Hybrid intraperitoneal onlay mesh repair for incisional hernias: a systematic review and meta-analysis.

INTRODUCTION: Laparoscopic IPOM is technically challenging, especially regarding fascial closure. Hybrid repair has been proposed as a simpler approach. We aimed to compare hybrid and laparoscopic intraperitoneal onlay mesh repair (IPOM) in patients undergoing ventral hernia repair (VHR). METHODS: We performed a systematic review of Cochrane, Scopus, and MEDLINE databases to identify studies comparing hybrid versus laparoscopic IPOM VHR reporting the outcomes of recurrence, mortality, seroma, postoperative complications, reoperation, surgical site infection, and operative time. Statistical analysis was performed using RStudio 4.1.2 using a random-effects model. RESULTS: We screened 2,896 articles and fully reviewed 22 of them. A total of five studies, encompassing 664 patients were included. Among them, 337 (50.8%) underwent laparoscopic IPOM. All patients had incisional hernias, with a mean diameter varying from 3 to 12.7 cm, 60% were women, with a mean BMI varying from 29.5 to 38. The hybrid approach had a lower rate of seroma when compared to the laparoscopic (OR 0.22; 95% CI 0.05 to 0.92; p = 0.038; I²=78%). We found no difference in recurrence, mortality, postoperative complications, reoperation, surgical site infection, and operative time between groups. CONCLUSION: Hybrid IPOM is a safe and effective method for incisional hernia repair. Moreover, it facilitates fascial defect closure and decreases postoperative seromas.

Quadratus lumborum block versus transversus abdominis plane block for inguinal hernia repair: A systematic review and meta-analysis with trial sequential analysis.

INTRODUCTION: Postoperative pain management is crucial for patient recovery with Quadratus Lumborum Block (QLB) and Transversus Abdominis Plane Block (TAPB) emerging as potential techniques. We aimed to compare the analgesic efficacy of QLB and TAPB in patients undergoing inguinal hernia repair. METHODS: We performed a systematic review of Cochrane, EMBASE, and MEDLINE databases to identify randomized controlled trials comparing QLB and TAPB in patients undergoing inguinal hernia repair. Outcomes included postoperative pain and opioid consumption. Statistical analysis was performed using RevMan 5.4. The review protocol was registered at PROSPERO (CRD42023445513). RESULTS: We included five RCTs encompassing 255 patients. QLB was associated with a significant decrease in postoperative pain (MD -0.45; 95% CI -0.75 to -0.14; and p = 0.004; I2  = 94%). However, we found no difference in 24-h opioid consumption between QLB and TAPB groups. CONCLUSION: QLB may offer superior pain reduction. However, its effect on opioid consumption remains unclear.

Heavyweight versus non-heavyweight mesh in ventral hernia repair: a systematic review and meta-analysis.

PURPOSE: There is considerable variability among surgeons regarding the type of mesh used in ventral hernia repair. There has been an increasing incidence of mesh fractures with lightweight (LW) and mediumweight (MW) meshes. However, HW mesh has been associated with a greater foreign body sensation and chronic pain. This meta-analysis aims to compare the outcomes of HW and non-heavyweight (NHW) meshes in ventral hernia repair. METHODS: We systematically reviewed the PubMed, Embase, Cochrane, and Scopus databases to identify studies comparing HW with NHW meshes in hernia repair. Outcomes analyzed included hernia recurrence, seroma, hematoma, foreign body sensation, postoperative pain, and wound infection. We performed two subgroup analyses focusing on randomized controlled trials and open retromuscular repairs. Statistical analysis was performed using RevMan 5.4. RESULTS: We screened 1704 studies. Nine studies were finally included in this meta-analysis and comprised 3001 patients from 4 RCTs and 5 non-randomized. The majority of patients (57.1%) underwent open retromuscular repair. HW mesh was significantly associated with increased in foreign body sensation (OR 3.71; 95% CI 1.40-9.84; p = 0.008), but there was no difference in other outcomes. In RCTs analysis, there was no difference between meshes. In open retromuscular repairs, HW mesh was associated with more seromas (OR 1.48; 95% CI 1.01-2.17; p = 0.05). CONCLUSION: Our study found that HW mesh was associated with more foreign body sensation. Also, open retromuscular repairs analysis showed that HW was associated with more seromas. Further randomized studies are needed to understand better the role of HW mesh in ventral hernia repair.

Endoscopic Treatment Using the Padlock Clip System for Rectourethral Fistula After Prostatectomy.

We present a case of a 68-year-old man with a rectourethral fistula (RUF) successfully treated with a unique endoscopic approach using the Padlock Clip system (Steris, Basingstoke, UK). This is a complex case of a patient who, after radical prostatectomy, continued to show several complications, including fistulas and relapses. Our work aims to enhance the literature with our technique and to help the scientific community in future RUF cases. Our case stands out because this therapeutic approach has not yet been described in the literature as a possible endoscopic treatment of RUF. Therefore, our topic description is essential to assist future similar cases.

Geospatial Analysis of Accessibility to Surgical Care, a Brazilian Local Perspective.

