Pain after conventional versus Ligasure haemorrhoidectomy. A meta-analysis

AbstractBackgroundHaemorrhoidectomy is a frequently performed surgical procedure and associated with postprocedural pain. The use of the Ligasure may result in a decreased incidence of pain as coagulation with high frequency current and active feedback control over the power output results in minimal thermal spread and limited tissue charring.MethodsA multi-database systematic search was conducted to identify trials randomizing conventional and Ligasure haemorrhoidectomy. Key journals were hand searched. There was no restriction on language. Two reviewers independently extracted data and assessed trial quality. Odd Ratios were generated for dichotomous variables. Weight Mean Differences were used for analysing continuous variables. Only random effects models were used. Heterogeneity was explored by sensitivity analysis.ResultsTwelve studies with 1142 patients met the inclusion criteria. The pain score at the first day following surgery was significantly less in the Ligasure group (10 studies, 835 patients, WMD −2.07 CI −2.77 to −1.38). The benefit was diminished at day 14 (VAS pain score, 4 studies, 183 patients, WMD −0.12 CI −0.37 to 0.12). The conventional technique took significantly longer to complete (11 trials, 9.15minutes, CI 3.21 to 15.09). Significantly less urinary retentions and less delayed wound healing were noted following Ligasure haemorrhoidectomy. There was no relevant difference in other postoperative complications, symptoms of recurrent bleeding or incontinence at final follow-up. Hospital stay was similar for both groups. Patients treated with the Ligasure-technique returned to work significantly earlier (4 studies, 451 patients, 4.88 days, CI 2.18 to 7.59). Sensitivity analysis in case of considerable heterogeneity distinguished closed from open conventional technique.ConclusionSince the usage of the Ligasure technique results in significantly less immediate postoperative pain after haemorrhoidectomy without any adverse effect on postoperative complications, convalescence and incontinence-rate, this technique is superior in terms of patient tolerance. Although there was a tendency for equal efficacy, more evaluation of the long-term risk of recurrent haemorrhoidal disease is required

Open ventral hernia repair with a composite ventral patch : final results of a multicenter prospective study

Background: This study assessed clinical outcomes, including safety and recurrence, from the two-year follow-up of patients who underwent open ventral primary hernia repair with the use of the Parietex (TM) Composite Ventral Patch (PCO-VP). Methods: A prospective single-arm, multicenter study of 126 patients undergoing open ventral hernia repair for umbilical and epigastric hernias with the PCO-VP was performed. Results: One hundred twenty-six subjects (110 with umbilical hernia and 16 with epigastric hernia) with a mean hernia diameter of 1.8cm (0.4-4.0) were treated with PCO-VP. One hundred subjects completed the two-year study. Cumulative hernia recurrence was 3.0% (3/101; 95%CI: 0.0-6.3%) within 24months. Median Numeric Rating Scale pain scores improved from 2 [0-10] at baseline to 0 [0-3] at 1 month (P<0.001) and remained low at 24months 0 [0-6] (P<0.001). 99% (102/103) of the patients were satisfied with their repair at 24months postoperative. Conclusions: The use of PCO-VP to repair primary umbilical and epigastric defects yielded a low recurrence rate, low postoperative and chronic pain, and high satisfaction ratings, confirming that PCO-VP is effective for small ventral hernia repair in the two-year term after implantation. Trial registration: The study was registered publically at clinicaltrials.gov (NCT01848184 registered May 7, 2013)

A multicenter prospective study of patients undergoing open ventral hernia repair with intraperitoneal positioning using the monofilament polyester composite ventral patch : interim results of the PANACEA study

This study assessed the recurrence rate and other safety and efficacy parameters following ventral hernia repair with a polyester composite prosthesis (Parietex™ Composite Ventral Patch [PCO-VP])

