Complex Abdominal Wall Reconstruction with Biologic Mesh for Ventral Hernia Repair in Solid Organ Transplant Recipients.

BACKGROUND: Ventral hernia is a common occurrence in patients undergoing solid organ transplant (SOT) and who require complex abdominal wall reconstruction (CAWR). The aim of this study was to analyze the outcomes of CAWR in SOT patients in a tertiary center. METHODS: We performed a prospective cohort study in patients who underwent CAWR with biological mesh at our center from January 2016 to November 2021. As per the study protocol, all patients will be followed for 3 years. RESULTS: During the study period, we performed CAWR in 38 SOT patients. The mean age (Standard Deviation: SD) was 61 (9.5) years and the majority were males (68%). Mean body mass index (SD) was 30.3 (5.5) kg/m2 and hernia repair was performed electively in 33 patients. The majority (82%) of the hernias were less than class 2 with a median mesh size (interquartile range) of 600 (400-800) cm2. Seventy-nine percent of patients were liver transplant recipients and the mesh was placed sub-lay (retro-rectus) (82%); the most common technique was posterior component separation (82%). Five patients (13.2%) had surgical site infection and 4 (10.5%) had unplanned reoperations. None of the patients died postoperatively and the 30-day readmission rate was 21%. Three patients (7.9%) had recurrence during follow-up and all of them underwent reoperation. CONCLUSIONS: Complex abdominal wall reconstruction (CAWR) using biologic mesh for solid organ transplant patients with ventral hernia is safe and has low recurrence when performed by a dedicated CAWR team.

Do the benefits of prophylactic inferior vena cava filters outweigh the risks in trauma patients? A meta-analysis.

INTRODUCTION: The aim of this systematic review and meta-analysis was to evaluate whether the benefits of prophylactic inferior vena cava filters (IVCF) outweigh the risks thereof. PATIENTS AND METHODS: PubMed, EMBASE, and Cochrane Library were systematically searched for records published from 1980 to 2018 by two independent researchers (MG, GG). The endpoints of interest were pulmonary embolism (PE) and deep vein thrombosis (DVT) rates. Quality assessment, data extraction and analysis were performed according to the Cochrane Handbook for Systematic Reviews of Interventions. Mantel-Haenszel method with odds ratio and 95% confidence interval (OR (95%CI)) as the measure of effect size was utilized for meta-analysis. RESULTS: Fifteen studies (two randomized controlled trials and 13 observational studies) were included in the meta-analysis. PE rate was 0.9% (11/1183) in IVCF vs. 0.6% (240/39,417) in No IVCF. This difference was not statistically significant [OR (95%CI) = 0.31 (0.06, 1.51); p = 0.15]. DVT rate was 8.4% (77/915) in IVCF vs. 1.7% (653/38,807) in No IVCF. The difference was not statistically significant [OR (95%CI) = 2.67 (0.90, 7.98); p = 0.08]. In the subset of RCTs, PE rate was 0% (0/64) in IVCF vs. 12% (6/5) in No IVCF. This difference was statistically significant [OR (95%CI) = 0.12 (0.01, 1.03); p = 0.05]. CONCLUSIONS: This meta-analysis found that prophylactic IVCF may be associated with decreased PE rates at the possible cost of increased DVT rates. Further observational and experimental clinical studies are needed to confirm the findings of this meta-analysis.

A Cost-Benefit Analysis of an Overseas Volunteer Mission to the Local Healthcare System.

BACKGROUND: The aim of this study was to comparatively evaluate the sustainability and cost-benefit of the Operation Giving Back Bohol surgical volunteerism mission (SVM) carried out in Bohol Province, Philippines, over twelve consecutive missions. METHODS: This was a cost-benefit analysis of prospectively collected financial data from twelve consecutive surgical volunteerism missions held between 2006 and 2018. The overall cost of an SVM and cost per patient were the endpoints of interest. Disability-adjusted life years (DALYs) and costs thereof were calculated for each patient undergoing surgery in the twelve SVMs. RESULTS: A mean of 112 ± 22 patients were included per year of the SVM. A statistically significant increasing trend in the overall cost of SVMs over time was found (R2 = .469; P = .014). A nonsignificant decreasing trend in the cost per patient over time was found (R2 = .007; P = .795). A total of 8811.71 DALYs were averted in the twelve SVMs. DALYs averted per year ranged between 474.02 (2009) and 969.16 (2012). Cost per a DALY averted ranged between $466.9 (2006) and $865.6 (2009). Comparison of the latter with GDP per capita showed that this SVM was "very cost-effective." CONCLUSION: The SVM contributes substantially to the health care system both clinically and financially. A total of 8812 DALYs were averted in these twelve SVMs. Costs per a DALY averted did not significantly change over the mission years. Increasing the number of patients served has increased the total cost of the mission with no impact on the cost per patient.