BACKGROUND: Surgical care has been neglected and recently discussed by the World Health Organization as a necessary component of health care. Situations that distance individuals and medical services are of particular concern. We aim to estimate the distance a patient who lives in a municipality without a general surgeon would have to travel to access surgical care; and to describe the geographical distribution of the surgical workforce. METHODS: We obtained the surgical data from DATASUS, from IBGE, the information regarding the classification of each municipality and its location, and FEPAM, the road network. We performed the geoprocessing analysis on QGIS and the statistical analysis on SPSS. RESULTS: The Rio Grande do Sul state had 496 municipalities, of which 69.4% were rural, with a mean of 9.19 general surgeons per overall municipality. A total of 237 cities had no general surgeons, of which 89.45% were in rural ones. There was a significant difference in the number of surgeons per municipality between rural and urban ones. We found a mean of 22.09 surgeons per 100,000 population. The mean distance traveled by a patient to a municipality with general surgeons available was 30.25 km, with a minimum of 2.46 km and a maximum of 268.22 km. CONCLUSIONS: Disparities are associated with the geospatial distribution of surgical care in the Rio Grande do Sul state. The surgical workforce and the distance a patient travels are irregular geographically. This study is the start of inspiring other similar studies about geospatial surgical analysis.

Surgical Treatment of the Five Most Common Types of Cancer in Brazil: 7 Years Analysis Overview.

BACKGROUND: Surgery is the main treatment for the majority of solid cancers. Studies investigating surgical interventions are a critical asset in improving patient health outcomes. We aim to analyze the temporal and spatial distribution of the surgical treatment of Brazil's 5 most common types of cancer. METHODS: The selected cancers were stomach, colorectal and rectosigmoid junction, bronchial and lung, breast, and prostatic. Surgical data were collected from the DATASUS database from 2013 to 2019. Statistical analyses included linear regression tests with a significance level of .05. RESULTS: From 2013 to 2019, 19.72% of the diagnoses of all cancers were treated surgically. Only breast cancer didn't have a significant linear increase in surgeries (P = .702). Prostatic cancer had the highest annual increase rate and breast the lowest. Analyzing the Brazilian regions, the Southeast had the highest incidence of oncological surgeries, and the Midwest had the lowest. DISCUSSION: Brazil's surgical oncology scenario is progressing positively through the analyzed period. The analysis of the 5 most common types of cancer in Brazil and their progression over the years provides an idea of the cancer surgery capacity in Brazil. There were disparities between the Brazilian regions in all types of cancer. Our study is the first step to better comprehending cancer care in Brazil and the access issues that some areas have. With that, it will be possible to provide better care to cancer patients needing surgical treatment.

Retrorectal Bronchogenic Cyst With a Sacrococcygeal Surgical Approach.

We present a case of a bronchogenic cyst in the retrorectal space that was successfully treated with a unique sacrococcygeal surgical approach, thus avoiding abdominal access. This report aims to enhance the literature with our technique and to help the scientific community in treating future retrorectal bronchogenic cyst cases. A 19-year-old man presented to the hospital with testicular pain refractory to over-the-counter analgesics. A cyst lesion in the presacral region was found during pelvic magnetic resonance imaging. We identified the cyst's epithelium as the respiratory type, containing ciliated pseudostratified columnar epithelium with foci of squamous metaplasia. The bronchogenic cyst is abnormal from the primitive foregut, and its location on the retrorectal site is rare. Patients with this type of lesion are usually asymptomatic, and discovery is commonly incidental during imaging exams. Excision is advised, and the prognosis is good after retroperitoneal bronchogenic cyst removal. Our description of the topic is essential to assist future similar cases.

Women Surgeons in Brazil: A Time Trend Analysis by Specialties in the Last Decade.

BACKGROUND: In surgery, there is a gender worldwide gap. In Brazil, we still do not have studies that describe this scenario. Based on this lack of research, we aim to assess the prevalence of women in surgical specialties, how it has changed over the years and how long it will take to achieve an equal distribution of men and women surgeons in Brazil. METHODS: We conducted a retrospective review of the last five editions of the Brazilian Medical Demography (2011, 2013, 2015, 2018, and 2020). We analyzed the absolute and proportional (women/total) increase in women registered in 13 surgical specialties in Brazil. We performed a linear regression, and we estimated the expected year of equal distribution of women and men in each subspecialty, through the linear regression equation. RESULTS: In absolute numbers of women, all surgical specialties presented a linear increase over the years (p <.05). In proportional numbers of women, however, 10 specialties showed a significant linear increase (p <.05) except cardiovascular surgery, hand surgery, and neurosurgery. According to the equation that predicts equal distribution, pediatric surgery will be the first one to achieve equal distribution, in 2026, and other specialties are far from achieving it. For example, Urology will not achieve equal distribution until 2433. CONCLUSIONS: There are fewer women surgeons in Brazil than men. However, in general, there is an increase in women in the analyzed specialties over the years. With the proportional inclusion of women in the Brazilian surgical workforce, we hope that we can achieve sex equality in Brazil.