Advantages and disadvantages of laparoscopic inguinal hernia repair (hernioplasty)

Aim: The aim of this study was to explore the advantages and disadvantages of laparoscopic hernioplasty by comparing them with conventional surgeries. Materials and methods: The study included 376 patients (344 men and 32 women) who underwent inguinal hernia repair in inpatient settings over a 3-year period (2017–2020). The patients were divided into two groups: patients with conventional hernioplasty (CH) - 312 patients (291 men and 32 women, mean age 55±15 years, range 18–93) and 64 patients with laparoscopic hernioplasty (LH), all of them middle-aged men at mean age 45±15 years (range 24–69). Results: Thirty-eight patients (59.38%) with LH were ASA class 1 patients while the CH patients were stratified in ASA classes 1 to 4. The LH group consisted of 39 patients who had transabdominal preperitoneal (TAPP) surgery and 25 who received total extraperitoneal (TEP) repair. The average operating time was 12 minutes (range 90–200 min) for TAPP and 50 minutes (range 20-125 min) for TEP. The mean intensity of pain score measured by VAS (0-10) was 4 (2-5) for CH patients and 3 (2-4) for LH patients. The duration of pain was 3 days (2-4) for CH patients and 2 days (1-3) for the LH group. Ninety-five percent (61/64) of LH patients defined their quality of life as “better”. Conclusions: The following factors are of particular importance for the choice of hernioplastic technique: operating time, possible intraoperative complications, the level of postoperative pain and potential postoperative analgesics, possible complications, patient recovery, length of hospital stay, cost, quality of life, and long-term results of the treatment

Candida Carriers among Individuals with Tongue Piercing—A Real-Time PCR Study

Among the local factors for oral candidiasis, the piercing of the tongue is recognized by some authors as a risk factor for the colonization of Candida albicans. There are few case reports in which Candida spp. colonization and infection are associated with tongue piercing but only one microbiological study supports this hypothesis in general. The aim of this study was to examine this possible association between the presence of both tongue piercing and Candida spp. in healthy individuals. Positive results for tongue colonization with Candida spp. were found in four (12.9%) of the tongue-pierced subjects and in three (9.67%) subjects of the control group (p = 0.550). All samples were identified as Candida albicans. The univariate and logistic regression analyses of possible risk factors for tongue colonization revealed that gender (p = 0.024), smoking more than 10 cigarettes per day (p = 0.021), and improper hygiene (p = 0.028) were statistically significant influencing factors in the multivariate analysis. The results suggest that the piercing of the tongue is not a risk factor for colonization of Candida spp

Advantages and disadvantages of laparoscopic inguinal hernia repair (hernioplasty)

Aim: The aim of this study was to explore the advantages and disadvantages of laparoscopic hernioplasty by comparing them with conventional surgeries. Materials and methods: The study included 376 patients (344 men and 32 women) who underwent inguinal hernia repair in inpatient settings over a 3-year period (2017–2020). The patients were divided into two groups: patients with conventional hernioplasty (CH) - 312 patients (291 men and 32 women, mean age 55±15 years, range 18–93) and 64 patients with laparoscopic hernioplasty (LH), all of them middle-aged men at mean age 45±15 years (range 24–69). Results: Thirty-eight patients (59.38%) with LH were ASA class 1 patients while the CH patients were stratified in ASA classes 1 to 4. The LH group consisted of 39 patients who had transabdominal preperitoneal (TAPP) surgery and 25 who received total extraperitoneal (TEP) repair. The average operating time was 12 minutes (range 90–200 min) for TAPP and 50 minutes (range 20-125 min) for TEP. The mean intensity of pain score measured by VAS (0-10) was 4 (2-5) for CH patients and 3 (2-4) for LH patients. The duration of pain was 3 days (2-4) for CH patients and 2 days (1-3) for the LH group. Ninety-five percent (61/64) of LH patients defined their quality of life as “better”. Conclusions: The following factors are of particular importance for the choice of hernioplastic technique: operating time, possible intraoperative complications, the level of postoperative pain and potential postoperative analgesics, possible complications, patient recovery, length of hospital stay, cost, quality of life, and long-term results of the treatment

Diagnostic Imaging Studies on Local and Systemic Erythropoietin Application for Promoting Bone Regeneration in Rat Calvarial Defects

The purpose of this study was to compare the effects of local and systemic application of recombinant human erythropoietin (rhEPO) on the healing of rat calvarial defects. Twenty-four male skeletally-mature Wistar rats were used. Two bone 5 mm critical size defects were created in calvarial bones of each rat. In rats from experimental group I (n = 12), EPO was applied locally on a collagen cone in left defects, whereas a collagen cone soaked with physiological saline was placed in right defects. The rats from experimental group II were injected once intraperitoneally with 4900 IU/kg EPO; a collagen cone was only placed in left defects, whereas the right defects were left empty. The systemic effect of EPO treatment was monitored by haematological analyses on days 0, 30 and 90. Bone healing was monitored via radiography and computed tomography on the same time intervals. The results demonstrated that local EPO application had no significant effect on haemopoiesis, unlike the systemic application. At the same time, it resulted in new bone formation and therefore, could be successfully used as a means of promoting bone regeneration

