RESUMO
PURPOSE: Given its potential advantages, open Transversus Abdominis Release (oTAR) has been proposed as a durable solution for complex AWR. However, its applicability in different scenarios remains uncertain. We aimed to analyze the current available evidence and determine surgical outcomes after oTAR. METHODS: We performed a systematic electronic search on oTAR in PubMed/Medline, Embase, and Cochrane Central Register of Controlled Trials databases. Postoperative morbidity and recurrence rates were included as primary endpoints and Quality of life (QoL) was included as secondary endpoint. A random-effect model was used to generate a pooled proportion with 95% confidence interval (CI) between all studies. RESULTS: A total of 22 studies with 4,910 patients undergoing oTAR were included for analysis. Mean hernia defect and mesh area were 394 (140-622) cm2 and 1065 (557-2206) cm2, respectively. Mean follow-up was 19.7 (1-32) months. The weighted pooled proportion of recurrence, overall morbidity, surgical site occurrences (SSO), surgical site infection (SSI), surgical site occurrences requiring procedural intervention (SSOPI), major morbidity and mortality were: 6% (95% CI, 3-10%), 34% (95% CI, 26-43%), 22% (95% CI, 16-29%), 11% (95% CI, 8-16%), 4% (95% CI, 3-7%), 6% (95% CI, 4-10%) and 1% (95% CI, 1-2%), respectively. A significant improvement in QoL after oTAR was reported among studies. CONCLUSION: Open TAR is an effective technique for complex ventral hernias as it is associated with low recurrence rate and a significant improvement in QoL. However, the relatively high morbidity rates observed emphasize the necessity of further patients' selection and optimization to improve outcomes.
RESUMO
BACKGROUND: Laparoscopic appendectomy (LA) is a common procedure among surgical trainees. However, first-year residents' involvement in this procedure is scarcely studied. We aimed to determine the safety and outcomes of LA performed by surgical interns early in their first year of surgical training. MATERIALS AND METHODS: A retrospective review of all patients who underwent LA for acute appendicitis from 2006 to 2019 was performed. All patients operated by surgical interns were included. The sample was divided into 2 groups: LA performed during the first (G1) and last 3 months (G2) of their first year of residency. Demographics, operative variables, and postoperative outcomes were compared between groups. RESULTS: A total of 2009 LA were performed during the study period; 1647 (82%) were done by surgical interns. A total of 934 LA were performed at both ends of the year; 505 belonged to G1 and 429 to G2. Each surgical intern performed a mean of 40 LA. Demographics, complicated appendicitis rates, and presence of peritonitis were comparable between groups. Operative time was longer in G1 (G1: 61 vs. G2: 52 min, P<0.0001). Major morbidity (G1: 2.1% vs. G2: 3.4%, P=0.2), postoperative intra-abdominal abscess rates (G1: 2.8% vs. G2: 2.8%, P=0.66), median length of hospital stay (G1: 1.9 vs. G2: 1.8 d, P=0.59), and readmission rates (G1: 1.6% vs. G2: 2%, P=0.73) were similar between groups. There was no mortality in the series. CONCLUSIONS: LA can be safely performed by supervised surgical interns early in their training. Despite a longer operative time, postoperative outcomes were favorable and similar as those achieved at the end of surgical internship.