Short-term complications after onlay versus preperitoneal mesh repair of umbilical hernias: a prospective randomized double-blind trial.

PURPOSE: To compare the incidence of surgical site occurrences (SSOs) following onlay versus preperitoneal mesh placement in elective open umbilical hernia repairs. METHODS: This study presents a secondary analysis of a randomized double-blind trial conducted on female patients with primary umbilical hernias admitted to a general hospital, in a residency training program setting. Fifty-six subjects were randomly assigned to either onlay (n=30) or preperitoneal (n=26) mesh repair group. Data on baseline demographics, past medical history, perioperative details, postoperative pain (visual analogue scale (VAS)), wound-related complications, and recurrence were assessed using a standardized protocol. RESULTS: No statistically significant differences were observed between groups regarding patients' demographics, comorbidities, or defect size. Operative time averaged 67.5 (28-110) min for onlay and 50.5 (31-90) min for preperitoneal repairs, p=.03. The overall rate of SSOs was 21.4% (n=12), mainly in the onlay group (33% vs 7.7%; p=0.02, 95% CI 0.03-0.85) and mostly due to seromas. There were no between-group significant differences in postoperative VAS scores at all timepoints. After a maximum follow-up of 48 months, one recurrence was reported in the onlay group. By logistic regression, the onlay technique was the only independent risk factor for SSOs. CONCLUSION: The presented data identified a decreased wound morbidity in preperitoneal umbilical hernia repairs, thus contributing to the limited body of evidence regarding mesh place selection in future guidelines. Further cases from this ongoing study and completion of follow-up are expected to also compare both techniques in terms of long-term outcomes. TRIAL REGISTRATION NUMBER: Brazilian Registry of Clinical Trials (ReBEC) UTN code: U1111-1205-0065 (date of registration: March 27, 2018).

Assessment of trauma scoring systems in patients subjected to exploratory laparotomy.

OBJECTIVE: to assess the epidemiological profile of patients undergoing exploratory trauma laparotomy based on severity and prognosis criteria, and to determine the predictive accuracy of trauma scoring systems in terms of morbidity and mortality. METHODS: retrospective cohort study and review of medical records of patients undergoing exploratory laparotomy for blunt or penetrating trauma at the Hospital de Pronto Socorro de Porto Alegre, from November 2015 to November 2019. Demographic data, mechanism of injury, associated injuries, physiological (RTS and Shock Index), anatomical (ISS, NISS and ATI) and combined (TRISS and NTRISS) trauma scores, intraoperative findings, postoperative complications, length of stay and outcomes. RESULTS: 506 patients were included in the analysis. The mean age was 31 ± 13 years, with the majority being males (91.3%). Penetrating trauma was the most common mechanism of injury (86.2%), predominantly by firearms. The average RTS at hospital admission was 7.5 ± 0.7. The mean ISS and NISS was 16.5 ± 10.1 and 22.3 ± 13.6, respectively. The probability of survival estimated by TRISS was 95.5%, and by NTRISS 93%. The incidence of postoperative complications was 39.7% and the overall mortality was 12.8%. The most accurate score for predicting mortality was the NTRISS (88.5%), followed by TRISS, NISS and ISS. CONCLUSION: the study confirms the applicability of trauma scores in the studied population. The NTRISS seems to be the best predictor of morbidity and mortality.

Assessment of trauma scoring systems in patients subjected to exploratory laparotomy / Avaliação dos escores de trauma em pacientes submetidos à laparotomia exploradora

ABSTRACT Objective: to assess the epidemiological profile of patients undergoing exploratory trauma laparotomy based on severity and prognosis criteria, and to determine the predictive accuracy of trauma scoring systems in terms of morbidity and mortality. Methods: retrospective cohort study and review of medical records of patients undergoing exploratory laparotomy for blunt or penetrating trauma at the Hospital de Pronto Socorro de Porto Alegre, from November 2015 to November 2019. Demographic data, mechanism of injury, associated injuries, physiological (RTS and Shock Index), anatomical (ISS, NISS and ATI) and combined (TRISS and NTRISS) trauma scores, intraoperative findings, postoperative complications, length of stay and outcomes. Results: 506 patients were included in the analysis. The mean age was 31 ± 13 years, with the majority being males (91.3%). Penetrating trauma was the most common mechanism of injury (86.2%), predominantly by firearms. The average RTS at hospital admission was 7.5 ± 0.7. The mean ISS and NISS was 16.5 ± 10.1 and 22.3 ± 13.6, respectively. The probability of survival estimated by TRISS was 95.5%, and by NTRISS 93%. The incidence of postoperative complications was 39.7% and the overall mortality was 12.8%. The most accurate score for predicting mortality was the NTRISS (88.5%), followed by TRISS, NISS and ISS. Conclusion: the study confirms the applicability of trauma scores in the studied population. The NTRISS seems to be the best predictor of morbidity and mortality.

RESUMO Objetivo: analisar o perfil epidemiológico dos pacientes submetidos a laparotomia exploradora por trauma com base em critérios de gravidade e prognóstico, e determinar a acurácia preditiva dos escores de trauma em termos de morbimortalidade. Métodos: estudo de coorte retrospectiva e revisão de prontuários dos pacientes submetidos a laparotomia exploradora por trauma contuso ou penetrante no Hospital de Pronto Socorro de Porto Alegre no período de novembro de 2015 a novembro de 2019. Foram avaliados dados demográficos, mecanismo do trauma, lesões associadas, índices fisiológicos (RTS e Shock Index), anatômicos (ISS, NISS e ATI) e mistos (TRISS e NTRISS), achados intraoperatórios, complicações pós-operatórias, tempo de internação e desfecho. Resultados: foram incluídos 506 pacientes na análise. A idade média foi de 31 ± 13 anos, com predomínio do sexo masculino (91,3%). O trauma penetrante foi o mecanismo de lesão mais comum (86,2%), sendo a maioria por arma de fogo. A média do RTS na admissão hospitalar foi 7,5 ± 0,7. A média do ISS e do NISS foi 16,5 ± 10,1 e 22,3 ± 13,6, respectivamente. A probabilidade de sobrevida estimada pelo TRISS foi de 95,5%, e pelo NTRISS de 93%. A incidência de complicações pós-operatórias foi de 39,7% e a mortalidade geral de 12,8%. O escore com melhor acurácia preditiva foi o NTRISS (88,5%), seguido pelo TRISS, NISS e ISS. Conclusões: o estudo confirma a aplicabilidade dos escores de trauma na população em questão. O NTRISS parece ser o sistema com melhor acurácia preditiva de morbimortalidade.