A systematic review and meta-analysis comparing adverse events and functional outcomes of different pouch designs after restorative proctocolectomy

Aim There is no consensus as to which ileoanal pouch design provides better outcomes after restorative proctocolectomy. This study compares different pouch designs. Method A systematic review of the literature was performed. A random effects meta-analytical model was used to compare adverse events and functional outcome. Results Thirty comparative studies comparing J, W, S and K pouch designs were included. No significant differences were identified between the different pouch designs with regard to anastomotic dehiscence, anastomotic stricture, pelvic sepsis, wound infection, pouch fistula, pouch ischaemia, perioperative haemorrhage, small bowel obstruction, pouchitis and sexual dysfunction. The W and K designs resulted in fewer cases of pouch failure compared with the J and S designs. J pouch construction resulted in a smaller maximum pouch volume compared with W and K pouches. Stool frequency per 24 h and during daytime was higher following a J pouch than W, S or K constructions. The J design resulted in increased faecal urgency and seepage during daytime compared with the K design. The use of protective pads during daytime and night-time was greater with a J pouch compared to S or K. The use of antidiarrhoeal medication was greater after a J reservoir than a W reservoir. Difficulty in pouch evacuation requiring intubation was higher with an S pouch than with W or J pouches. Conclusion Despite its ease of construction and comparable complication rates, the J pouch is associated with higher pouch failure rates and worse function. Patient characteristics, technical factors and surgical expertise should be considered when choosing pouch design

A systematic review and network meta-analysis comparing energy devices used in colorectal surgery

Background The aim of this study was to compare energy devices used for intraoperative hemostasis during colorectal surgery. Methods A systematic literature review and Bayesian network meta-analysis performed. MEDLINE, EMBASE, Science Citation Index Expanded, and Cochrane were searched from inception to August 11th 2021. Intraoperative outcomes were operative blood loss, operative time, conversion to open, conversion to another energy source. Postoperative outcomes were mortality, overall complications, minor complications and major complications, wound complications, postoperative ileus, anastomotic leak, time to first defecation, day 1 and 3 drainage volume, duration of hospital stay. Results Seven randomized controlled trials (RCTs) were included, reporting on 680 participants, comparing conventional hemostasis, LigaSure (TM), Thunderbeat(R) and Harmonic(R). Harmonic(R) had fewer overall complications compared to conventional hemostasis. Operative blood loss was less with LigaSure (TM) (mean difference [MD] = 24.1 ml; 95% confidence interval [CI] - 46.54 to - 1.58 ml) or Harmonic(R) (MD = 24.6 ml; 95% CI - 42.4 to - 6.7 ml) compared to conventional techniques. Conventional hemostasis ranked worst for operative blood loss with high probability (p = 0.98). LigaSure (TM), Harmonic(R) or Thunderbeat(R) resulted in a significantly shorter mean operative time by 42.8 min (95% CI - 53.9 to - 31.5 min), 28.3 min (95% CI - 33.6 to - 22.6 min) and 26.1 min (95% CI - 46 to - 6 min), respectively compared to conventional electrosurgery. LigaSure (TM) resulted in a significantly shorter mean operative time than Harmonic(R) by 14.5 min (95% CI 1.9-27 min) and ranked first for operative time with high probability (p = 0.97). LigaSure (TM) and Harmonic(R) resulted in a significantly shorter mean duration of hospital stay compared to conventional electrosurgery of 1.3 days (95% CI - 2.2 to - 0.4) and 0.5 days (95% CI - 1 to - 0.1), respectively. LigaSure (TM) ranked as best for hospital stay with high probability (p = 0.97). Conventional hemostasis was associated with more wound complications than Harmonic(R) (odds ratio [OR] = 0.27; CI 0.08-0.92). Harmonic(R) ranked best with highest probability (p = 0.99) for wound complications. No significant differences between energy devices were identified for the remaining outcomes. Conclusions LigaSure (TM), Thunderbeat(R) and Harmonic(R) may be advantageous for reducing operative blood loss, operative time, overall complications, wound complications, and duration of hospital stay compared to conventional techniques. The energy devices result in comparable perioperative outcomes and no device is superior overall. However, included RCTs were limited in number and size, and data were not available to compare all energy devices for all outcomes of interest

Convergence in Government Spending: Theory and Cross-Country Evidence

Les technologies de production permettent de supposer raisonnablement que la compétition internationale entre facteurs de production aboutira à une convergence de la production par habitant. Y a-t-il un processus analogue qui va mener à une convergence de l'activité du secteur public? Nous fournissons un modèle simple qui prévoit une convergence des dépenses publiques sous certaines conditions. Nous démontrons que le modèle de Barro (1990) prédisant une croissance endogène provoquée par les dépenses publiques justifie les assomptions nécessaires et renforce ainsi l'hypothèse de convergence. Nous discutons aussi la possibilité que la globalisation croissante ait conduit à une convergence des dépenses publiques. Notre enquête empirique transversale produit une évidence irréfutable de convergence des dépenses publiques par habitant pour la consommation, le capital et l'éducation. Ces résultats fournissent un cadre nouveau pour expliquer les forces dynamiques qui déterminent la croissance des dépenses publiques. Copyright WWZ and Helbing & Lichtenhahn Verlag AG 2004.

The Effect of Government on Economic Growth in Fiji

This paper investigates the empirical relationship between the size of government and the process of economic growth in Fiji. The results reported here present a mixed picture, in that the model estimated specifies two different effects of the government sector on economic growth. Using annual time series data for the period 1964-1999, it is found that government expenditure exerts a strong beneficial impact on economic growth. However, marginal factor productivity in the government sector is found to be lower than that of the private sector. The reasons for this low productivity are two-fold: the result of the lack of market incentives and signals in the public sector and the involvement of Fiji's government in some activities which may be rationalised in terms of the socio-political objectives of the Fijian government. While recognising that there may be factors which may hinder the process of efficiency in the private sector, it can be argued that by shifting factors of production from the low productivity (government) sector to the high productivity (private) sector, the rate of growth of GNP will increase