Open vs. robot-assisted preperitoneal inguinal hernia repair. Are they truly clinically different?

INTRODUCTION: Inguinal hernia repair lacks a standard repair technique, with laparo-endoscopic and open preperitoneal methods showing similar outcomes. Despite higher costs, the popularity of robotic surgery is on the rise, driven by technological advantages. Controversies persist in comparing open repair techniques with the robotic approach, given contradictory results. The objective of this study was to compare postoperative outcomes, including complications, chronic pain, and recurrence, between open and robotic-assisted preperitoneal inguinal hernia repair. METHODS: This single-center retrospective study encompassed patients undergoing elective inguinal hernia repair in a specialized unit, employing both open preperitoneal and robotic-assisted laparoscopic approaches from September 2018 to May 2023. Comparative analysis of short- and long-term outcomes between these techniques was conducted. Additionally, multivariate logistic regression was employed to explore predictors of postoperative complications. RESULTS: A total of 308 patients met the inclusion criteria. 198 (64%) patients underwent surgery using an open preperitoneal approach and 110 (36%) using robot-assisted laparoscopy. Patients in the robot-assisted group were younger (P = 0.006) and had fewer comorbidities (P < 0.001). There were no differences between the groups in terms of postoperative complications (P = 0.133), chronic pain (P = 0.463) or recurrence (P = 0.192). Multivariate analysis identified ASA ≥ III (OR, 1.763; 95%CI, 1.068-3.994; P = 0.027) and inguinoscrotal hernias (OR, 2.371, 95%CI, 1.407-3.944; P = 0.001) as risk factors of postoperative complications. CONCLUSIONS: Both open preperitoneal and robotic-assisted laparoscopic approaches show similar outcomes for complications, chronic pain, and recurrence when performed by experienced surgeons. The open preperitoneal approach, with its quicker operative time, may be advantageous for high-comorbidity cases. Treatment choice should consider patient factors, surgeon experience, and healthcare resources.

Polymorphisms of the FOXF1 and MHC locus genes in individuals undergoing esophageal acid reflux assessments.

Gastroesophageal reflux disease (GERD) may lead to Barrett's esophagus (BE). Previously, a large genome-wide association study found two germline markers to be associated with BE, FOXF1 rs9936833 (C allele) and MHC rs9257809 (A allele). This study evaluated whether these two polymorphisms are associated with gastroesphageal acid reflux as measured by 24-hour pH testing. Patients with acid reflux symptoms referred for esophageal manometry and 24-hour pH monitoring at University Health Network (Toronto, ON) were enrolled. DNA extracted from blood was genotyped using a Taqman Polymerase Chain Reaction (PCR) assay. DeMeester scores of ≥14.7 or prior evidence of reflux esophagitis on endoscopy defined individuals with esophageal acid reflux. Logistic regression analysis, adjusted for clinical risk factors, was used to calculate odds ratios with 95% confidence intervals for each polymorphism in relation to the presence of acid reflux. Of 182 patients, the median age was 50 years and 62% were female; 95 (52%) met the definition of GERD. In the multivariable analysis, both FOXF1 rs9936833 (OR = 1.82; 95%CI: 1.12-2.96; P = 0.02) and MHC rs9257809 (OR = 9.36; 95%CI: 2.92-29.99; P < 0.001) remained significantly associated with presence of acid reflux. When both polymorphisms were placed in the same model, the adjusted ORs were 2.10 (95%CI: 1.24-3.53; P = 0.005) and 10.95 (95%CI: 3.32-36.09; P < 0.001), respectively. The association for risk allele C in FOXF1 rs9936833 and risk allele A in MHC rs9257809 with the presence of acid reflux suggests a potential pathophysiologic mechanism for the role of genetic influences in BE development.

Evidence for a new magnetic field scale in CeCoIn5.

The Nernst coefficient of displays two distinct anomalies in magnetic field. The feature detected at Hk approximately 23 T is similar to what is observed in CeRu2Si2 at Hm = 7.8 T where a metamagnetic transition occurs. In CeCoIn5, new frequencies are observed in de Haas-van Alphen oscillations when the field exceeds 23 T where the Dingle temperature decreases by about 30%. Based on the Nernst coefficient anomalies, the magnetic phase diagram of CeCoIn5 is revised.

Thermal transport in the hidden-order state of URu2Si2.

We present a study of thermal conductivity in the normal state of the heavy-fermion superconductor URu2Si2. Ordering at 18 K leads to a steep increase in thermal conductivity and (in contrast with all other cases of magnetic ordering in heavy-fermion compounds) to an enhancement of the Lorenz number. By linking this observation to several other previously reported features, we conclude that most of the carriers disappear in the ordered state and this leads to a drastic increase in both the phononic and electronic mean free path.

Giant Nernst effect in CeCoIn5.

We present a study of Nernst and Seebeck coefficients of the heavy-fermion superconductor CeCoIn5. Below 18 K, concomitant with a field-dependent Seebeck coefficient, a large sublinear Nernst signal emerges with a magnitude drastically exceeding what is expected for a multiband Fermi-liquid metal. In the mixed state, in contrast with all other superconductors studied before, this signal overwhelms the one associated with the motion of superconducting vortices. The results point to a hitherto unknown source of transverse thermoelectricity in strongly interacting electrons.

Diamagnetic orbital response of mesoscopic silver rings.

We report measurements of the flux-dependent orbital magnetic susceptibility of an ensemble of 10(5) disconnected silver rings at 217 MHz. Because of the strong spin-orbit scattering rate in silver this experiment is a test of existing theories on ensemble averaged persistent currents. Below 100 mK the rings exhibit a magnetic signal with a flux periodicity of h/2e consistent with averaged persistent currents, whose amplitude is of the order of 0.3 nA. The sign of the oscillations indicates unambiguously diamagnetism in the vicinity of zero magnetic field. This sign is a priori not consistent with theoretical predictions for average persistent currents. We discuss several possible explanations of this result.