The impact of intracorporeal anastomosis in right laparoscopic colectomy in the surgical site infections and the hospital stay: a cohort study.

Ileocolic anastomosis in laparoscopic-assisted right colectomy is frequently performed extracorporeally. Intracorporeal anastomosis could be associated with several short-term benefits. However, it is a more technically demanding procedure. The primary endpoint of the study aimed to evaluate the postoperative surgical-site infection rate and its impact on the length of hospital stay after laparoscopic right colectomy with intracorporeal anastomosis compared to extracorporeal anastomoses. Between 2010 and 2019, 108 unselected consecutive patients underwent right colectomy. An observational comparative cohort study of two anastomosis techniques, intracorporeal (IA) versus extracorporeal (EA), was conducted. Data were extracted from a prospectively maintained colorectal surgery database of a university-affiliated hospital and retrospectively analyzed. The main exclusion criteria were emergency surgery and medical or anesthetic contraindication for laparoscopy. 53 patients underwent right colectomy with IA, and 55 had extracorporeal anastomoses. The groups did not differ in demographics, anesthetic risk, intraoperative data, pathological outcomes, or overall survival. Mean operative time was longer in the IA group (156.9 vs. 146.0 min; p = 0.061). A significant reduction in the anastomotic leak rate was observed in the IA group compared with the EA group (0 vs. 7.3%; p = 0.045) with no differences in the intraabdominal abscess rate (IA: 1.9% vs. EA: 1.8%; p = 0.97). The wound infection rate was 5.7% for IA and 10.9% for EA (p = 0.324). The hospital stay was significantly shorter for those who had intracorporeal anastomoses (5.2 ± 3.3 vs. 10.8 ± 9.6 days; p = 0.000). Right colectomy with intracorporeal anastomosis was associated with less surgical-site infections and a significantly shorter hospital stay than EA technique. Surgeons should consider the IA as the first option when performing laparoscopic right colectomy. Registration number: NCT04350203 ( http://www.clinicaltrials.gov ).

Prevención de la hernia incisional mediante malla retrofascial fijada con cianoacrilato / Incisional hernia prevention using a cyanoacrilate-fixed retrofascial mesh

Introducción: La incidencia de hernia incisional en pacientes de riesgo (obesidad, cáncer, etc.) es elevada, incluso en cirugía laparoscópica. El objetivo de este estudio es evaluar la seguridad del empleo de mallas profilácticas retrofasciales fijadas con cianoacrilato en la incisión de asistencia en pacientes con sobrepeso sometidos a cirugía laparoscópica colorrectal. Métodos: Estudio prospectivo de cohortes, no aleatorizado, de pacientes sometidos a resección laparoscópica electiva por cáncer colorrectal entre enero de 2013 y marzo de 2016. Aquellos con índice de masa corporal superior a 25 kg/m2 fueron evaluados para implantar una malla profiláctica fijada con cianoacrilato (Histoacryl®) como refuerzo de la incisión de asistencia. Resultados: Se analizan 52 pacientes (índice de masa corporal medio: 28,4±2 kg/m2). En 15 pacientes se implantó una malla profiláctica. El tiempo de implante siempre fue inferior a 5 minutos. No hubo diferencias significativas en la tasa de infección de herida (12 vs. 10%). Ninguna malla requirió ser explantada. Aunque el seguimiento medio es menor (14,1±4 vs. 22,3±9 meses), no ha aparecido hernia incisional en el grupo malla. Por el contrario, en el grupo no malla se han observado una evisceración (2,7%) y 4 eventraciones de la incisión de asistencia (10,8%). No hubo diferencias significativas entre los grupos respecto a hernia incisional de trócar (6,6 vs. 5,4%). Conclusiones: La implantación de mallas profilácticas en pacientes con sobrepeso u obesidad sometidos a cirugía laparoscópica colorrectal es segura y parece reducir la tasa de eventraciones a corto plazo. La fijación con cianoacrilato es un método rápido que facilita el procedimiento sin complicaciones adicionales (AU)

Introduction: The rate of incisional hernia in high-risk patients (obesity, cancer, etc.) is high, even in laparoscopic surgery. The aim of this study is to evaluate the safety of the use of cyanoacrylate fixed prophylactic meshes in the assistance incision in overweight or obese patients undergoing laparoscopic colorectal surgery. Methods: A prospective, non-randomized cohort study of patients undergoing elective laparoscopic resection for colorectal cancer between January 2013 and March 2016 was performed. Those with a body mass index greater than 25 kg / m2 were evaluated to implant a prophylactic meshes fixed with cyanoacrylate (Histoacryl®) as reinforcement of the assistance incision. Results: 52 patients were analyzed (mean body mass index: 28.4±2 kg / m 2). Prophylactic meshes was implanted in 15 patients. The time to put the mesh in place was always less than 5minutes. There was no significant difference in wound infection rate (12% vs. 10%). No mesh had to be explanted. Although the mean follow-up was shorter (14.1±4 vs. 22.3±9 months), there were no incisional hernia in the mesh group. On the other hand, in the non-mesh group, 1 acute evisceration (2.7%) and 4 incisional hernia of the assistance incision were observed (10.8%). There were no significant differences between groups regarding trocar incisional hernia (6.6 vs. 5.4%). Conclusions: The implantation of a reinforcement prophylactic mesh in overweight or obese patients undergoing laparoscopic colorectal surgery is safe and seems to reduce the short-term rate of incisional hernia. Fixation with cyanoacrylate is a rapid method that facilitates the procedure without additional complications (AU)

Incisional hernia prevention using a cyanoacrilate-fixed retrofascial mesh. / Prevención de la hernia incisional mediante malla retrofascial fijada con cianoacrilato.

