Symptomatic Non-parasitic benign hepatic cyst: Evaluation of Management by Deroofing in Ten Consecutive Cases

Background/Purpose: Solitary non-parasitic cysts of the liver are commonly asymptomatic and do not require treatment. Rarely, however, the cysts become symptomatic and are then best treated surgically. The optimal surgical treatment is debatable. The aim of this study was to evaluate the role of deroofing as a safe and effective approach in the management of simple non-parasitic hepatic cysts. Materials & Methods: From January 2002 to October 2008, 10 patients (8 females and 2 males) with histologically proven non-parasitic, benign, simple hepatic cysts underwent deroofing at Tanta University Hospital. Deroofing was achieved by open surgery in 3 cases and by laparoscopic surgery in 7 patients. The principle of both open and laparoscopic approaches was to remove as much as possible of the cyst wall, destroy the endothelial lining and pack the residual cavity with omentum. Results: All of our patients had a solitary cyst with a mean diameter of 12.5 cm (range; 9-18 cm) and all were symptomatic. The most common complaint was upper abdominal pain (n=7, 70%). Age ranged from 1 - 72 year with a median of 15 years. Three patients (30%) were treated with open deroofing while 7 patients (70%) underwent laparoscopic deroofing. One out of these 7 patients was converted to open surgery. Recurrence occurred in 2 patients but was asymptomatic and discovered on follow up because of the small diameter of recurrent cysts (3-4 cm). The follow up period ranged between 12 – 72 months (median 20 months). Conclusion: with proper selection of patients, laparoscopic deroofing of symptomatic, benign, solitary, non-parasitic hepatic cysts is safe, effective and offers all the advantages of minimally invasive surgery. Open deroofing should be reserved for cysts inaccessible by laparoscopy, when the diagnosis is in doubt and for difficulties encountered at laparoscopy.Index Word: hepatic cyst, laparoscopy

Systematic review and meta-analysis of prophylactic mesh placement for prevention of incisional hernia following midline laparotomy

PURPOSE: Incisional hernia is a common long-term complication after laparotomy. This study investigated whether prophylactic mesh reinforcement of laparotomy reduced the rate of incisional hernia, with emphasis on trial design and quality. METHODS: A systematic review of published literature was performed for studies comparing incisional hernia presence following conventional closure or prophylactic mesh reinforcement. Studies were assessed using the Cochrane Risk of Bias Tool, the Jadad score and the Newcastle Ottawa Scale (NOS). The primary endpoint was incisional hernia, assessed by meta-analysis. RESULTS: Seven studies [four randomised controlled trials (RCTs) and three prospective trials] included 588 patients; 262 received mesh reinforcement. All studies included elective patients at high risk of incisional hernia. Six incorporated a polypropylene mesh and one a biologic mesh. Four studies were judged high quality by NOS and two of four RCTs were at low risk of bias, although overall outcome assessment from all studies was either poor or mediocre. Mesh significantly reduced the rate of incisional hernia [odds ratio (OR) 0.15, p

Systematic Review and Meta-Regression of Factors Affecting Midline Incisional Hernia Rates: Analysis of 14 618 Patients

<div><p>Background</p><p>The incidence of incisional hernias (IHs) following midline abdominal incisions is difficult to estimate. Furthermore recent analyses have reported inconsistent findings on the superiority of absorbable versus non-absorbable sutures.</p><p>Objective</p><p>To estimate the mean IH rate following midline laparotomy from the published literature, to identify variables that predict IH rates and to analyse whether the type of suture (absorbable versus non-absorbable) affects IH rates.</p><p>Methods</p><p>We undertook a systematic review according to PRISMA guidelines. We sought randomised trials and observational studies including patients undergoing midline incisions with standard suture closure. Papers describing two or more arms suitable for inclusion had data abstracted independently for each arm.</p><p>Results</p><p>Fifty-six papers, describing 83 separate groups comprising 14 618 patients, met the inclusion criteria. The prevalence of IHs after midline incision was 12.8% (range: 0 to 35.6%) at a weighted mean of 23.7 months. The estimated risk of undergoing IH repair after midline laparotomy was 5.2%. Two meta-regression analyses (A and B) each identified seven characteristics associated with increased IH rate: one patient variable (higher age), two surgical variables (surgery for AAA and either surgery for obesity surgery (model A) or using an upper midline incision (model B)), two inclusion criteria (including patients with previous laparotomies and those with previous IHs), and two circumstantial variables (later year of publication and specifying an exact significance level). There was no significant difference in IH rate between absorbable and non-absorbable sutures either alone or in conjunction with either regression analysis.</p><p>Conclusions</p><p>The IH rate estimated by pooling the published literature is 12.8% after about two years. Seven factors account for the large variation in IH rates across groups. However there is no evidence that suture type has an intrinsic effect on IH rates.</p></div