Coatings for Permanent Meshes Used to Enhance Healing in Abdominal Hernia Repair: A Scoping Review.

INTRODUCTION: Hernia meshes are used to reduce recurrence and pain rates, but the rates are still high. This could be improved with coatings of the mesh. This scoping review aimed to provide an overview of mesh coatings used to promote healing in abdominal hernia repair and to report beneficial and unbeneficial effects. METHODS: We included human and animal studies with abdominal hernias that were repaired with non-commercially coated meshes. We searched Pubmed, Embase, Cochrane Central, LILACS, and CNKI without language constraints. RESULTS: Of 2933 identified studies, 58 were included: six studies had a total of 408 humans and 52 studies had 2679 animals. The median follow-up was 12 months (range 1-156), and 95% of the hernias were incisional. There were 44 different coatings which included platelet-rich plasma, mesenchymal stem cells, growth factors, vitamin E, collagen-derived products, various polysaccharides, silk proteins, chitosan, gentamycin, doxycycline, nitrofurantoin, titanium, and diamond-like carbon. Mesenchymal stem cells and platelet-rich plasma were the most researched. Mesenchymal stem cells notably reduced inflammation and foreign body reactions but did not impact other healing metrics. In contrast, platelet-rich plasma positively influenced tissue ingrowth, collagen deposition, and neovascularization and had varying effects on inflammation and foreign body reactions. CONCLUSION: We identified 44 different mesh coatings and they showed varying results. Mesenchymal stem cells and platelet-rich plasma were the most studied, with the latter showing considerable promise in improving biomechanical properties in hernia repair. Further investigations are needed to ascertain their definitive use in humans.

A comparison of cover letters written by ChatGPT-4 or humans.

INTRODUCTION: Artificial intelligence has started to become a part of scientific studies and may help researchers with a wide range of tasks. However, no scientific studies have been published on its ussefulness in writing cover letters for scientific articles. This study aimed to determine whether Generative Pre-Trained Transformer (GPT)-4 is as good as humans in writing cover letters for scientific papers. METHODS: In this randomised non-inferiority study, we included two parallel arms consisting of cover letters written by humans and by GPT-4. Each arm had 18 cover letters, which were assessed by three different blinded assessors. The assessors completed a questionnaire in which they had to assess the cover letters with respect to impression, readability, criteria satisfaction, and degree of detail. Subsequently, we performed readability tests with Lix score and Flesch Kincaid grade level. RESULTS: No significant or relevant difference was found on any parameter. A total of 61% of the blinded assessors guessed correctly as to whether the cover letter was written by GPT-4 or a human. GPT-4 had a higher score according to our objective readability tests. Nevertheless, it performed better than human writing on readability in the subjective assessments. CONCLUSION: We found that GPT-4 was non-inferior at writing cover letters compared to humans. This may be used to streamline cover letters for researchers, providing an equal chance to all researchers for advancement to peer-review. FUNDING: This study received no financial support from external sources. TRIAL REGISTRATION: This study was not registered before the study commenced.

Nerve identification during open inguinal hernia repair: a systematic review and meta-analyses.

PURPOSE: Inguinal hernia repair is one of the most common operations worldwide and despite this, the incidence of chronic pain remains high after inguinal hernia repair. The optimal nerve handling strategy is controversial and the rate at which nerves are identified remains uncertain. This study aimed to determine the identification rates of the ilioinguinal, iliohypogastric, and genitofemoral nerves as well as nerve handling strategies. METHODS: This review was registered on PROSPERO (CRD 42023416576). PubMed, Embase, and Cochrane Central were systematically searched. Studies with more than 10 patients were included if they reported an identification rate for at least one of the nerves during elective open inguinal hernia repair in adults. Studies requiring nerve identification in their study design were excluded. Bias was assessed with the JBI critical appraisal tool and Cochrane's RoB-2 tool. The overall estimate of the prevalence was analysed with prevalence meta-analyses. RESULTS: A total of 23 studies were included. The meta-analyses included 18 studies, which resulted in an identification rate of 82% (95% CI: 76-87%) for the ilioinguinal nerve, 62% (95% CI: 54-71%) for the iliohypogastric nerve, and 41% (95% CI: 27-55%) for the genitofemoral nerve. Nerves were spared in 82% of all repairs. CONCLUSION: The ilioinguinal, iliohypogastric, and genitofemoral nerves were identified in 82%, 62%, and 41% of surgeries, respectively. Most studies used a nerve-preserving strategy. The role of nerve identification in the development of chronic pain remains uncertain, as well as the optimal nerve handling strategy.

Reoperation for Recurrence is Affected by Type of Mesh in Laparoscopic Ventral Hernia Repair: A Nationwide Cohort Study.

