Computer-based multimodal training module facilitates standardization of complete mesocolic excision technique for right-sided colon cancer: Long-term oncological outcomes.

AIM: The aim of this study is to demonstrate our video training tool developed to teach and standardize complete mesocolic excision (CME) for right-sided colon cancer and also to present our long-term oncological outcomes. METHOD: Educational narrative videos were produced to demonstrate the technical steps of CME. First, a three-dimensional animation video was prepared. Then cadaveric dissections were recorded in a step-by-step fashion, following the sequences of open and minimally invasive surgery. These were followed by videos of real-life demonstrations of surgical procedures, enhanced by superimposed animations of key anatomical structures. In order to demonstrate the impact of this training module on outcomes of patients undergoing CME, we retrospectively queried data from before (2005-2010) and after (2011-2019) implementation of standardized CME in our practice. RESULTS: A total of 180 consecutive patients underwent right hemicolectomy between 2005 and 2019. Fifty-four patients underwent surgery before and 126 patients after CME principles were elaborated and standardized. Of those patients who had surgery after the training module, 58 (46%) underwent open surgery and 68 (54%) underwent laparoscopic colectomy. Demographics, perioperative parameters and morbidity were comparable between the groups. The 5-year overall and disease-free survival rates were significantly improved after implementation of CME training (p = 0.059 and p = 0.041, respectively). Also, 5-year overall and disease-free survival rates for all patients were considerably better than our reported national outcomes. CONCLUSION: Our comprehensive step-by-step training video module for the CME technique demonstrates surgical anatomical planes and important vascular structures and variations. The video also helps standardization of the CME technique and should contribute to improved histopathological and oncological outcomes.

Outcome of the patients with chronic mesh infection following open inguinal hernia repair.

PURPOSE: Hernia repairs are the most common elective abdominal wall procedures performed by general surgeons. The use of a mesh has become the standard for hernia repair surgery. Herein, we discuss a management strategy for chronic mesh infections following open inguinal hernia repair with onlay prosthetic mesh. METHODS: In this study, 15 patients with chronic mesh infections following open inguinal hernia repairs were included. The medical records of these patients were retrospectively reviewed and information regarding presentation, type of previous hernia repair, type of mesh, operative findings and bacteriological examination results were obtained. In all cases, the infected mesh was removed completely and the patients were treated with antibiotic regimens and local wound care. RESULTS: Fifteen mesh removals due to chronic infection were performed between January 2000 and March 2012. The mean interval of hernia repair to mesh removal was 49 months. All patients were followed up for a median period of 62 months (range, 16 to 115 months). In all patients, the infections were resolved successfully and none were persistent or recurrent. However, one patient developed recurrent hernia and one developed nerve injury. CONCLUSION: Chronic mesh infection following hernia repair mandates removal of the infected mesh, which rarely results in hernia recurrence.

Red cell distribution width as a predictor of mortality in acute pancreatitis.

INTRODUCTION: Acute pancreatitis (AP) is a common cause for hospitalization worldwide. Identification of patients at risk for mortality early in the course of AP is an important step in improving outcome. Red cell distribution width (RDW) is reflective of systemic inflammation. The objective of this study was to investigate the association between RDW and mortality in patients with AP. METHODS: A total of 102 patients with AP were included. Demographic data, etiology of pancreatitis, organ failure, metabolic disorder, hospitalization time, and laboratory measures including RDW were obtained from each patient on admission. RESULTS: Estimating the receiver operating characteristic area under the curve showed that RDW has very good discriminative power for mortality (area under the curve = 0.817; 95% confidence interval, 0.689-0.946). With a cutoff value of 14.8 for RDW, mortality could be correctly predicted in approximately 77% of cases. CONCLUSIONS: Red cell distribution width on admission is a predictor of mortality in patients with AP.

Trocar site hernia after laparoscopic cholecystectomy.

AIM: The aim of this study was to elucidate the influence of pre and perioperative factors on the development of trocar site hernia after a laparoscopic cholecystectomy procedure. PATIENTS AND METHODS: A total of 776 patients who underwent a laparoscopic cholecystectomy procedure in our Department of General Surgery between 1999 and 2004 were assigned as the study group. The control group included patients without trocar site hernias after a cholecystectomy. The effect of five variables, including gender, age, body mass index (BMI), operation duration, and the type of cholecystitis on the development of a trocar site hernia after a laparoscopic cholecystectomy was assessed by univariable and multivariable models. RESULTS: In the univariate analysis, female gender (P = 0.021), older age (P < 0.001), higher BMI at the time of surgery (P < 0.001), and an increased duration of surgery (P < 0.001) have been found to increase the likelihood of a trocar site hernia formation. However, in the multivariable model, the gender was not a significant variable to influence the development of this complication. CONCLUSIONS: The development of a postoperative trocar site hernia may be prevented by the closure of 10-mm trocar sites in patients who are older than 60 years, obese, and who have a longer duration of operation.