Oral melatonin did not reduce anxiety before elective hernia repair: A randomised, double-blinded, placebo-controlled trial.

BACKGROUND: Preoperative anxiety is a common issue in surgery. Preoperative anxiety may lead to increased mortality, pain and dissatisfaction with surgery. Melatonin is a drug with only mild adverse effects and has previously been shown to reduce anxiety and pain in the perioperative setting. The aim of study was to investigate the anxiolytic effect of melatonin in the preoperative setting. METHODS: This study was a randomised, double-blinded, placebo-controlled clinical trial. Included patients were allocated in the ratio 1:1 to either the placebo group or the melatonin group. Patients received 10 mg melatonin or placebo the evening before surgery, 2 h before surgery, immediately after surgery and the evening after surgery. Preoperative anxiety was examined 1 h before surgery, using the State Trait Anxiety Inventory (STAI) questionnaire, along with a Visual Analogue Scale (VAS) of anxiety. Furthermore, participants filled out a sleep log each morning, where we examined sleep quality, comfort and drowsiness. RESULTS: Sixteen patients received placebo treatment and 17 patients received melatonin. Median state anxiety on the STAI scale at baseline was 27 (interquartile range [IQR] 22-34) for the melatonin group and 27 (IQR 23-31) for the placebo group. In the primary outcome of preoperative anxiety 1 h before surgery, the median state anxiety on the STAI scale was 27 (IQR 24-34) for the melatonin group and 28 (24-33) for the placebo group, p = .814. VAS anxiety was median 7 (0-28) for the melatonin group and median 7 (1-13) for the placebo group, p = .813. Furthermore, there were no statistically significant differences between the two groups in the secondary outcomes of sleep quality and consumption of analgesics. CONCLUSION: Melatonin did not reduce preoperative anxiety in patients undergoing hernia repair. Preoperative anxiety levels were low, which limits the generalisability of our findings.

[Christmas article: Flying fattens and swimming slims - the secret of the mermaid].

INTRODUCTION We aimed to investigate how, changes in atmospheric pressure influence the human body. METHODS The study was an observational study, reported according to the STROBE-guideline (STrengthening the Reporting of OBservational studies in Epidemiology). Participants had their abdominal circumference measured on ground level, at the bottom of a pool, and during flight. This was used to investigate the relationship between atmospheric pressure and abdominal circumference. RESULTS We included 17 participants for the flight study and 12 participants for the pool study. Flying increased abdominal circumference from median 82 cm (range: 72-117 cm) at ground level to 86 cm (74-122 cm) in flight, p = 0.001. Submersion in water caused a decrease in abdominal circumference from median 82 cm (70-116 cm) at ground level to 79 cm (67-114 cm) under water, p = 0.003. Furthermore, flying resulted in a significant increase in self-reported flatulence and bloating from median 27 (0-69) to 50 (0-93), p = 0.02 (scale 0-100). Flying also caused an increase in abdominal pain from median 0 (0-68) to 3 (0-70), p = 0.02 (scale: 0-100). CONCLUSION Our findings confirm that changes to environment and thereby atmospheric pressure, influence abdominal circumference. This is likely due to expansion and compression of bowel gasses related to the ambient atmospheric pressure. Interestingly, our findings may help explain the physical appearance of mermaids. FUNDING none. TRIAL REGISTRATION none.

Laparotomy with suture repair is the most common treatment for obturator hernia: a scoping review.

BACKGROUND: Obturator hernias are rare and associated with high mortality. However, the optimal surgical approach remains unknown. We aimed to investigate the available evidence and examine the surgical details regarding obturator hernia defect closure as well as the recurrence rates of the different approaches. METHODS: We reported this scoping review according to the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analysis Extension for Scoping Reviews) and registered the protocol online. A comprehensive literature search in five different databases was conducted. The population was patients undergoing surgery for obturator hernia. Articles were included for data charting if the management of the hernia defect was reported. Data regarding surgical details, and hernia recurrence were extracted. RESULTS: A total of 1299 patients from 313 articles were included. In total, 937 patients underwent open obturator hernia repair, in which 992 hernias were repaired (including some bilateral obturator hernias). A total of 295 patients underwent laparoscopic repair for 341 obturator hernias, and for the remaining 67 patients, type of surgery was not reported. For open surgery, suture repair was the most common method of repair (n = 508, 51%) with a recurrence rate of 10%. For laparoscopic surgery, the most common repair of the defect was mesh repair (n = 299, 88%) with no reported recurrences. CONCLUSION: Open surgery with primary suture repair is the most common method of repair for obturator hernia but is associated with a recurrence rate of 10%. Laparoscopic mesh repair is becoming more common and have seemingly very low recurrence rates and may be a better method of repair.