OBJECTIVE: To compare the reoperation rate for recurrence between different mesh types in laparoscopic ventral hernia repair. SUMMARY OF BACKGROUND DATA: Ventral hernia repair has improved over the last decades. Nevertheless, recurrence rates are still high, and one type of mesh was recently found to increase it even more. METHODS: A nationwide cohort study based on prospectively collected data from the Danish Ventral Hernia Database. We included adult patients that had undergone a laparoscopic ventral hernia repair for either an incisional or a primary hernia. The primary and incisional hernias were analyzed in separate cohorts. The mesh-group with the lowest reoperation for recurrence curve was used as the reference. The outcome was reoperation for recurrence. RESULTS: Study population comprised 2874 patients with primary hernias and 2726 with incisional hernias. For primary hernias, Physiomesh [HR = 3.45 (2.16-5.51)] and Proceed Surgical Mesh [HR = 2.53 (1.35-4.75)] had a significantly higher risk of reoperation for recurrence than DynaMesh-IPOM. For incisional hernias, Physiomesh [HR = 3.90 (1.80-8.46), Ventralex Hernia Patch (HR = 2.99 (1.13-7.93), Parietex Composite (incl. Optimized) (HR = 2.55 (1.17-5.55), and Proceed Surgical Mesh (HR = 2.63 (1.11-6.20)] all had a significantly higher risk of reoperation for recurrence than Ventralight ST Mesh. CONCLUSION: For primary hernias, Physiomesh and Proceed Surgical Mesh had a significantly higher risk of reoperation for recurrence compared with DynaMesh-IPOM. For incisional hernias, the risk was significantly higher for Physiomesh, Parietex Composite, Ventralex Hernia Patch, and Proceed Surgical Mesh compared with Ventralight ST Mesh. This indicates that type of mesh may be associated with outcomes, and mesh choice could therefore depend on hernia type.

Reply to "Correspondence on 'cover letters written by ChatGPT-4 or humans'".

This is a reply to the: "Correspondence on "cover letters written by ChatGPT-4 or humans"" Dan Med J 2024;71(1):A205177.

Surgeon Volume and Risk of Reoperation after Laparoscopic Primary Ventral Hernia Repair: A Nationwide Register-Based Study.

BACKGROUND: Repairs of primary ventral hernias are common procedures but are associated with high recurrence rates. Therefore, it is important to investigate risk factors for recurrence to optimize current treatments. The aim of this study was to assess the impact of annual surgeon volume on the risk of reoperation for recurrence after primary ventral hernia repair. STUDY DESIGN: We conducted a nationwide register-based study with data from the Danish Ventral Hernia Database and the Danish Patient Safety Authority's Online Register linked via surgeons' authorization identification. We included patients 18 years and older, undergoing umbilical or epigastric hernia repair between 2011 and 2020. Annual surgeon volume was categorized into ≤ 9, 10 to 19, 20 to 29, and ≥ 30 cases. Patients were followed until reoperation, death, emigration, or end of the study period. RESULTS: We included 7,868 patients who underwent laparoscopic (n = 1,529 [19%]), open mesh (n = 4,138 [53%]), or open nonmesh (n = 2,201 [28%]) repair. There was an increased risk of reoperation after laparoscopic umbilical or epigastric hernia repair for surgeons with ≤ 9 (hazard ratio 6.57; p = 0.008), 10 to 19 (hazard ratio 6.58; p = 0.011), and 20 to 29 (hazard ratio 13.59; p = 0.001) compared with ≥ 30 cases/y. There were no differences in risk of reoperation after open mesh and open nonmesh repair in relation to annual surgeon volume. CONCLUSIONS: There was a significantly higher risk of reoperation after laparoscopic primary ventral hernia repair performed by lower-volume surgeons compared with high-volume surgeons. Additional research investigating how sufficient surgical training and supervision are ensured is indicated to reduce risk of reoperation after primary ventral hernia repair.

Adding sutures to tack fixation of mesh does not lower the re-operation rate after laparoscopic ventral hernia repair: a nationwide cohort study.

BACKGROUND: There are various ways of fixating an intraperitoneal onlay mesh during a laparoscopic ventral hernia repair. The risk of complications is high, and around 22% of the hernias will recur within 3.5 years. The aim of this study was to assess if sutures in addition to tack fixation would reduce the re-operation rate for recurrence compared with permanent tacks without sutures. METHODS: This study was based on the data from the nationwide Danish Ventral Hernia Database, which contains information of ventral hernia repairs from all hospitals in Denmark. Two different cohorts of patients were created and analyzed separately. The primary outcome was the re-operation rate for recurrence, analyzed with the Cox regression model and illustrated with a Kaplan-Meier plot adjusted for confounders. The follow-up period was defined as months from the first hernia repair to re-operation for recurrence, death, or the 1st of June 2017. RESULTS: The first cohort included 598 patients with absorbable sutures and tacks compared with 1793 patients with permanent tacks. The second cohort included 72 patients with permanent sutures and tacks compared with 216 patients with permanent tacks. In the suture groups, the tack material was either permanent or absorbable. When adjusting for possible confounders in the Cox regression model, there were no significant differences in the re-operation rate for recurrence between the groups in the two cohorts. CONCLUSION: Adding sutures, either absorbable or permanent, to tack fixation of mesh during laparoscopic ventral hernia repair did not influence the re-operation rates for recurrence.

Loss of Smell and Taste After General Anesthesia: A Case Report.

This case report describes a patient, who lost the ability to smell and taste after receiving a propofol-based general anesthesia for a laparoscopic inguinal hernia repair. Immediately after the procedure, the patient had anosmia (loss of smell), ageusia (loss of taste), and light dysphagia. Assessment by an otorhinolaryngologist and the results of a magnetic resonance imaging could not clarify the pathology behind these symptoms. Although there are several plausible explanations for the patient's anosmia and ageusia (eg, cerebral infarcts, nerve damage, chronic sinusitis), the most likely explanation is an uncommon adverse drug reaction to the anesthetic agents used during the procedure.