Postoperative Recurrence Rate Research Articles

Balancing Bleeding Risk and Thromboembolic Complications in Elderly Chronic Subdural Hematoma Patients Undergoing Burr Hole Trephination : A Multicenter Retrospective Cohort Study and Literature Review.

Chronic subdural hematoma (CSDH) patients using antithrombotic agents (AT) at high risk for cardiovascular disease are increasing. The authors aimed to analyze the factors influencing outcome by targeting patients using AT and to establish a desirable treatment strategy. A retrospective analysis was performed on data from 462 patients who underwent burr hole trephination (BHT) surgery for CSDH at five hospitals from March 2010 to June 2021. Outcomes included incidence of postoperative acute bleeding, recurrence rate, and morbidity or mortality rate. Patients were divided into the following four groups based on their history of AT use : no AT. Only antiplatelet agents (AP), only anticoagulants (AC), both of AP and AC. In addition, a concurrent literature review was conducted alongside our cohort study. Of 462 patients, 119 (119/462, 25.76%) were using AT. AP prescription did not significantly delay surgery (p=0.318), but AC prescription led to a significant increase in the time interval from admission to operation (p=0.048). After BHT, AP or AC intake significantly increased the period required for an in-dwelling drain (p=0.026 and p=0.037). The use of AC was significantly related to acute bleeding (p=0.044), while the use of AP was not (p=0.808). Use of AP or AC had no significant effect on CSDH recurrence (p=0.517 and p=1.000) or reoperation (p=0.924 and p=1.000). Morbidity was not statistically correlated with use of either AP or AC (p=0.795 and p=0.557, respectively), and there was no significant correlation with mortality for use of these medications (p=0.470 and p=1.000). Elderly CSDH patients may benefit from maintenance of AT therapy during BHT due to reduced thromboembolic risk. However, the use of AC necessitates individualized due to potential postoperative bleeding. Careful post-operative monitoring could mitigate prognosis and recurrence impacts.

Comparing packing and non-packing of the abscess cavity post incision and drainage of perianal abscess: A meta-analysis

Background: Pain is a very important factor in patient recovery and satisfaction. Following incision and drainage of perianal abscess, wound packing has been found to be very painful. The aim of this study is to compare packing the wound and not packing the wound after incision and drainage (I&D) of perianal abscess, taking into account recurrence rate, rate of occurrence of perianal fistula as well as post-operative pain. Materials and Method: Standard medical electronic databases were searched with the help of a local librarian and relevant published randomised controlled trials (RCT) were shortlisted according to the inclusion criteria. The summated outcome of post-operative pain score, recurrence rate, and rate of occurrence of perianal fistula was evaluated using the principles of meta-analysis on RevMan 5 statistical software. Result: Three RCTs on 490 patients undergoing I&D of perianal abscess were found suitable for this meta-analysis. In the random effects model analysis, the post operative pain score was statistically lower in NPG [risk ratio 0.66, 95%, CI (0.36, 0.97), Z=4.25, P=0.0001]. There was no heterogeneity [Tau2=0.15; chi2=9.32; df=6; I2=36 %; p=0.16] between the studies, however, statistically it was not significant. In addition, there was no statistical difference between the 2 groups in terms of recurrence of perianal abscess or the occurrence of perianal fistula [risk ratio 0.64, 95%, CI (0.31, 1.31), Z=1.23, P=0.22], [risk ratio 1.41, 95%, CI (0.89, 2.23), Z=1.47, P=0.14] respectively. Conclusion: Not packing the wound post I&D of perianal abscess is associated with significantly reduced VAS pain scores, which may result in improved recovery and patient satisfaction and has no effect on recurrence rate or the occurrence of perianal fistula. However, more RCTs recruiting a greater number of patients are required to endorse these findings.

Effects of intravenous chemotherapy after TURBT for high-risk nonmuscle invasive bladder cancer: results of a retrospective study.