Laparoscopic Sleeve Gastrectomy Feasible for Bariatric Revision Surgery

Bariatric revision surgery is associated with several complications that can be attributed to decreased quality of tissue and complexity of the surgery. A laparoscopic sleeve gastrectomy is a simple technique with potential advantages. Therefore, the results of this procedure were evaluated as a revisional option. Fifty-one patients underwent laparoscopic sleeve gastrectomy (LSG). Indications for the LSG were insufficient weight loss (34 patients, group 1) or vomiting (17 patients, group 2) following a laparoscopic adjustable gastric banding (LAGB) or vertical banded gastroplasty (VBG). Patient and procedure characteristics as well as outcome were collected prospectively. From October 2006 to June 2010, 51 patients with a failed prior bariatic procedure (VBG or LAGB) were converted to (L)SG. The conversion rate was zero. The median procedure time was 99 min (range 54–221) and hospital stay was 3 days (range 2–38). There was no mortality after 30 days. Complications included bleeding (six) and leakage of the staple line (seven). Mean follow-up was 13.8 (2–46) months. LSG as revision surgery for insufficient weight loss resulted in extra weight loss of 52.7%, and the overall extra weight loss was 49.3%. When LSG was performed because of vomiting, 82% was able to eat solid food at follow-up. Of the 65 pre-existent co-morbidities, 21 were resolved and 18 improved. LSG as a revision procedure is feasible. An additional weight loss and further resolution of co-morbidity seem achievable, however, at the cost of a high number of complications. Therefore, revision bariatric surgery should be limited to expert tertiary bariatric centers

The Value of Tracking Data on the Behavior of Patients Who Have Undergone Bariatric Surgery:Explorative Study

Background: To maintain the benefits of a bariatric procedure, patients have to change their lifestyle permanently. This happens within a context of coresponsibilities of health care professionals and their social support system. However, most interventions are focused on the patient as an individual. In this explorative pilot study, behavioral, contextual, and experiential data were gathered to obtain insight on coresponsibility. Objective: The aim of this study is to explore the use of trackers by patients who have undergone bariatric surgery in a data-enabled design approach. Methods: Behavioral and contextual data on the households of patients who have undergone bariatric surgery were explored using a smartphone with an interactive user interface (UI), weight scale, activity bracelet, smart socket, accelerometer motion sensor, and event button to find examples of opportunities for future interventions. Results: A total of 6 households were monitored. Approximately 483,000 data points were collected, and the participants engaged in 1483 conversations with the system. Examples were found using different combinations of data types, which provided the obesity team a better understanding of patient behaviors and their support system, such as a referral to a family coach instead of a dietician. Another finding regarding the partners was, for example, that the conversational UI system facilitated discussion about the support structure by asking for awareness. Conclusions: An intelligent system using a combination of quantitative data gathered by data tracking products in the home environment and qualitative data gathered by app-enhanced short conversations, as well as face-to-face interviews, is useful for an improved understanding of coresponsibilities in the households of patients who have undergone bariatric surgery. The examples found in this explorative study so far encourage research in this field.</p

The Value of Tracking Data on the Behavior of Patients Who Have Undergone Bariatric Surgery:Explorative Study

Background: To maintain the benefits of a bariatric procedure, patients have to change their lifestyle permanently. This happens within a context of coresponsibilities of health care professionals and their social support system. However, most interventions are focused on the patient as an individual. In this explorative pilot study, behavioral, contextual, and experiential data were gathered to obtain insight on coresponsibility. Objective: The aim of this study is to explore the use of trackers by patients who have undergone bariatric surgery in a data-enabled design approach. Methods: Behavioral and contextual data on the households of patients who have undergone bariatric surgery were explored using a smartphone with an interactive user interface (UI), weight scale, activity bracelet, smart socket, accelerometer motion sensor, and event button to find examples of opportunities for future interventions. Results: A total of 6 households were monitored. Approximately 483,000 data points were collected, and the participants engaged in 1483 conversations with the system. Examples were found using different combinations of data types, which provided the obesity team a better understanding of patient behaviors and their support system, such as a referral to a family coach instead of a dietician. Another finding regarding the partners was, for example, that the conversational UI system facilitated discussion about the support structure by asking for awareness. Conclusions: An intelligent system using a combination of quantitative data gathered by data tracking products in the home environment and qualitative data gathered by app-enhanced short conversations, as well as face-to-face interviews, is useful for an improved understanding of coresponsibilities in the households of patients who have undergone bariatric surgery. The examples found in this explorative study so far encourage research in this field.</p

