoperative morbidity, anastomotic leakage or mortality. However, patients operated by colorectal surgeons had higher rates of primary anastomosis, lower rates of ostomy, conversion and shorter length of hospital stay.

Factores de riesgo de recidiva luego de la hernioplastia inguinal laparoscópica: seguimiento de una cohorte a 5 años / Risk factors for recurrence after laparoscopic inguinal hernia repair: a 5-year retrospective cohort study

Antecedentes: la hernioplastia inguinal laparoscópica ha demostrado múltiples beneficios. Sin embargo, la tasa de recidiva continúa siendo materia de estudio y controversia. Objetivo: analizar factores de riesgo de recidiva poshernioplastia inguinal laparoscópica con seguimiento posoperatorio alejado. Material y métodos: se incluyó una serie consecutiva de pacientes con hernioplastia inguinal laparoscópica (TAPP). Período: diciembre de 2012 hasta mayo de 2017, con seguimiento mínimo de 6 meses. Se dividió la muestra en dos grupos, G1: pacientes con recidiva y G2: pacientes sin recidiva. Se analizaron variables demográficas, quirúrgicas y resultados alejados a 5 años. Resultados: se realizaron 717 hernioplastias en 443 pacientes. El tabaquismo, una recidiva previa, la malla menor de 12 ×15 cm y cirugías realizadas por equipos con menos de 30 plásticas/año se relacionaron en forma significativa con recidiva en el análisis univariado (p < 0,05). Sin embargo, el tabaquismo y los pacientes operados por equipos de menor experiencia mostraron significancia estadística en el análisis multivariado (p < 0,01). Con un seguimiento de 2 años se detectó una tasa de recidiva de 1,5%, mientras que esa cifra ascendió a 2,6% (n = 19) a los 5 años. Conclusión: prolongar el tiempo de seguimiento más allá de los 2 años luego de la plástica inguinal laparoscópica permite una detección más precisa de la tasa de recidiva. En la presente serie, el tabaquismo y un equipo tratante de menor experiencia fueron factores que impactan de forma significativa en su desarrollo.

Background: The benefits of laparoscopic inguinal hernia repair are multiple; however, the recurrence rate is still controversial and under debate. Objective: The aim of this study is tu analyze the risk factors associated with long-term recurrence after laparoscopic inguinal hernia repair. Material and methods: The cohort was made up of consecutive patients undergoing transabdominal preperitoneal approach between December 2012 and May 2012, with a minimum follow-up of 6 months. The sample was divided into two groups: G1 (patients with recurrence) and G2 (patients without recurrence). The demographic and clinical variables and the outcomes at 5 years were analyzed. Results: A total of 717 inguinal hernia repairs were performed in 443 patients. Smoking habits, previous recurrence, mesh size < 12 ×15 cm and surgeries carried out by surgical teams performing < 30 procedures per year were significantly associated with recurrence on univariate analysis (p < 0.05). but only smoking habits and surgeries performed by less experienced surgeons showed statistical significance on multivariate analysis (p < 0.01). Recurrence rate was 1.5% at years and increased to 2.6% (n = 19) at 5 years. Conclusion: Extending the follow-up period beyond 2 years after laparoscopic inguinal hernia repair allows a more accurate detection of the recurrence rate. In this series, smoking habits and surgeries performed by less experienced surgeons were significantly associated with recurrences.