ABSTRACT
PURPOSE: Laparoscopic herniorrhaphy (LH) has become the treatment of choice in many centers for patients with inguinal hernia (IH). Our aim was to compare the morbidity outcomes of bilateral vs unilateral IH repair using the laparoscopic total extra-peritoneal (TEP) technique, to determine whether undertaking bilateral IH repair places patients at additional risk. METHODS: Manuscripts published up to the end of 2021 on PubMed/MEDLINE, EMBASE, Cochrane Library, Scopus, and Web of Science were searched. Patients (> 16 years) undergoing a primary elective unilateral or bilateral TEP operation, using the standard 3-port laparoscopic technique, were identified. Quality of evidence was assessed using the GRADE criteria. Meta-analysis was conducted where possible. Where this was not possible, vote counting was conducted using effect direction plots. RESULTS: Eight observational studies, with a total of 18,153 patients were included. Operative time was significantly longer for bilateral operations. There was no significant difference in conversion to open, post-operative seroma, urinary retention, haematoma, and length of hospital stay. There was an increased rate of hernia recurrence in patients undergoing bilateral IH repair. CONCLUSION: Although limited by the observational nature of the included studies, there is no conclusive evidence to suggest a differential burden of morbidity between unilateral and bilateral TEP IH repair. As all included papers are from observational studies only, evidence from all outcomes is at best very low quality. This manuscript thereby highlights a need for randomized controlled trials to be conducted in this area.
Subject(s)
Hernia, Inguinal , Laparoscopy , Humans , Hernia, Inguinal/surgery , Herniorrhaphy/adverse effects , Herniorrhaphy/methods , Peritoneum/surgery , Laparoscopy/adverse effects , Laparoscopy/methods , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Postoperative Complications/surgery , Treatment OutcomeABSTRACT
BACKGROUND: The allocation of cadaveric livers for transplantation in the United States is now based on the severity of illness as determined by the Model for End-Stage Liver Disease (MELD), which was developed to predict short-term mortality in patients with cirrhosis. However, its impact to predict posttransplantation survival is controversial. The objective of this study was to determine the association of various pretransplantation risk factors, including the MELD score and whether its use to allocate organs is likely to lead to overall poorer outcomes of liver transplantation. METHODS: The 1,032 consecutive adult liver transplantation patients at King's College Hospital between 2 January 1994 and 29 December 2001 were examined for 9 preoperative risk factors, including MELD score, using univariate and multivariate techniques. Based on their pretransplantation MELD scores, we categorized recipients as low (<15) medium (15-25), or high (>25). Kaplan-Meier patient survival analysis was used to identify differences in outcomes. RESULTS: The patients had a mean age of 47.2 years and mean posttransplantation follow-up of 5.3 years. Univariate analysis showed recipient diabetes mellitus, renal dysfunction, and pretransplantation MELD score to be associated with patient survival. Multivariate analysis showed the MELD score to be significantly associated with death during long-term follow-up. CONCLUSIONS: A high pretransplantation MELD score was associated with poor posttransplantation outcomes.
Subject(s)
Health Status Indicators , Liver Diseases/diagnosis , Liver Diseases/surgery , Liver Transplantation , Adult , Female , Humans , Kaplan-Meier Estimate , Liver Diseases/mortality , Liver Transplantation/adverse effects , Liver Transplantation/mortality , London , Male , Middle Aged , Multivariate Analysis , Predictive Value of Tests , Proportional Hazards Models , Retrospective Studies , Risk Assessment , Risk Factors , Severity of Illness Index , Time Factors , Tissue and Organ Procurement , Treatment OutcomeSubject(s)
CD40 Antigens/physiology , CD40 Ligand/physiology , Graft Survival/immunology , Immunosuppression Therapy/methods , Sirolimus/therapeutic use , Skin Transplantation/immunology , Transplantation, Homologous/immunology , Animals , Graft Survival/drug effects , Male , Rats , Rats, Inbred Lew , Time FactorsABSTRACT
Wild maize, agricultural maize, and associated Manihot fossil polleni indicative of early agriculture after about 7300 years ago have been discovered in the Gatun basin, Panama. The course of risinig sea level in the Canal Zone during the past 11,300 years is calculated.
ABSTRACT
Freshwater peats from the continental shelf off northeastern United States contain the same general pollen sequence as peats from ponds that are above sea level and that are of comparable radiocarbon ages. These peats indicate that during glacial times of low sea level terrestrial vegetation covered the region that is now the continental shelf in an unbroken extension from the adjacent land areas to the north and west.
