Genitourinary function and defecation after colorectal cancer surgery with low-and high-ligation of the inferior mesenteric artery:A meta-analysis

BACKGROUND The effect of low ligation(LL)vs high ligation(HL)of the inferior mesenteric artery(IMA)on functional outcomes during sigmoid colon and rectal cancer surgery,including urinary,sexual,and bowel function,is still controversial.AIM To assess the effect of LL of the IMA on genitourinary function and defecation after colorectal cancer(CRC)surgery.METHODS EMBASE,PubMed,Web of Science,and the Cochrane Library were systematically searched to retrieve studies describing sigmoid colon and rectal cancer surgery in order to compare outcomes following LL and HL.A total of 14 articles,including 4750 patients,were analyzed using Review Manager 5.3 software.Dichotomous results are expressed as odds ratios(ORs)with 95%confidence intervals(CIs)and continuous outcomes are expressed as weighted mean differences(WMDs)with 95%CIs.RESULTS LL resulted in a significantly lower incidence of nocturnal bowel movement(OR=0.73,95%CI:0.55 to 0.97,P=0.03)and anastomotic stenosis(OR=0.31,95%CI:0.16 to 0.62,P=0.0009)compared with HL.The risk of postoperative urinary dysfunction,however,did not differ significantly between the two techniques.The meta-analysis also showed no significant differences between LL and HL in terms of anastomotic leakage,postoperative complications,total lymph nodes harvested,blood loss,operation time,tumor recurrence,mortality,5-year overall survival rate,or 5-year disease-free survival rate.CONCLUSION Since LL may result in better bowel function and a reduced rate of anastomotic stenosis following CRC surgeries,we suggest that LL be preferred over HL.

Strategies and challenges in treatment of varicose veins and venous insufficiency

Patients with varicose veins can be treated with conservative or surgical approaches based on the clinical conditions and patient preferences.In the recent decade,the recommendations for managing symptomatic varicose veins have changed dramatically due to the rise of minimally invasive endovascular techniques.The literature was systematically searched on Medline without language restrictions.All papers on the treatment of varicose veins and venous insufficiency with different procedures were included and reviewed.Endovenous laser ablation(EVLA)and radiofrequency ablation(RFA)both are same safe and effective in terms of occlusion rate,and time to return to normal activity.In comparison with RFA or EVLT,Cure conservatrice et Hemodynamique de l’Insufficience Veineuse en Ambulatoire(CHIVA)may cause more bruising and make little or no difference to rates of limb infection,superficial vein thrombosis,nerve injury,or hematoma.In terms of recurrence of varicose veins,there is little or no difference between CHIVA and stripping,RFA,or EVLT.Great saphenous vein recanalization is highest in the ultrasound-guided foam sclerotherapy(FS)group(51%)during 1 year of follow-up.The 2013 National Institute for Health and Care Excellence clinical guidelines recommend surgery as a third-line therapeutic option after EVLA or RFA and sclerotherapy.Although the mechanochemical endovenous ablation(MOCA)is a non-thermal,non-tumescent option and appears to be of similar efficacy to stab avulsion with no potential risk of nerve damage,the overall success rate of MOCA is lower than those of other procedures such as EVLA,RFA,or high ligation and stripping.EVLA is the most cost-effective therapeutic option,with RFA being a close second for the treatment of patients with varicose veins.Endovenous thermal ablation(EVLA or RFA)is recommended as a first-line treatment for varicose veins and has substituted the high ligation of saphenofemoral junctional reflux and stripping of varicose veins.Ultrasound-guided FS is associated with a high recurrence rate and can be used in conjunction with other procedures.MOCA and cyanoacrylate embolization appear promising,but evidence of their effectiveness is required.

Multifactor study of efficacy and recurrence in laparoscopic surgery for inguinal hernia

BACKGROUND Inguinal hernia is a common clinical manifestation in children with a low selfhealing rate.AIM To determine the effect of laparoscopic surgery on indirect inguinal hernia and the risk factors for postoperative recurrence and to provide a reference for the clinical treatment and prevention of recurrence.METHODS We selected 360 children who underwent laparoscopic high ligation in our hospital as the laparoscopic group and 120 patients treated for inguinal hernia with conventional surgery as the control group.The operation time,blood loss,incision length,hospitalization time,total hospitalization cost and surgical complications were compared between the two groups.According to telephone follow-up or return visits,the children who had recurrence within 2 years after the operation in the laparoscopic group were analyzed,and the laparoscopic high ligation hernia sac level was analyzed by the logistic multifactor method.Ligation was used to treat recurrence in children with inguinal hernia.RESULTS The operation time,blood loss,length of incision,and length of hospital stay in the laparoscopic group were lower than those in the control group(P<0.05).The total hospitalization cost in the laparoscopic group was higher than that in the control group(P<0.05).The operative complication rate was 1.67%lower than that in the control group(12.50%)(P<0.05).In 360 children with laparoscopic high ligation of the hernia sac,14 patients had recurrence within 2 years after surgery.After analysis,14 cases in the recurrence group did not recur.The preoperative incarceration rate,inner ring diameter,ligature use and age difference were statistically significant(P<0.05).According to logistic regression multivariate analysis,an inner ring diameter≥1.0 cm,the use of an absorbable ligature line and age>3 years increased the risk of postoperative recurrence in children with inguinal hernia after laparoscopic high ligation of the hernia sac(P<0.05).CONCLUSION Laparoscopic surgery for indirect inguinal hernia in children has the advantages of low trauma and a rapid postoperative recovery.An inner ring diameter≥1.0 cm,the use of absorbable ligature,and age>3 years may increase the risk of recurrence after laparoscopic high ligation of the hernia sac.