Extraction-site incisional hernia after laparoscopic colorectal surgery: should we carry out a study about prophylactic mesh closure?

BACKGROUND: Prophylactic mesh closure has only scarcely been studied to avoid extraction-site incisional hernia after laparoscopic colorectal surgery. The aim was to analyze extraction-site incisional hernia incidence after laparoscopic colorectal surgery to assess if prophylactic mesh closure should be studied. METHODS: A retrospective analytic cohort study was conducted in patients who had undergone laparoscopic colorectal surgery with an extraction-site incision. Extraction-site incisional hernia was diagnosed during clinical examination or imaging. Risk factors for extraction-site incisional hernia were analyzed. RESULTS: Two hundred and twenty-five patients were included. More than 80% of the patients had a malignant disease. Ninety-two patients (40.9%) underwent right colectomy. Midline extraction-site incision was used in 86 (38.2%) patients. After a mean follow-up of 2.4 years, 39 (17.3%) patients developed an extraction-site incisional hernia. Midline extraction-site incision was associated with incisional hernia when compared to transverse and Pfannenstiel incision (39.5% vs. 3.6%, OR 17.5, p < 0.001). Surgery to repair an extraction-site incisional hernia was also more frequent in the group of patients with a midline incision (10.5% vs. 1.4%, OR 8.0, p = 0.002). In the multivariate analysis, incisional hernia was associated with body mass index, high blood pressure, and midline incision. CONCLUSIONS: Extraction-site incisional hernia was mainly related to midline incisions; therefore, midline incision should be avoided whenever possible. Studying prophylactic mesh closure for Pfannesnstiel or transverse incisions is needless, as these incisions have a low incisional hernia risk.

Es segura la hernioplastia sin sutura como opción para tratar las hernias de pared abdominal ? Estudio prospectivo con un adhesivo tisular sintético (n-hexil-alfa-cianoacrilato) / Effect of vitamin D deficiency on hypocalcaemia after total thyroidectomy due to benign goitre

Introducción El uso de adhesivos tisulares puede ser una alternativa a la sutura en la fijación de la malla, pero su experiencia clínica es muy limitada. Material y métodos Estudio prospectivo y descriptivo en un grupo de 35 pacientes con hernias inguinales operados mediante hernioplastia sin sutura (20 vía abierta y 15 vía endoscópica); la prótesis se fijó con adhesivo sintético (n-hexil-α-cianoacrilato). Este grupo se ha comparado con uno control operado mediante hernioplastia utilizando suturas. Todos los pacientes seguían protocolo de cirugía mayor ambulatoria. Se han registrado variables peri- y postoperatorias. El seguimiento se realizó a la semana, al mes, a los 6 meses y al año. Resultados No ha existido morbilidad asociada con el uso del adhesivo tisular. Durante una mediana de 15 meses no se han detectado complicaciones ni recurrencias. En la hernioplastia abierta el uso del adhesivo disminuye de forma significativa el tiempo quirúrgico (30min versus 62min, p=0,001), el dolor postoperatorio (de 2,4 a 4,5 a la semana, p < 0,001) y el consumo de analgésico (de 7 a 14 días, p < 0,001). En el abordaje laparoscópico se demuestran diferencias significativas a favor del adhesivo en el dolor (p=0,001 a las 24h) y consumo de analgésicos (p <0,001). El análisis económico demuestra un ahorro anual de 117.461,2 euros (sobre 460 hernias).Conclusión El uso de un adhesivo tisular sintético (n-hexil-α-cianocrilato) es seguro como medio de fijación en las hernioplastias no complejas en pacientes sin comorbilidad, con buenos resultados postoperatorios (AU)