European Hernia Society guidelines on management of rectus diastasis

Rectus diastasis; Hernia; GuidelinesDiástasis del recto; Hernia; PautasDiàstasi del recte; Hèrnia; PautesBackground The definition, classification and management of rectus diastasis (RD) are controversial in the literature and a variety of different surgical treatments have been described. This article reports on the European Hernia Society (EHS) Clinical Practice Guideline for RD. Method The Guideline group consisted of eight surgeons. The Grading of Recommendation, Assessment, Development and Evaluation (GRADE) approach and the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument were used. A systematic literature search was done in November 2018 and updated in November 2019 and October 2020. Nine Key Questions (KQs) were formulated. Results Literature reporting on the definition, classification, symptoms, outcomes and treatments was limited in quality, leading to weak recommendations for the majority of the KQs. The main recommendation is to define RD as a separation between rectus muscles wider than 2 cm. A new classification system is suggested based on the width of muscle separation, postpregnancy status and whether or not there is a concomitant hernia. Impaired body image and core instability appear to be the most relevant symptoms. Physiotherapy may be considered before surgical management. It is suggested to use linea alba plication in patients without concomitant hernia and a mesh-based repair of RD with concomitant midline hernias. Conclusion RD should be defined as a separation of rectus muscles wider than 2 cm and a new classification system is suggested

Ekstrak Virgin Coconut Oil Sebagai Sumber Pangan Fungsional

Virgin Coconut Oil (VCO) merupakan salah satu jenis minyak nabati yang dapat bermanfaat dari aspek medis dan nutrisi karena dapat mencegah dan membantu mengobati penyakit tertentu serta dapat mempermudah proses pencernaan makanan dan penyerapan gizi. VCO dapat bertindak sebagai antioksidan dan antifotooksidan yang disebabkan oleh kandungan komponen minor (mikronutrien). Tujuan penelitian ini adalah mengekstrak komponen minor VCO menjadi produk untuk pangan fungsional yang mampu berperan sebagai antioksidan dan mengetahui peran VCO sebagai antiradikal bebas secara in vitro. Penelitian ini menggunakan metode eksperimental dengan 3 tahap yaitu: 1. Ekstraksi VCO menggunakan pelarut etanol dan metanol, 2. Pengujian penangkapan radikal bebas ekstrak VCO secara in vitro dengan metode 1,1-difenil-2-pikrilhidrazil (DPPH), 3. Identifikasi dan pengujian komponen kimia pada ekstrak VCO, identifikasi dan pengujian komponen minor pada ekstrak VCO dengan menggunakan High Performance Liquid Chromatography (HPLC). Hasil penelitian ini menunjukkan bahwa rendemen ekstrak VCO semakin tinggi dengan semakin tingginya persentase pelarut, ekstraksi dengan menggunakan etanol menghasilkan rendemen ekstrak yang lebih tinggi dibanding dengan menggunakan metanol. Aktivitas antioksidan dan kandungan total tokoferol dari ekstrak VCO semakin tinggi dengan semakin tingginya persentase pelarut yang digunakan. Salah satu senyawa tokoferol yang terdapat dalam VCO adalah -tokoferol. Berdasarkan analisa statistik menunjukkan bahwa etanol dan metanol menghasilkan sifat kimia ekstrak yang relatif sama, sehingga dapat direkomendasikan bahwa untuk mengekstraksi komponen minor dari VCO dapat menggunakan etanol karena di samping aman dari aspek kesehatan juga dapat menghasilkan rendemen ekstrak yang lebih tinggi