This study compared the efficacy and safety of intravenous chemotherapy combined with intravesical chemotherapy versus intravesical chemotherapy alone for high-risk nonmuscle invasive bladder cancer (HRNMIBC) patients after transurethral resection of the bladder tumor (TURBT) surgery. A retrospective analysis was performed on 349 HRNMIBC cases admitted to TangDu hospital between January 2014 and June 2019. After TURBT, 262 patients received intravesical chemotherapy alone, whereas 87 patients underwent intravesical chemotherapy in combination with intravenous chemotherapy. The recurrence rate and progression rate were assessed by Chi-square test, the prognostic factors for tumor recurrence were predicted by univariable and multivariable Cox hazards analyses, recurrence-free survival (RFS) and progression-free survival (PFS) were calculated using the Kaplan-Meier method. In this study, the recurrence rate was 24.7% (19/77) in the intravenous chemotherapy combined group and 41.6% (102/245) in the intravesical chemotherapy group, while the progression rate was 6.5% (5/77) and 14.3% (35/245) in the two groups respectively. The two groups differed significantly in recurrence rate (p = 0.007) while the progression rate did not show a significant difference (p = 0.071). Multivariable analyses revealed that additional intravenous chemotherapy treatment was an independent prognostic factor for tumor recurrence in the cohort (hazard ratio [HR], 0.495, 95% confidence interval [CI], 0.275-0.892, p = 0.019). Kaplan-Meier curves showed significant differences in RFS and PFS between the two groups, with a log-rank P value of p < 0.005 and p = 0.045, respectively. Grade 3/4 toxicity was reported in 2 of 77 patients in the intravenous chemotherapy combined group, including nausea/vomiting 1.3% (1/77) and hypoleukemia 1.3% (1/77). Intravenous chemotherapy of gemcitabine and cisplatin combined with intravesical chemotherapy after TURBT can effectively reduce the postoperative recurrence rate, most toxicities were minor and reversible, and it may be considered as a new choice for HRNMIBC patients.

A prognostic nomogram for predicting recurrence-free survival of stage I–III colon cancer based on immune-infiltrating Treg-related genes

PurposeA high postoperative recurrence rate seriously impedes colon cancer (CC) patients from achieving long-term survival. Here, we aimed to develop a Treg-related classifier that can help predict recurrence-free survival (RFS) and therapy benefits of stage I–III colon cancer.MethodsA Treg-related prognostic classifier was built through a variety of bioinformatic methods, whose performance was assessed by KM survival curves, time-dependent receiver operating characteristic (tROC), and Harrell’s concordance index (C-index). A prognostic nomogram was generated using this classifier and other traditional clinical parameters. Moreover, the predictive values of this classifier for immunotherapy and chemotherapy therapeutic efficacy were tested using multiple immunotherapy sets and R package “pRRophetic".ResultsA nine Treg-related classifier categorized CC patients into high- and low-risk groups with distinct RFS in the multiple datasets (all p < 0.05). The AUC values of 5-year RFS were 0.712, 0.588, 0.669, and 0.662 in the training, 1st, 2nd, and entire validation sets, respectively. Furthermore, this classifier was identified as an independent predictor of RFS. Finally, a nomogram combining this classifier and three clinical variables was generated, the analysis of tROC, C-index, calibration curves, and the comparative analysis with other signatures confirmed its predictive performance. Moreover, KM analysis exhibited an obvious discrepancy in the subgroups, especially in different TNM stages and with adjuvant chemotherapy. We detected the difference between the two risk subsets of immune cell sub-population and the response to immunotherapy and chemotherapy.ConclusionsWe built a robust Treg-related classifier and generated a prognostic nomogram that predicts recurrence-free survival in stage I–III colon cancer that can identify high-risk patients for more personalized and effective therapy.