INTRODUCTION: The rate of incisional hernia in high-risk patients (obesity, cancer, etc.) is high, even in laparoscopic surgery. The aim of this study is to evaluate the safety of the use of cyanoacrylate fixed prophylactic meshes in the assistance incision in overweight or obese patients undergoing laparoscopic colorectal surgery. METHODS: A prospective, non-randomized cohort study of patients undergoing elective laparoscopic resection for colorectal cancer between January 2013 and March 2016 was performed. Those with a body mass index greater than 25kg / m2 were evaluated to implant a prophylactic meshes fixed with cyanoacrylate (Histoacryl®) as reinforcement of the assistance incision. RESULTS: 52 patients were analyzed (mean body mass index: 28.4±2kg / m 2). Prophylactic meshes was implanted in 15 patients. The time to put the mesh in place was always less than 5minutes. There was no significant difference in wound infection rate (12% vs. 10%). No mesh had to be explanted. Although the mean follow-up was shorter (14.1±4 vs. 22.3±9 months), there were no incisional hernia in the mesh group. On the other hand, in the non-mesh group, 1 acute evisceration (2.7%) and 4 incisional hernia of the assistance incision were observed (10.8%). There were no significant differences between groups regarding trocar incisional hernia (6.6 vs. 5.4%). CONCLUSIONS: The implantation of a reinforcement prophylactic mesh in overweight or obese patients undergoing laparoscopic colorectal surgery is safe and seems to reduce the short-term rate of incisional hernia. Fixation with cyanoacrylate is a rapid method that facilitates the procedure without additional complications.

HAL-RAR (Doppler guided haemorrhoid artery ligation with recto-anal repair) is a safe and effective procedure for haemorrhoids. Results of a prospective study after two-years follow-up.

PURPOSE: To analyse prospectively results of HAL-RAR technique by evaluating pain, perioperative complications and clinical outcome after two years followup. METHODS: A prospective study design including 30 consecutive patients with haemorrhoids grade III-IV treated from June 2012. After discharge, patients received a specific questionnaire to record postoperative pain, delayed complications, evolution/disappearance of the symptoms that led to the surgical intervention (bleeding, prolapse, itching, pain and soiling). A visual analog scale (VAS) was used to measure pain. Outpatient follow-up was carried out at 7 days, and 1, 6 and 12 months and annually thereafter. Pre, intra and postoperative data (including physical examination) had been recorded prospectively. RESULTS: The median operating time (range) was 40 (26-60) minutes. Average hospital stay (range) was 11 (3-25) hours. No postoperative complications were observed in 29 cases (96.6%). Median follow-up was 26 (12-36) months. All the patients attended the follow-up. Mean postoperative pain was VAS = 1.7 on the seventh day and it was practically non-existent (VAS = 0.7) 1 month after the procedure. 87.5% of patients confirmed complete relief of symptoms after 30 days and 93% of patients feel free of symptoms 6 months after the procedure. No patient has experienced late complications as dyschezia, urgency, soiling or faecal incontinence. After 24 months follow-up, recurrence of bleeding and prolapse was observed in only 1 patient; 93% of patients have considered results of HAL-RAR as very good or excellent. CONCLUSION: HAL-RAR is safe and almost painless technique and it has very good results in the control of haemorrhoidal symptoms. This procedure should be considered as an effective first treatment option for haemorrhoids.

Information slows down hierarchy growth.

We consider models of growing multilevel systems wherein the growth process is driven by rules of tournament selection. A system can be conceived as an evolving tree with a new node being attached to a contestant node at the best hierarchy level (a level nearest to the tree root). The proposed evolution reflects limited information on system properties available to new nodes. It can also be expressed in terms of population dynamics. Two models are considered: a constant tournament (CT) model wherein the number of tournament participants is constant throughout system evolution, and a proportional tournament (PT) model where this number increases proportionally to the growing size of the system itself. The results of analytical calculations based on a rate equation fit well to numerical simulations for both models. In the CT model all hierarchy levels emerge, but the birth time of a consecutive hierarchy level increases exponentially or faster for each new level. The number of nodes at the first hierarchy level grows logarithmically in time, while the size of the last, "worst" hierarchy level oscillates quasi-log-periodically. In the PT model, the occupations of the first two hierarchy levels increase linearly, but worse hierarchy levels either do not emerge at all or appear only by chance in the early stage of system evolution to further stop growing at all. The results allow us to conclude that information available to each new node in tournament dynamics restrains the emergence of new hierarchy levels and that it is the absolute amount of information, not relative, which governs such behavior.

FDA's nozzle numerical simulation challenge: non-Newtonian fluid effects and blood damage.

Data from FDA's nozzle challenge-a study to assess the suitability of simulating fluid flow in an idealized medical device-is used to validate the simulations obtained from a numerical, finite-differences code. Various physiological indicators are computed and compared with experimental data from three different laboratories, getting a very good agreement. Special care is taken with the derivation of blood damage (hemolysis). The paper is focused on the laminar regime, in order to investigate non-Newtonian effects (non-constant fluid viscosity). The code can deal with these effects with just a small extra computational cost, improving Newtonian estimations up to a ten percent. The relevance of non-Newtonian effects for hemolysis parameters is discussed.