A model to determine factors influencing intraoperative complications in sleeve gastrectomy.

Objective: The study presents a logistic regression model describing the factors leading to intraoperative complications in laparoscopic sleeve gastrectomy (LSG) and a detailed description of the intraoperative complications that occurred in our operations. Material and methods: The study was designed as a retrospective and cohort study. It includes patients who underwent laparoscopic sleeve gastrectomy between January 2008 and December 2020. Results: The study included 257 patients. The mean (SD) age of all patients included in the study was 40.28 (9.58) years. The body mass index of our patients ranged from 31.2 to 86.6 kg/m2. The Stepwise Backward model was used (Cox and Snell R2 = 0.051, Nagelkerke R2 = 0.072, Hosmer-Lemesxow χ2 = 1.968, df = 4, p = 0.742, overall model accuracy of 70.4%). The model shows that pre-operative diabetes mellitus or hypertension Stage 3 significantly increases the probability or risk of intraoperative complications. Conclusions: The study shows which intraoperative complications occur in LSG, how they can be remedied and which factors can lead to them and influence the outcome of the operation itself. The recognition and successful treatment of intraoperative complications are very important as they reduce the number of reoperations and treatment costs.

Objetivo: El estudio presenta un modelo de regresión logística que describe los factores que conducen a las complicaciones intraoperatorias en la gastrectomía en manga laparoscópica (LSG) y una descripción detallada de las complicaciones intraoperatorias que ocurrieron en nuestras operaciones. Material y métodos: Estudio de cohorte retrospectivo. Incluye pacientes que se sometieron a LSG entre enero de 2008 y diciembre de 2020. Resultados: El estudio incluyó a 257 pacientes. La edad media (DE) de los pacientes del estudio fue de 40.28 (9.58) años. El índice de masa corporal de nuestros pacientes osciló entre 31.2 y 86.6 kg/m2. Se utilizó el modelo Stepwise Backward (Cox y Snell R2 = 0.051, Nagelkerke R2 = 0.072, Hosmer-Lemesxow χ2 = 1.968, gl = 4, p = 0.742, precisión global del modelo del 70.4%). El modelo muestra que la diabetes mellitus o hipertensión preoperatoria en estadio 3 aumenta significativamente la probabilidad de complicaciones intraoperatorias. Conclusiones: El estudio muestra qué complicaciones intraoperatorias ocurren en la LSG, cómo se pueden remediar y qué factores pueden conducir a ellas e influir en el resultado de la operación en sí. El reconocimiento y el tratamiento exitoso de las complicaciones intraoperatorias son muy importantes ya que reducen el número de reintervenciones y los costos del tratamiento.

A rating instrument for fear of hospitalisation.

AIMS AND OBJECTIVES: To develop and validate a reliable instrument that can measure fear of hospitalisation experienced by outpatients. BACKGROUND: After having a diagnosis established, some patients experience sense of fear, unpleasantness and embarrassment due to the possibility to be admitted to a hospital. Currently, there is no available instrument for measuring fear of hospitalisation. DESIGN: Cross-sectional study for assessing reliability and validity of a questionnaire. METHOD: The questionnaire with 17 items and answers according to the Likert scale was developed during two brainstorming sessions of the research team. Its reliability, validity and temporal stability were tested on the sample of 330 outpatients. The study was multicentric, involving patients from seven cities and three countries. RESULTS: Fear of hospitalisation scale showed satisfactory reliability, when rated both by the investigators (Cronbach's alpha .799) and by the patients themselves (Cronbach's alpha .760). It is temporally stable, and both divergent and convergent validity tests had good results. Factorial analysis revealed three domains: fear of being injured, trust to medical staff and fear of losing privacy or autonomy. CONCLUSIONS: This study developed new reliable and valid instrument for measuring fear of hospitalisation. RELEVANCE TO CLINICAL PRACTICE: Identification of patients with high level of fear of hospitalisation by this instrument should help clinicians to administer measures which may decrease fear and prevent avoidance of healthcare utilisation.

'Plug Free' Connector Placement Modification of a Bilayer Patch Device in Male Indirect Inguinal Hernioplasty

The bilayer patch device (Ethicon, Prolen Hernia System®) for inguinal hernia repair has a connector that acts as a 'plug' in the internal inguinal ring. The position of this 'plug' component may be responsible for higher incidence of chronic pain and intestinal damage. We assumed that changing the position of the connector of a bilayer patch device (PHS®) and placing it medially in Hesselbach triangle would contribute to lower incidence of chronic pain and would not result in intestinal damage, with good clinical outcome following indirect inguinal hernioplasty. This retrospective study included 73 patients with 76 indirect inguinal hernias, who underwent the procedure of modifying the position of the bilayer patch device in the 2005-2015 period. The mean age of the patients was 57 years. Three patients had early postoperative complications (3.95%), two of which had postoperative seroma and one had postoperative pain. Three patients (3.95%) had late postoperative complications. One patient (1.32%) had chronic pain. There was one recurrence (1.32%) and one patient (1.32%) needed the mesh removed due to discomfort. The 'plug free' position of the connector of a bilayer patch device in patients with indirect inguinal hernioplasty is a safe procedure with low rate of chronic pain, no intestinal damage, and standard low recurrence.

Hepatocellular carcinoma and impact of aflatoxin difuranocoumarin derivative system ­ A case report.

Introduction: Hepatocellular carcinoma (HCC) is the most frequent type of liver malignancy. As a carcinogen, aflatoxin B1 (AFB1) causes HCC by inducing deoxyribonucleic acid adducts that lead to genetic changes in liver cells and may be the cause of HCC in up to 30% of cases. The incidence of HCC has been on the rise and is an issue in the countries of the Western Balkans. Case Outline: This paper presents a case of a 37-year-old woman who was diagnosed with HCC, without hepatitis B, hepatitis C, or liver cirrhosis. The patient consumed milk and dairy products in quantities of over two liters per day over the course of 20 years, which indicates the impact of aflatoxin in milk on HCC. A positive signal for the presence of AFB1 was detected by ELISA (enzyme-linked immunosorbent assay) in-house using immunoperoxidase screening test. Conclusion: As carcinogenic difuranocoumarin derivative, aflatoxin B1 is the most likely cause of malignant transformation of hepatocytes, which resulted in hepatocellular carcinoma in this patient.