Failure of Mesenteric Defect Closure After Roux-en-Y Gastric Bypass

Routine closure of mesenteric defects after Roux-en-Y gastric bypass may not be an effective permanent closure

Protocol to develop a core outcome set in incisional hernia surgery : the HarMoNY Project

Incisional hernia has an incidence of up to 20% following laparotomy and is associated with significant morbidity and impairment of quality of life. A variety of surgical strategies including techniques and mesh types are available to manage patients with incisional hernia. Previous works have reported significant heterogeneity in outcome reporting for abdominal wall herniae, including ventral and inguinal hernia. This is coupled with under-reporting of important clinical and patient-reported outcomes. The lack of standardisation in outcome reporting contributes to reporting bias, hinders evidence synthesis and adequate data comparison between studies. This project aims to develop a core outcome set (COS) of clinically important, patient-oriented outcomes to be used to guide reporting of future research in incisional hernia. This project has been designed as an international, multicentre, mixed-methods project. Phase I will be a systematic review of current literature to examine the current clinical and patient-reported outcomes for incisional hernia and abdominal wall reconstruction. Phase II will identify the outcomes of importance to all key stakeholders through in depth qualitative interviews. Phase III will achieve consensus on outcomes of most importance and for inclusion into a COS through a Delphi process. Phase IV will achieve consensus on the outcomes that should be included in a final COS. The adoption of this COS into clinical and academic practice will be endorsed by the American, British and European Hernia Societies. Its utilisation in future clinical research will enable appropriate data synthesis and comparison and will enable better clinical interpretation and application of the current evidence base. This study has been registered with the Core Outcome Measures in Effectiveness Trials initiative. CRD42018090084

Mini-laparoscopic versus laparoscopic approach to appendectomy

BACKGROUND: The purpose of this clinical study is to evaluate the feasibility of using 2-mm laparoscopic instruments to perform an appendectomy in patients with clinically suspected acute appendicitis and compare the outcome of this mini-laparoscopic or "needlescopic" approach to the conventional laparoscopic appendectomy. METHODS: Two groups of patients undergoing appendectomy over 24 months were studied. In the first group, needlescopic appendectomy was performed in 15 patients by surgeons specializing in advanced laparoscopy. These patients were compared with the second or control group that included 21 consecutive patients who underwent laparoscopic appendectomy. We compared the patients' demographic data, operative findings, complications, postoperative pain medicine requirements, length of hospital stay, and recovery variables. Differences were considered statistically significant at a p-value < 0.05. RESULTS: Patient demographics, history of previous abdominal surgery, and operative findings were similar in both groups. There was no conversion to open appendectomy in either group. No postoperative morbidity or mortality occurred in either group. The needlescopic group had a significantly shorter mean operative time (p = 0.02), reduced postoperative narcotics requirements (p = 0.05), shorter hospital stay (p = 0.04), and quicker return to work (p = 0.03) when compared with the laparoscopic group. CONCLUSIONS: We conclude that the needlescopic technique is a safe and effective approach to appendectomy. When performed by experienced laparoscopic surgeons, the needlescopic technique results in significantly shorter postoperative convalescence and a prompt recovery