The Role of Telemedicine in Surgical Specialties During the COVID-19 Pandemic: A Scoping Review.

BACKGROUND: The objective of this study was to evaluate the current body of evidence on the use of telemedicine in surgical subspecialties during the COVID-19 pandemic. METHODS: This was a scoping review conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR). MEDLINE via Ovid, PubMed, and EMBASE were systematically searched for any reports discussing telemedicine use in surgery and surgical specialties during the first period (February 2020-August 8, 2020) and second 6-month period (August 9-March 4, 2021) of the COVID-19 pandemic. RESULTS: Of 466 articles screened through full text, 277 articles were included for possible qualitative and/or quantitative data synthesis. The majority of publications in the first 6 months were in orthopedic surgery, followed by general surgery and neurosurgery, whereas in the second 6 months of COVID-19 pandemic, urology and neurosurgery were the most productive, followed by transplant and plastic surgery. Most publications in the first 6 months were opinion papers (80%), which decreased to 33% in the second 6 months. The role of telemedicine in different aspects of surgical care and surgical education was summarized stratifying by specialty. CONCLUSION: Telemedicine has increased access to care of surgical patients during the COVID-19 pandemic, but whether this practice will continue post-pandemic remains unknown.

Use of Biologic Mesh for the Treatment and Prevention of Parastomal Hernias.

Parastomal hernia is a frequent complication of ostomy formation with an incidence of up to 56% depending on the type and location of the ostomy as well as the length of follow-up. This review seeks to provide concise insight into the current state of parastomal hernia repair using a hernia mesh, with a particular focus on biologic mesh. Surgical techniques and clinical outcomes of the "keyhole", modified Sugarbaker, and sandwich procedures are described. The current body of evidence on prophylactic biologic mesh placement to prevent parastomal hernia is discussed. Current evidence (while not high-quality) supports the hypothesis that prophylactic biologic mesh placement may decrease parastomal hernia rates. Further experimental and observational clinical studies are required to better understand the role of prophylactic mesh placement to prevent parastomal hernia in patients undergoing colorectal resection with permanent ostomy.

Current state and future perspectives of telemedicine use in surgery during the COVID-19 pandemic: A scoping review protocol.

INTRODUCTION: The biggest concerns in the current pandemic are enormous workload pressure, psychological distress, caregiver burnout, and, even worse, transmission of the virus among healthcare workers. One of the potentially beneficial tools in reducing the above-mentioned risks for overwhelming the healthcare system is telemedicine. Although the role of telemedicine and related interventions as a crisis management tool has increased, the current state of the implementation of telemedicine in surgery and surgical subspecialties has not been adequately evaluated. OBJECTIVE AND SIGNIFICANCE: The objective of this review is to screen the literature, extract expert opinions, qualitative, and quantitative data on the current use and future directions in the implementation of telemedicine in surgery and surgical subspecialties during the COVID-19 pandemic. The findings would potentially help in understanding the challenges and future directions of telemedicine use in surgery. METHODS AND ANALYSIS: The databases to be searched include PubMed, EMBASE, and MEDLINE (via Ovid). In addition, ClinicalTrials.gov and medRxiv.org will be searched for any ongoing and/or unpublished studies. The reference lists of articles included in the review will be screened to assess the sensitivity of the search. Literature search, quality assessment, followed by data extraction will be performed by two independent researchers. The findings of the data synthesis will be reported in diagrams, tables, and text. This review will consider reports that include expert opinions, qualitative and quantitative data on the implementation of telemedicine in surgery and surgical subspecialties (including patients with surgical disease of any age) during the COVID-19 pandemic. In addition, future perspectives reported based either on the evidence provided by the data or on expert opinions will be considered. ETHICS AND DISSEMINATION: This study does not require an institutional review board approval given its summary design nature. Findings of this systematic review will be published in a peer-reviewed journal. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO does not currently accept registrations for scoping reviews, literature reviews or mapping reviews.