Endoscopic enhanced-view totally extraperitoneal retromuscular approach for ventral hernia repair.

BACKGROUND: Primary or incisional ventral hernia repair is one of the most common surgical procedures, addressed to general surgeons. The enhanced view-totally extraperitoneal technique (eTEP) was first described by Deas for inguinal hernias, but lately it has been applied to ventral hernias by Belyansky et al. So far, results are promising and data about the procedure are rising. METHODS: Retrospective comparative analysis of 27 recruited eTEP procedures and 27 IPOM operations for the period between April 2017 and June 2018 at the department of Endoscopic surgery of Military Medical Academy, Sofia. Baseline characteristics, operative records and perioperative data are provided and compared for both groups. RESULTS: Fifty-four patients were included. There were no differences between age, sex, BMI, primary or incisional hernias, co-morbidity, active smoking, EHS-classification and immunosuppression through the patients in different groups. Mean defect area-eTEP is 71 cm2 with no statistical difference, compared to IPOM-76 cm2. Operative time in eTEP is significantly longer with mean time of 186 min and 90 min in IPOM patients. Mean length of stay did not differ between the groups, with 2.9 days after eTEP and 3.4 after IPOM. Median pain score from the intraoperative (the day of surgery) to the seventh postoperative day is lower in the eTEP group. No surgical site infections and/or mesh infections were present. There was one readmission in the IPOM group with ASBO, and it was managed conservatively. There were no reinterventions and perioperative mortality in the sample. CONCLUSION: We found out that the eTEP/eRS approach is feasible and safe. Our study shows comparable results of eTEP/eRS to the IPOM procedure with reduced video analogue scale pain score to the 7th postoperative day and increased operative time. The study contributes to the upcoming evidence in the field of new minimally invasive techniques for ventral hernia repair.

A Meta-Analysis of Quality of Life, Estimated by Questionnaires of the European Organization for Research and Treatment of Cancer (EORTC) after Rectal Cancer Surgery.

BACKGROUND: Rectal carcinoma is one of the most common cancers on a global scale. Although there were major improvements in its treatment during the last two decades, surgery is still the only curative method. However, is often complicated and can cause disorder of different aspects of the patients self-perception of health. The aim of this study is performing ofa meta-analysis for evaluation and comparison of the quality of liferesults after rectal cancer treatment. METHODS: Search of relevant articles, which were published between 2000 and 2015, was performed. The outcomes of abdominoperineal resection and anterior resection were analyzed with the EORTC's quality of life measuring instruments - quality-of-life questionnaire C30 (QLQ-C30)and quality-of-life questionnaire CR38 (QLQ-CR38). The assessment score, appropriate for the survey, was established at least one year after radical surgery. The Statistical Package for Social Sciences (SPSS) package of IBM Statistics, version 19 was used for the statistical analyses. RESULTS: 13 studies, published between 2001 and 2015, have been presented in this meta-analysis. Data from 1805 patients,with a mean age of 64.7 years, have been included. When comparing Miles extirpation and sphincter-sparing operations,statistical significance was detected for the following variables:social functioning (74.6 ± 8.5 vs. 83.4 ± 8.6, P = 0.045),constipation (11 ± 8.4 vs. 22.6 ± 8.3, P = 0.032), and body image (67.9 ± 14 vs. 82.5 ± 9.1, P= 0.01). CONCLUSION: Preservation of the sphincter is a better treatment option that should be carefully considered. Dependently registered differences, our conviction for the rectal cancer care concern needs individualization of the approach in this surgery.It is essential that the policy of avoidance of abdominoperineal resection (APR) cannot currently be justified on the grounds of quality-of-life (QoL) results alone.

ASSESSMENT OF THE SEXUAL FUNCTION AFTER RECTAL CANCER SURGERY.

INTRODUCTION: Introduction: Sexual functioning is one of the most important components of subjective term quality of life. The growing incidence of rectal cancer recent decades lead to a tendency to optimize the diagnostic and therapeutic process, to perform better staging and postoperative disease control. Clearing the operational plan to achieve radicality and preservation of pelvic autonomic innervation are key components affecting sexual function and subsequent quality of life of patients. MATERIALS AND METHODS: It was used data from questionnaires QLQ C30 and QLQ C38 to assess sexual function, according to the methodology of the EORTC (European Organization for Research and Treatment of Cancer). Information was collected of 71 patients operated and monitored in Complex Cancer Center of Veliko Tarnovo during the period 01.2005-06.2010 year. It compares 38 underwent sphincter-sparing operations and 33 abdominoperineal resections having definitive stoma. Patients had fulfilled questionnaires more than six full months after surgery forming a functional scale related to sexual function. RESULTS: A significantly higher number men after abdominoperineal resection have trouble to ejaculate compared to patients after anterior resection of the rectum. Statistically significant difference in sexual function between studied groups was observed in the male sex. CONCLUSION: The psychometric values of the self-perception of health were highest after treatment of high rectal carcinomas. Sphincter-spared men after rectal resection had significant fewer problems with ejaculation, compared with patients suffered abdominoperinealna cutter. Sexual dysfunction was significantly more common in men underwent rectum extirpation compared to patients undergoing conservative surgery.