Membrane anatomy-based radical resection for esophageal cancer

Radical resection of gastrointestinal tumors based on the membrane anatomy theory has significantly reduced the postoperative recurrence rate and improved the surgical efficacy. However, the theory of membrane anatomy has not been widely adopted in radical surgery for esophageal cancer. Our study found that the esophagus also has a membranous anatomical structure. As a foregut organ, the esophagus also has a mesenteric structure, and there is also a fifth metastasis pathway within the esophageal mesentery for esophageal cancers. The leak and metastasis of cancer caused by destruction of the mesenteric integrity may be the fundamental reason for the high postoperative recurrence rate. Using the nano carbon and indocyanine green fluorescence tracing technique, we demonstrated the lymphatic drainage of the upper esophageal segment to the left gastric artery mesenteric lymph nodes. Therefore, in the radical resection of esophageal cancer, we used the membrane anatomy theory for guidance to completely remove the esophageal cancer, esophageal mesentery, left gastric artery and its mesentery, as well as all structures within the mesentery, preventing the spread of cancer cells through the blood vessels, lymphatic system, and mesentery, and improving the efficacy and prognosis. This article elaborates on the theoretical basis of the anatomical structure of the esophageal membrane, embryonic development, imaging, autopsy, and endoscopic observation of the structure, as well as the application effect of the esophageal membrane anatomical theory in esophageal cancer radical surgery. It elucidates the anatomical structure of the esophageal membrane and the lymphatic drainage characteristics of esophageal cancer, reveals the law of lymphatic metastasis in esophageal cancer, optimizes lymphatic dissection strategies, and improves the efficacy of esophageal cancer radical surgery.

Allergic Rhinitis as an Independent Risk Factor for Postoperative Recurrence of Children Chronic Sinusitis.

(1) Background: The recurrence rate of childhood recurrent sinusitis varies widely between 12% and 50%, with the postoperative recurrence risk factors remaining largely unidentified. We sought to enhance the understanding of chronic rhinosinusitis (CRS) via a retrospective observational childhood cohort. (2) Methods: The study recruited 125 cases. Demographic data and univariate and multivariate logistic regression analyses were conducted to investigate potential risk factors of childhood recurrent sinusitis following functional endoscopic sinus surgery (FESS). (3) Results: A postoperative recurrence rate of 21.6% was determined. Among the participants, 21 cases presented a history of allergic rhinitis (AR), with the remaining 104 cases being AR-free. A significantly heightened recurrence rate was noted in those bearing a history of AR compared to their counterparts devoid of such history (p < 0.000). The fully adjusted logistic regression model indicated a 21.04-fold increased risk of postoperative recurrence in childhood CRS bearing a history of AR compared to those without an AR history (p = 0.000), highlighting the history of AR as an independent risk factor for postoperative childhood recurrent sinusitis (p = 0.001); (4) Conclusions: The data implicate AR as an independent risk factor for postoperative childhood recurrent sinusitis.

The existence of biliary intraepithelial neoplasia at resection margin is not a risk factor for recurrence of biliary tract cancer

Abstract Background Invasive carcinoma or dysplasia (biliary intraepithelial neoplasia [BilIN]) is often found in the surgical stumps of biliary tract cancer. We investigated whether the presence of BilIN at the surgical margin is a risk factor for recurrence. Materials and Methods Seventy-five consecutive patients who underwent curative resection for biliary tract cancer were included in this study. We retrospectively evaluated the surgical margin status (negative, BilIN, or positive) and analyzed the postoperative disease recurrence rate and recurrence pattern by the status. Results The disease-free survival rate was significantly worse in the positive margin group than in the negative margin group (11 vs 18 months, P = 0.027). There were no statistical differences between the BilIN-positive group and the other two groups. In the multivariate analysis, infiltrative growth c (hazard ratio [HR], 3.348; 95% confidence interval [CI], 1.368–8.195; P = 0.008) and pathological exhumed margin (HR, 2.670; 95% CI, 1.097–6.495; P = 0.030) were independent recurrence factors. The margin status of BilIN was not associated with recurrence (HR, 0.867; 95% CI, 0.491–2.946; P = 0.687). Conclusions The BilIN component at the surgical margin was not associated with short-term recurrence, but the pathological exhumed margin positive and infiltrative growth c were. Infiltrative growth c may be a potential predictive factor for recurrence.

Intraoperative irrigation of artificial cerebrospinal fluid and temperature of irrigation fluid for chronic subdural hematoma: a systematic review and meta-analysis.

