Technical Aspects Of Interventions Research Articles

WP4.17 - Laparoscopic versus open repair of perforated peptic ulcer: a systematic scoping review and in-depth evaluation of existing evidence

Abstract Background Perforated peptic ulcer remains a common cause of morbidity and mortality worldwide. Surgical treatment includes a trend towards minimally invasive surgery. To safely implement this, it is important to understand the key steps that have been assessed in clinical trials. The aim of this review is to assess the reporting of intervention steps in laparoscopic and open ulcer repair. Methods A systematic search was performed of the MEDLINE, EMBASE, & clinical trial databases (PROSPERO (CRD42023404537)). Randomised trials on laparoscopic vs open repair of peptic ulcer were included. Data extracted included study metadata, as well as technical aspects of interventions, use of co-interventions. Study design was assessed using the PRECIS-2 tool, to explore whether trials were predominantly pragmatic or explanatory, and also using the Cochrane Risk of Bias tool. Results 408 studies were screened for eligibility, and nine full-texts were included. This included six studies from China, two from India, and one from the Netherlands. Incision, ulcer closure details, and lavage, were the best reported aspects of laparoscopic repair (n=7). Method of access, incision, and ulcer closure were well described in 8 studies. Co-interventions such as antibiotic use, analgesia, and H pylori eradication were poorly described. Interventions were delivered by high volume laparoscopic surgeons. Studies were considered at high risk of bias. PRECIS-2 assessment found studies were neither fully pragmatic nor explanatory. Conclusions Laparoscopic repair of perforated peptic ulcer is a poorly defined intervention. Standardisation of key steps and co-interventions is required to facilitate a well designed randomised trial.

Minimally invasive surgery for obstructive jaundice caused by malignant tumors

Purpose of the study . On the basis of the accumulated experience to optimize approaches to the preoperative preparation, technical aspects of X-ray surgical antegrade minimally invasive endobiliary interventions, rational postoperative management of patients in order to reduce postoperative complications, improving treatment outcomes and quality of life of patients. Materials and methods . We analyzed 1610 percutaneous transhepatic endobiliary surgeries with separate examination of 1186 X-ray surgical procedures of percutaneous external biliary drainage (PEBD) and 424 cases of antegrade endobiliary stenting (AEBS) Results. Complications after PEBD were developed in 9 (0.76%) patients: the procedure-related bleeding was noted in 3 (0.25%) cases, and bleeding caused by the progression of hepatic failure, hypocoagulation in 6 (0.5%) cases. 3 patients (0.25%) of this group died. Complications after AEBS were registered in 35 (8.3%) patients: acute postoperative pancreatitis in 24 (5.7%) cases, progression of liver failure, hypocoagulation in 9 (2.1%), tumor-induced duodenal stenosis in 2 (0.47%) cases. One patient (0.24%) of this group died. Reduction in complications after PEBD and AEBS is directly associated with surgery techniques, the use of special tools, and tactics of patient management. Conclusion. The prevention of complications, treatment outcomes, and the quality of life of patients receiving interventional antegrade endobiliary surgery are inextricably associated with the technical aspects of interventions, the tools and tool materials, necessary correction of endogenous toxicosis, pancreatitis, hepatic failure, and hemostatic system disorders. Constant monitoring of the results of new technologies is necessary to analyze gathered experience for possible correction and optimization of tactical approaches and schemes for more effective treatment of patients with this severe pathology.

Messiness of forest governance: How technical approaches suppress politics in REDD+ and conservation projects

Abstract Reduction of Emissions from Deforestation and Forest Degradation (REDD+) was originally conceived to address the global problem of climate change by reducing deforestation and forest degradation at national and subnational levels in developing countries. Since its inception, REDD+ proponents have increasingly had to adapt global ideas to local demands, as the rollout process was met with on-the-ground realities, including suspicion and protest. As is typical in aid or ‘development’ projects conceived in the global North, most of the solutions advanced to improve REDD+ tend to focus on addressing issues of justice (or ‘fairness’) in distributive terms, rather than addressing more inherently political objections to REDD+ such as those based on rights or social justice. Using data collected from over 700 interviews in five countries with both REDD+ and non-REDD+ cases, we argue that the failure to incorporate political notions of justice into conservation projects such as REDD+ results in ‘messiness’ within governance systems, which is a symptom of injustice and illegitimacy. We find that, first, conservation, payment for ecosystem services, and REDD+ project proponents viewed problems through a technical rather than political lens, leading to solutions that focused on procedures, such as ‘benefit distribution.’ Second, focusing on the technical aspects of interventions came at the expense of political solutions such as the representation of local people’s concerns and recognition of their rights. Third, the lack of attention to representation and recognition justices resulted in illegitimacy. This led to messiness in the governance systems, which was often addressed in technical terms, thereby perpetuating the problem. If messiness is not appreciated and addressed from appropriate notions of justice, projects such as REDD+ are destined to fail.

World Federation of Vascular Societies: Presidential Address

The presidential address describes briefly the history of the World Federation for Vascular Societies (WFVS) and its objectives. Vascular Surgery today includes interventional procedures (open surgical and endovascular) in addition to risk factor reduction and medical treatment. It is equally important to train in clinical investigative methods, non-surgical treatment, decision making as is training in technical aspects of interventions. Similarly, it is vital, that the vascular specialist always recommends the treatment which is best to the individual patient, not only what he can do or what is best for other reasons, i.e. financial. Due to the increasing complex procedures - endovascular evolution and what is then “left” for open surgery - specialisation into “mainly open vascular surgeon” and “mainly endovascular surgeon” preceded by a common basic training into both, seems unavoidable. Similar, in order to be able to train with relevant case mix and numbers, and in order always to have both complex open and endovascular skills on call 24 hours per day, 365 days a year, centralisation into larger units is necessary. The WFVS is important simply looking at the huge demographic differences throughout the world. In addition, for introduction of new treatments, training issues and dissemination of science a global organisation like the WFVS is needed.

The State of the Art in Pulmonary Vein Stenosis -Diagnosis & Treatment.

Pulmonary vein stenosis is a rare but serious complication of pulmonary vein isolation to treat atrial fibrillation. Pulmonary vein angioplasty/stenting has emerged as the treatment of choice for significantly stenotic veins. Guidelines for post ablation evaluation of the pulmonary veins, including the timing and method of surveillance for possible stenosis, the criteria for intervention, the technical aspects of intervention, and finally the surveillance post intervention, are still being developed. The relatively high rate of restenosis after intervention in a subset of patients remains a great challenge. A better understanding of the pathophysiology underlying this syndrome is needed to appropriately answer many of the remaining questions. The goal of this manuscript is to describe what has been learned about this complication and its treatment from a relatively large experience in a single institution over the past decade, and provide a comprehensive review of the existing literature in order to shed as much light on the subject as is possible, while at the same time exposing the areas that need further study.