Introduction: The purpose of this study was to analyse the relationship between preoperative serum levels of vitamin D and postoperative hypocalcaemia after total thyroidectomy. Material and methods: A prospective observational study was conducted on 113 patients treated by total thyroidectomy due to benign disease. Preoperative vitamin D serum levels and postoperative albumin-corrected calcium and parathormone (PTH) levels were determined. Sensitivity, specificity, positive predictive value and negative predictive value ofvitamin D and PTH levels, respectively, in the diagnosis of postoperative hypocalcaemia were calculated. Results: Hypocalcaemia was diagnosed in 44 (38.9%) patients. Vitamin D levels were signifi-cantly higher in the group of patients with normal postoperative calcium (median: 25.4 pg/mL; range: 4-60), compared to those who developed hypocalcaemia (median: 16.4 pg/mL; range: 6.3-46.9) (P = .001). Postoperative hypocalcaemia was more frequent in patients with vitamin D < 30 ng/mL (39/78) (50%), than among those with normal levels (5/35) (14.2%)(P = .001). Sensitivity, specificity, positive predictive value and negative predictive value were 88% and 68%, 43% and 82%, 50% and 71%, and 85% and 80% for vitamin D and PTH, respectively. Vitamin D and PTH showed independent prognostic values on the risk of hypocalcaemia. The OR associated with vitamin D < 30 ng/mL was 4.25 (95% CI: 1.31-13.78)(P = .016), and the OR of PTH < 13 pg/mL was 15.4 (95% CI: 4.83-49.1) (P < .001).Conclusion: Vitamin D deficiency is a risk factor of hypocalcaemia after total thyroidectomy for benign goitre. The vitamin D level provides independent prognostic information, which his complementary to that given by PTH (AU)

[Effect of vitamin D deficiency on hypocalcaemia after total thyroidectomy due to benign goitre]. / Efecto de la deficiencia de vitamina D sobre la hipocalcemia tras tiroidectomía total por bocio benigno.

INTRODUCTION: The purpose of this study was to analyse the relationship between preoperative serum levels of vitamin D and postoperative hypocalcaemia after total thyroidectomy. MATERIAL AND METHODS: A prospective observational study was conducted on 113 patients treated by total thyroidectomy due to benign disease. Preoperative vitamin D serum levels and postoperative albumin-corrected calcium and parathormone (PTH) levels were determined. Sensitivity, specificity, positive predictive value and negative predictive value of vitamin D and PTH levels, respectively, in the diagnosis of postoperative hypocalcaemia were calculated. RESULTS: Hypocalcaemia was diagnosed in 44 (38.9%) patients. Vitamin D levels were significantly higher in the group of patients with normal postoperative calcium (median: 25.4pg/mL; range: 4-60), compared to those who developed hypocalcaemia (median: 16.4pg/mL; range: 6.3-46.9) (P=.001). Postoperative hypocalcaemia was more frequent in patients with vitamin D < 30ng/mL (39/78) (50%), than among those with normal levels (5/35) (14.2%) (P=.001). Sensitivity, specificity, positive predictive value and negative predictive value were 88% and 68%, 43% and 82%, 50% and 71%, and 85% and 80% for vitamin D and PTH, respectively. Vitamin D and PTH showed independent prognostic values on the risk of hypocalcaemia. The OR associated with vitamin D < 30ng/mL was 4.25 (95% CI: 1.31-13.78) (P=.016), and the OR of PTH<13pg/mL was 15.4 (95% CI: 4.83-49.1) (P<.001). CONCLUSION: Vitamin D deficiency is a risk factor of hypocalcaemia after total thyroidectomy for benign goitre. The vitamin D level provides independent prognostic information, which is complementary to that given by PTH.

Expression of CD45 and proliferative response to CD3 as suitable classification markers of patients with gastric adenocarcinoma.

25 patients with resectable gastric adenocarcinoma, subdivided according to the absence or presence of residual neoplasic disease (RND- or RND+, respectively), were studied. Cytofluorometric analysis and proliferative responses to mitogens was performed in peripheral blood mononuclear cells of patients. When compared to healthy subjects, the percentage of CD3-expressing cells was significantly reduced in both groups of patients studied (p < 0.0001 in all instances). However, when CD45 is considered instead of (CD3, its expression is found to be significantly reduced only in the RND+ patients (72% +/- 11), when compared with the control group (96 +/- 1%, p < 0.0001). Likewise, cells from these patients significantly less proliferated when stimulated with monoclonal antibodies to CD3 than control cells (18,920 +/- 6,019 cpm vs. 42,697 +/- 1,798 cpm, p = 0.0036); a difference not found if RND- patients (33,619 +/- 11,733 cpm) were considered. We propose that the low expression of CD45 and the poor response to CD3 are markers that are able to identify the subgroup of patients in whom the disease will tend to progress more rapidly. We also suggest the use of such markers as additional criteria for the classification of patients with gastric adenocarcinoma or to identify patients who require more aggressive therapeutic strategies.