To systematically review the different types of irrigation fluid and the different temperatures of irrigation fluid on postoperative recurrence rates in the evacuation of chronic subdural hematoma (CSDH). We conducted a comprehensive search of electronic databases, including PubMed, Embase, the Cochrane Library, the China National Knowledge Infrastructure (CNKI), WanFang, the Chinese VIP Information (VIP), and China Biology Medicine (CBM), and reference lists of relevant studies to identify all eligible studies. Two reviewers independently screened the titles and abstracts for inclusion, and the full-text articles were assessed for eligibility based on predetermined inclusion and exclusion criteria. Data were extracted using a standardized form, and the quality of the studies was assessed using a risk of bias tool. Meta-analyses were performed using a fixed-or random-effects model, and heterogeneity was assessed using the I2 statistic. The primary endpoint was the postoperative recurrence rate. After stringent screening, a total of 11 studies were identified, including six English publications, four Chinese publications, and one Japanese publication, involving a population of 29,846 patients. Our meta-analysis provides evidence that artificial cerebrospinal fluid (ACF) could decrease the post-operative recurrence rate by 47% after the evacuation of CSDH when compared to normal saline (NS) [(odds ratio) OR 0.53, 95% confidence intervals (CI): 0.31-0.90, p = 0.02, I2 = 67%]. Besides, the irrigation fluid at body temperature could decrease the postoperative recurrence rate of CSDH by 64% when compared to room temperature (OR = 0.36, 95% CI = 0.22-0.59, p < 0.0001, I2 = 0%). Our analysis revealed significant difference in the choice of irrigation fluid for CSDH surgery. Notably, we found that irrigation with fluid at body temperature demonstrated superiority over irrigation with fluid at room temperature, resulting in fewer instances of recurrence. This straightforward technique is both safe and widely available, providing an opportunity to optimize outcomes for patients with CSDH. Our findings suggest that the use of body-temperature NS or ACF of room temperature during operation should be considered a standard of procedure in CSDH surgery. Nevertheless, whether the different temperature of ACF could be considered a standard of procedure in CSDH surgery still need high-quality RCTs to further identify. https://www.crd.york.ac.uk/prospero/; Identifier CRD42023424344.

Safety and efficacy of left colic artery preservation in laparoscopic anterior resection for lower rectal cancer.

Background: To evaluate the safety and efficacy of left colic artery (LCA) preservation in laparoscopic anterior resection with D3 lymphadenectomy for lower rectal cancer. Methods: A total of 117 patients with lower rectal cancer who received laparoscopic anterior resection were retrospectively analyzed. Results: No differences were detected in terms of the numbers of harvested lymph nodes and metastatic lymph nodes, the intraoperative and postoperative complications or the postoperative recurrence and survival rates between the two groups (p>0.05), but the LCA preservation group showed a lower anastomotic leakage rate than the LCA nonpreservation group (2/49 vs 12/68). Conclusion: LCA preservation may help reduce the incidence of anastomotic leakage without impairing surgical and oncological outcomes.

Transabdominal retro muscular versus intraperitoneal onlay mesh repair of ventral hernia: a randomized controlled study

Background Although laparoscopic ventral hernia repair has become a well-established alternative for open repair, traditional intraperitoneal mesh placement in direct contact with the bowel had many drawbacks and complications; in addition, it requires extensive mesh fixation and special composite mesh. Using the peritoneum and posterior rectus sheath as a barrier between the mesh and the bowel will evade these complications and decrease the cost. Patients and methods This prospective study was conducted in between May 2022 and December 2022 on 50 patients with noncomplicated ventral hernia with an average defect size of 5 cm. Patients were randomly allocated into two groups: intraperitoneal onlay mesh (IPOM) group (25) patients and transabdominal retro muscular mesh (TARM) group (25) patients. Both groups were compared as regards preoperative demographics, intraoperative complications and operative time and postoperative outcomes and complications. Results With a mean age of (44.96±7.27) of IPOM and (48.92±7.17) of TARM group, a significant longer operative time was spent in TARM repair (108.40±9.43 min). Postoperative pain was less in patients with TARM repair and hence they had earlier recovery and restoration of daily activities. Using a double-face composite mesh made the cost of IPOM repair significantly higher than TARM (P &lt; 0.001). Overall postoperative complications and recurrence rate showed no significant difference between both techniques. Conclusion TARM repair seems to be a safe and good alternative to IPOM repair in terms of lower economic cost and less postoperative pain.

Risk factors for the recurrence of primary spontaneous pneumothorax after video-assisted thoracoscopic surgery in patients younger than 40 years.