The use of simulators to acquire ERCP skills : a systematic review

Background and Aims: Endoscopic retrograde cholangiopancreatography (ERCP) is a technically demanding diagnostic and therapeutic endoscopic procedure with a high risk for adverse events such as post-ERCP pancreatitis and bleeding. Since endoscopists with less experience have higher adverse event rates, the training of new residents on ERCP simulators has been suggested to improve the resident's technical skills necessary for ERCP. However, there is a lack of consensus on whether the training program should focus on a threshold number of procedures or be more tailored to the individual's performance. Furthermore, there is also disagreement on which form of simulator(s) should be used. Therefore, the primary outcome of this systematic review was to study the extent to which simulators used for ERCP training are correctly validated. Methods: In 2022, a systematic search of the literature was conducted on MEDLINE and SCOPUS under the guidance of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 protocol seeking articles with the MeSH terms 'Endoscopic Retrograde Cholangiopancreatography' OR 'ERCP' in combination with 'simulation' OR 'simulator'. Results: The search resulted in 41 references. A total of 19 articles met the inclusion criteria and were included in the qualitative analysis. Only one of the articles fulfilled the criteria of a robust validation study. Conclusions: Since only one of the 19 articles met the requirements for a thorough and correct validation, further studies with sufficient numbers of subjects, that evaluate complete preclinical training programs based on validated ERCP simulators are warranted

Conventional and digital pleural drainage systems – advantages and disadvantages

Introduction: Pleural cavity drainage is a crucial component of the surgical management of patients with various chest diseases. Digital drainage systems are increasingly used in contemporary thoracic surgical procedure, which is likely a result of their effectiveness in achieving early postoperative ambulation, cutting down on hospital stays and lowering costs. The vast majority of thoracic surgeons worldwide prefer digital drainage systems to traditional ones. The advantages of the former, however, are disputed by some researchers. Aim: The objective of this study was to compare the two types of pleural drainage mechanisms, conventional and digital, in terms of duration of pleural drainage in days, financial cost, and postoperative air leak duration. Materials and methods: The study focused on 80 patients who underwent various thoracic surgical interventions in the Clinic of Thoracic and Abdominal Surgery at St George University Hospital in Plovdiv. They were divided into two groups: group 1 consisted of 42 patients who were postoperatively attached to a conventional non-mobile pleural drainage system, and group 2 consisted of 38 patients in whom a mobile digital pleural drainage system was used. The main analyzed data were duration of pleural drainage, duration of postoperative air leak, hospital stay, and financial costs. Results: The average duration of pleural drainage, regardless of surgery and type of drainage system applied was 4.86±0.8 days. The average duration of pleural drainage in patients attached to the mobile digital drainage system was shorter than that in patients with a conventional pleural non-mobile drainage system, regardless of the type of surgery done. This difference was statistically significant in favor of the digital pleural drainage system. The study also found a statistically significant difference in terms of financial costs in favor of digital draining system. The average cost of a hospital stay for patients attached to a mobile digital drainage system was BGN 119.40±7.15, whereas the average cost of a hospital stay for patients connected to a traditional pleural drainage system (PDS) was BGN 159±10.50. Regarding the duration of postoperative air leak, the difference between the types of pleural drainage mechanism used was not convincing. Conclusions: Digital pleural drainage systems provide clinicians with an opportunity to assess the postoperative air leak more precisely, track its dynamics, shorten hospital stays, reduce postoperative costs, and optimize the time to remove the chest drain. Based on these features, they will undoubtedly continue to enter everyday surgical practice

Surgical treatment of pneumothorax in patients with COVID-19 – results and management

Introduction: The new coronavirus, SARS-CoV-2, provokes infection with different clinical presentation. It involves an asymptomatic condition, mild variants with fever and dry cough to severe pneumonia, adynamia and respiratory failure with lethal outcome. The fibrotic lung tissue after the inflammatory process is a background for development of a secondary pneumothorax. Although it rarely causes lethal outcomes in COVID-19 patients, pneumothorax requires early diagnosis and adequate treatment to prevent any complications and decrease mortality rate.Aim: The aim of this study was to analyse the results of surgical treatment of hospitalized COVID-19 patients with pneumothorax in terms of demographic data, concomitant diseases, complications, and outcome.Materials and methods: Longitudinal prospective study was carried out with 26 patients with pneumothorax as a result of SARS-CoV-2 infection. They were treated at the Intensive Care Unit of the Infectious Disease Clinic and at the Second Clinic of Surgery, St George University Hospital in Plovdiv over a 6-month period from September 2020 to February 2021.Results: Seventeen of the patients were men and nine – women. Twenty-four of all patients underwent thoracentesis and two of them had a video-assisted thoracoscopy. The mean age of the studied patients with pneumothorax and COVID-19 was 66.77±12.61 years, which shows that it is the patients of advanced age with concomitant diseases that are at a higher risk of serious complications and adverse outcome. Of the hospitalized 1245 patients with COVID-19, 385 (30.92%) passed away. Of all hospitalized patients with SARS-CoV-2, 26 (2.08%) developed pneumothorax. Sixteen of them (62%) passed away. The possibility of a lethal outcome for intubated patients increased more than twice.Conclusions: The pneumothorax as a complication of COVID-19 carries high mortality and severely worsens the prognosis for these patients