Video-assisted thoracoscopic surgery (VATS) is a standard primary spontaneous pneumothorax (PSP) procedure. However, its high recurrence rate compared to open thoracotomy is a problem. Therefore, various methods to prevent recurrence have been developed. The present study investigated the risk factors for postoperative recurrence of PSP after VATS. From January 2008 to November 2022, 207 patients younger than 40 years of age without underlying pulmonary disease underwent thoracoscopic bullectomy for PSP. Among them, 96 underwent staple line reinforcement with a polyglycolic acid (PGA) sheet and autologous blood spraying. Patient characteristics and surgical outcomes were analyzed to determine the prognostic factors for postoperative recurrence. Twenty-seven patients (13.0%) experienced recurrences. A multivariate analysis using Cox regression analysis revealed that age younger than 20 years [P=0.039; hazard ratio (HR) =2.337; 95% confidence interval (CI): 3.283-17.287], history of contralateral pneumothorax (P<0.001; HR =7.533; 95% CI, 1.486-12.336), and no staple line reinforcement (P=0.007; HR =4.282; 95% CI, 1.043-5.236) were risk factors for recurrence after pneumothorax surgery. Age younger than 20 years and history of contralateral pneumothorax were risk factors for postoperative recurrence of pneumothorax. Staple line reinforcement with a PGA sheet and spraying of autologous blood reduced the postoperative recurrence rate of PSP.

Radiomics: A radiological evidence-based artificial intelligence technique to facilitate personalized precision medicine in hepatocellular carcinoma.

The high postoperative recurrence rates in hepatocellular carcinoma (HCC) remain a major hurdle in its management. Appropriate staging and treatment selection may alleviate the extent of fatal recurrence. However, effective methods to preoperatively evaluate pathophysiologic and molecular characteristics of HCC are lacking. Imaging plays a central role in HCC diagnosis and stratification due to the non-invasive diagnostic criteria. Vast and crucial information is hidden within image data. Other than providing a morphological sketch for lesion diagnosis, imaging could provide new insights to describe the pathophysiological and genetic landscape of HCC. Radiomics aims to facilitate diagnosis and prognosis of HCC using artificial intelligence techniques to harness the immense information contained in medical images. Radiomics produces a set of archetypal and robust imaging features that are correlated to key pathological or molecular biomarkers to preoperatively risk-stratify HCC patients. Inferred with outcome data, comprehensive combination of radiomic, clinical and/or multi-omics data could also improve direct prediction of response to treatment and prognosis. The evolution of radiomics is changing our understanding of personalized precision medicine in HCC management. Herein, we review the key techniques and clinical applications in HCC radiomics and discuss current limitations and future opportunities to improve clinical decision making.

A New Approach: Determination of the Safe Surgical Margin in Pterygium Surgery.

In this retrospective study, we aimed to determine the safe surgical limit for excision of pterygium tissue. Therefore, we aimed to prevent excessive or incomplete normal conjunctival tissue excision during surgery in the coming years. Autografted pterygium surgery was performed between January 2015 and April 2016, and the excised pterygium tissue was examined histopathologically. The files of 44 patients, who had not previously undergone any ocular surgery, who did not have an inflammatory disease and who continued to be checked for at least 1 year, were retrospectively examined. The distance (P-DSEM) from the excised pterygium tissue to the surgical excision margin was measured by a pathologist. Postoperative recurrence rates were evaluated according to this value. In this way, the clean surgical margin was determined. The mean age of the participants was 44.77 ± 12.70, and the mean follow-up time was 55.61 ± 16.38 months. Recurrence developed in 5 out of 44 patients (11.4%). The average recurrence duration was 51 ± 13.87 days. Distance to the average surgical margin was 3.88 ± 0.91 mm. The surgical distances of 5 patients with recurrence were 2, 2.5, 2, 3, and 3 mm, respectively. It was determined that recurrence was less as the distance (P-DSEM) from the tissue to the surgical excision margin increased (p = 0.001). We found that the recurrence rate in pterygium surgery was linked to the clean surgical margin. When planning pterygium surgery, we believe that determining the amount of tissue to be excised before surgery will reduce recurrence rates.

Impact of titanium-coated polypropylene mesh on functional outcome and quality of life after inguinal hernia repair

ObjectiveThis study aims to compare the clinical outcomes of complications, quality of life, and chronic pain between titanium-coated polypropylene mesh and polypropylene mesh after Lichtenstein or TAPP surgery. MethodsA retrospective cohort study was conducted, involving patients who underwent inguinal hernia repair using Timesh light®, Optilene LP®, or 3DMax™ meshes between January 2020 and May 2022. Based on the surgical method, patients were divided into Lichtenstein and TAPP groups, and further categorized according to the type of mesh used. The primary endpoints assessed postoperative complications, postoperative pain, and postoperative quality of life. Secondary endpoints included postoperative sensation in the surgical area and postoperative recurrence rate. ResultsA total of 180 Lichtenstein procedures and 478 TAPP procedures were included in the analysis after propensity score matching. The findings revealed that patients with titanium-coated polypropylene mesh did not exhibit significant advantages in perioperative data. Within three months to one year after TAPP surgery, patients with the titanium-coated polypropylene mesh reported improved foreign body sensation during activities (P = 0.002) and a lower incidence of chronic pain (P = 0.008). However, after one year, these advantages of titanium-coated polypropylene mesh were no longer significant during activity or at rest. In the TAPP group, the titanium-coated polypropylene mesh depicted advantages in the single score of the SF-36 questionnaire. ConclusionsThe utilization of titanium-coated polypropylene mesh resulted in reduced foreign body sensation and chronic pain in activity within one year after TAPP surgery, significantly enhancing certain aspects of the patient's quality of life compared to polypropylene mesh.

Effectiveness of the modified darn repair method in inguinal hernia repair: 10 years of experience

&lt;b&gt;Aim&lt;/b&gt;: We aimed to evaluate the effectiveness of the Modified Darn Repair (MDR) method performed in our clinic for Inguinal Hernia Repair (IHR) and to determine the postoperative complications and recurrence rates of this method.&lt;br /&gt; &lt;b&gt;Material and methods:&lt;/b&gt; The records of all patients who underwent IHR with MDR method in our clinic between January 2012 and December 2021 were obtained from the hospital database. Demographic characteristics of the patients, intraoperative findings, hospitalization and return to normal activities, postoperative complications and recurrence rates were retrospectively analyzed.&lt;br /&gt; &lt;b&gt;Results&lt;/b&gt;: A total of 892 patients aged between 18 and 85 with a male:female ratio of 14:1 were studied. Of 1011 elective IHRs, 773 were unilateral (right/left: 452/321) and 119 (119 right + 119 left) were bilateral.&amp;nbsp; Hernia types were 667 (66%) indirect, 273 (27%) direct, 71(7%) pantaloon (combined) hernias. All procedures were performed under spinal anesthesia. The mean duration of surgery was 35 (15-75) minutes, hospital stay was 1.1 (1-3) days, and return to normal activities was 12.8 (10-20) days. The postoperative complications were wound infection in 33 (3.26%) patients, hematoma in 11 (1.09%) patients, and abscess/seroma in 15 (1.48%) patients. In addition, suture material reaction developed in 1 (0,12%) patient. Recurrence was observed in 25 (2.4%) patients and no mortality was observed in any patient.&lt;br /&gt; &lt;b&gt;Conclusion:&lt;/b&gt; The goal of every surgeon is to have a non-recurring repair in IHR without leaving a foreign body in the patient. Despite the criticism, we believe that the MDR technique is a safe, effective and viable option.

Curative Effect and Complication Rate of Abdominal Myomectomy and Laparoscopic Myomectomy in the Treatment of Uterine Fibroids

Objective: To compare and analyze the clinical efficacy and complication rate of abdominal myomectomy with those of laparoscopic myomectomy in uterine fibroids. Methods: This study was carried out from January 2021 to January 2023 on 150 patients with uterine fibroids. The patients were divided into two groups, a study group (n = 75) and a control group (n = 75), by digital table grouping. Patients in the control group underwent abdominal myomectomy, whereas patients in the study group underwent laparoscopic myomectomy. Surgery-related indicators, incidence of complications, ovarian function indicators, recurrence rate, and pregnancy rate were compared between the two groups. Results: The surgery-related indicators of the study group were lower than those of the control group (P &lt; 0.05 ); the incidence of postoperative complications was lower in the study group than in the control group (P &lt; 0.05); the postoperative ovarian function indicators of the study group were lower than those of the control group (P &lt; 0.05); there were no significant differences in postoperative recurrence rate and pregnancy rate between the two groups (P &gt; 0.05). Conclusion: For patients with uterine fibroids, abdominal myomectomy and laparoscopic myomectomy have similar recurrence and pregnancy rates, but laparoscopic myomectomy can shorten the recovery time and reduce the incidence of complications and the impact on ovarian function. Therefore, the latter should be applied in clinical settings.

Bilaterally parallel elliptic flap versus Karydakis flap in primary pilonidal sinus disease: a randomized controlled trial.

Pilonidal sinus disease is a disease that especially affects the young population and causes loss of workforce. Although many treatment methods have been defined, there is still no "gold standard" treatment method. Our objective was to evaluate the postoperative results of bilateral parallel elliptical flap and Karydakis flap in the surgical treatment of pilonidal sinus. This study was conducted at the Colorectal Surgery Department of Ankara Numune Training and Research Hospital. It designed a prospective randomized controlled study. Patients that underwent surgery due to pilonidal sinus were included in the study. The patients were randomly divided into two groups. Surgery was performed with the bilateral parallel elliptical flap (BPEF) technique in one group and the Karydakis flap (KF) technique in the other group. Postoperative pain, length of hospital stay, wound complications, time taken to return to work/school, and recurrence incidence were evaluated. A total of 102 patients were included in the study, 49 in the BPEF group and 53 in the KF group. The length of hospital stay was similar in the BPEF and KF groups (1.41 ± 0.81 and 1.45 ± 0.84, respectively; p > 0.05). There was less postoperative pain in the BPEF group (2.47 ± 1.02 vs 3.57 ± 1.10, p < 0.05). Wound complications were observed in nine patients in the BPEF group (18.2%) and 14 patients in the KF group (26.2%). The time to return to work/school was shorter in the BPEF group (21.06 ± 6.37 vs 27.04 ± 7.45; p < 0.05). Recurrence developed in two (4%) patients in the BPEF group and three (5.6%) patients in the KF group (p > 0.05). The patients who underwent surgery with the bilateral parallel elliptical flap technique had less pain and a shorter time to return to work/school after the operation. The postoperative complication and recurrence rates were similar in both groups. clinicaltrials.gov identifier: NCT05851690. (5/11/2023) (retrospectively registered).

MRI Semiotics Features and Difficulties of Differential Diagnosis of Hepatic Metastases from Neuroendocrine Tumours

Relevance: Isolated bilobar multifocal hepatic lesion is consider to be the most common metastatic neuroendocrine tumor(NET) growth pattern. Underestimation of the metastatic burden in the NET patients at the initial diagnosis frequently occurs, thus leading to a high postoperative recurrence rate (more than 60 % of cases within 5 years).Purpose: To identify the MRI-hallmarks of liver metastatic NETs and to present the most difficult diagnostic cases.Material and methods: 103 patients with histology confirmed liver metastatic NET were enrolled in the study. All patients underwent abdominal contrast-enhanced (CE) MRI. A total of 241 lesions were assessed. Quantitative indicators of signal intensity (SI) on native and post-contrast T1-weighted images (WI) were measured in metastases. Additionally, the shape, contours, surface of metastases, SI on native images, characteristics of CE, the presence of hemoglobin degradation products and the boundary levels in the structure of metastases were qualitatively assessed.Results: Metastatic liver disease in NET is mostly multifocal: 78 (75.7 %) patients had 5 or more lesions. Metastases were round in 53.5 % of cases, oval in 17.5 % of cases, irregular in 29 % of cases. In 61 % of cases, the contours of the lesions were clear, in 39 % — indistinct. Smooth and bumpy surface of metastases was determined in 31.5 % and 68.5 % of cases, respectively. The presence of hemoglobin degradation products in the structure of metastases was determined in 26.2 % of patients, the formation of the boundary levels — in 8.1 % of patients. Most of the lesions had a hyperintense signal on T2-WI with and without FS and a hypointense signal on native T1-WI. The proportions of actively, moderately and poorly MR contrast agent (MRCA) enhanced lesions were 30.8, 32.6 and 36.6 %, in the arterial phase and 16.3, 55.4 and 28.3 % in the venous phase, respectively. The apparent diffusion coefficient (ADC) values varied significantly. In some cases, small metastatic NET were visualized only in the arterial phase of CE and were not detected on other MRI sequences, thus requiring differentiation from other hepatic hypervascular lesions.Conclusion. The MRI semiotics features of hepatic metastases from NETs is described. Small flesions of active accumulation of MRCA in the arterial phase in the presence of primary NET must be differentiated from metastatic lesions.

Analysis of the efficacy of laparoscopic high hernia sac ligation in adolescent indirect hernia

ObjectiveInguinal hernias are a common disease that may present at all ages. Adolescents are a unique patient population between children and adults. The etiology and the surgical treatment strategies of adolescent indirect hernias are not clear. Specifically, whether these kinds of hernias should be treated by high ligation or mesh repair remains controversial. We aimed to evaluate the efficacy of laparoscopic high hernia sac ligation in adolescent indirect hernia.MethodsThe data of adolescent patients who underwent laparoscopic high hernia sac ligation at the The First People’s Hospital of Foshan,China, from January 2012 to December 2019 were analyzed retrospectively. Data collected included their age, gender, weight, surgical method, hernia ring diameter, operation time, postoperative recurrence rate and postoperative complications.ResultsA total of 70 patients were enrolled, including 61 males (87.14%) and 9 females (12.86%),all patients were aged 13–18 years old (mean 14.87 ± 1.56years), weighed 28-92 kg (mean 53.04 ± 10.60 kg). All 70 patients underwent laparoscopic surgery except 2 patients with irreducible hernias who converted to laparotomy.The hernia ring diameter ranged from 0.5 to 3 cm (mean 1.39 ± 0.49 cm), and was ≤ 2 cm in 68 cases (97.14%).The operative length ranged from 12 to 105 min (average 24.96 ± 12.61 min), There were 37(52.9%) right-sided hernias, 32 (45.7%) left-sided hernias, 1 (1.4%) bilateral hernia.There were 67(95.7%)reducible hernias,2(2.9%)irreducible hernias ,and 1(1.4%)incarcerated hernia.Hospital stays ranged from 1 to 5 days (mean 2.37 ± 1.05 days). Follow-ups were performed from 30-119months (mean 74.27 ± 28.14months). There were no cases of recurrence, howere, incision infection occured in 1 patient, who underwent a second operation 6 months after surgery, and 4 (5.7%) patients had complaints of intermittent pain around the ligation incision site, mostly during exercise .ConclusionLaparoscopic high hernia sac ligation is feasible for treatment of adolescent indirect hernias with a hernia ring diameter of ≤ 2 cm.

Laparoscopic inguinal hernia repair: A comparison of transabdominal preperitoneal and total extraperitoneal techniques—Results of initial experiences

Abstract Aims: This study aimed to analyze the results of transabdominal preperitoneal (TAPP) and total extraperitoneal (TEP) repairs performed by two authors and to compare two laparoscopic methods. Materials and Methods: Patients who underwent inguinal hernia surgery in a secondary-care hospital between 2019 and 2022 were evaluated retrospectively. Demographics, hernia side and type, primary or recurrent hernia situation, size of hernia orifice, operation type, postoperative complications, duration of operation, length of hospital stay, recurrence, and follow-up time were examined. Perioperative outcomes were compared between the two groups. Results: One hundred and eleven patients were analyzed. The mean age was 49.4 ± 13 years, with a male/female ratio of 106/5. About 82% of hernias were unilateral, and 18% were bilateral. Sixty-four TAPP and 47 TEP repairs were performed. Follow-up time (months, mean ± standard deviation) (range) was 14.2 ± 10 (1–37). About 42.3% of the hernias were direct, 49.5% were indirect, and 8.1% were pantaloon hernias. The recurrence rate was 1.8%. The operation time was significantly lower in the TEP than in TAPP (64.4 ± 23.5, 96.7 ± 31.9, respectively, P &lt; 0.001). TAPP was preferred in patients with larger hernia orifices (P = 0.01). The two groups had no significant difference regarding postoperative complications and recurrence rate. Conclusion: Our study did not detect any significant difference between TAPP and TEP repair regarding recurrence rate and postoperative complication. Laparoscopic inguinal hernia repair, which has advantages such as short hospital stay and less pain, can be safely performed in a secondary-care hospital.