Specimen retrieval approaches in patients undergoing laparoscopic colorectal resections:a literature-based review of published studies

Objective:To review the published studies reporting various specimen retrieval incisions being used by colorectal surgeons in patients undergoing laparoscopic colorectal resections(LCR).Methods:Standard medical electronic databases were searched to find relevant articles and a summary conclusion was generated.Results:There were 43 studies reporting various approaches used for the purpose of specimen retrieval in 2388 patients undergoing LCR.The most common approaches were periumbilical midline incision(1260 reported case in the literature),transverse incision(583 reported cases in the literature)in the right-or left iliac fossa,depending on the side of colonic resection,and Pfannensteil incision(293 reported cases in the literature).Periumbilical midline incision was associated with the higher risk of developing incisional hernia(odds ratio 53.72;95%confidence interval 7.48–386.04;Z=3.96;P=0.0001).In terms of surgical site infection(SSI),there was no difference between the three common approaches to specimen retrieval.Transanal and transvaginal approaches were associated with higher risk of SSI.Conclusions:Midline,transverse and Pfannensteil incisions were the most commonly used approaches for specimen retrieval following LCR.Midline incision was associated with higher risk of incisional hernia.Risk of SSI was similar in all three common approaches.The transanal and transvaginal approaches pose a higher risk of SSI.These conclusions are based on the combined outcome of published case series,case reports and comparative studies.Randomized,controlled trials with longer follow-up are required before recommending the routine use of any approach for specimen retrieval in patients undergoing LCR.

Use of antibacterial sutures for skin closure in controlling surgical site infections: a systematic review of published randomized, controlled trials

Objective:The objective of this article is to systematically analyse the randomized,controlled trials that compare the use of antibacterial sutures(ABS)for skin closure in controlling surgical site infections.Methods:Randomized,controlled trials on surgical patients comparing the use of ABS for skin closure in controlling the surgical site infections were analysed systematically using RevMan^(■)and combined outcomes were expressed as odds ratios(OR)and standardized mean differences(SMD).Results:Seven randomized,controlled trials evaluating 1631 patients were retrieved from electronic databases.There were 760 patients in the ABS group and 871 patients in the simple suture group.There was moderate heterogeneity among trials(Tau^(2)=0.12;chi^(2)=8.40,df=6[P<0.01];I^(2)=29%).Therefore in the random-effects model,the use of ABS for skin closure in surgical patients was associated with a reduced risk of developing surgical site infections(OR,0.16;95%CI,0.37,0.99;z=2.02;P<0.04)and postoperative complications(OR,0.56;95%CI,0.32,0.98 z=2.04;P=0.04).The durations of operation and lengths of hospital stay were similar following the use of ABS and SS for skin closure in patients undergoing various surgical procedures.Conclusion:Use of ABS for skin closure in surgical patients is effective in reducing the risk of surgical site infection and postoperative complications.ABS is comparable with SS in terms of length of hospital stay and duration of operation.

Limited segmental rectal resection in the treatment of deeply infiltrating rectal endometriosis:10 years’experience from a tertiary referral unit

Background.The management of symptomatic rectal endometriosis is a challenging condition that may necessitate limited stripping or limited segmental anterior rectal resection(LSARR)depending upon the extent and severity of the disease.Objective.To report the efficacy of LSARR in terms of pain,quality of life and short-and long-term complications—in particular,those pertaining to bowel function.Methods.The case notes of all patients undergoing LSARR were reviewed.The analysed variables included surgical complications,overall symptomatic improvement rate,dysmenorrhoea,dyspareunia,and dyschezia.Chronic pain was measured using a visual analogue scale.Quality of life was measured using the EQ-5D questionnaire.Bowel symptoms were assessed using the Memorial Sloan Kettering Cancer Centre(MSKCC)questionnaire.Results.Seventy-four women who underwent LSARR by both open and laparoscopic approaches were included in this study.Sixty-nine(93.2%)women reported improvement in pain and the same percentage would recommend the similar procedure to a friend with the same problem.Approximately 42%of women who wished to conceive had at least one baby.The higher frequency of defecation was a problem in the early post-operative period but this settled in later stages without influencing the quality of life score.Post-operative complications were recorded in 14.9%of cases.Conclusions.LSARR for rectal endometriosis is associated with a high degree of symptomatic relief.Pain relief achieved following LSARR does not appear to degrade with time.As anticipated,some rectal symptoms persist in few patients after long-term follow-up but LSARR is nonetheless still associated with a very high degree of patient satisfaction.

Open transinguinal preperitoneal mesh repair of inguinal hernia:a targeted systematic review and meta-analysis of published randomized controlled trials

Objective:The objective of this article is to systematically analyse the randomized,controlled trials comparing transinguinal preperitoneal(TIPP)and Lichtenstein repair(LR)for inguinal hernia.Methods:Randomized,controlled trials comparing TIPP vs LR were analysed systematically using RevMan®and combined outcomes were expressed as risk ratio(RR)and standardized mean difference.Results:Twelve randomized trials evaluating 1437 patients were retrieved from the electronic databases.There were 714 patients in the TIPP repair group and 723 patients in the LR group.There was significant heterogeneity among trials(P<0.0001).Therefore,in the random effects model,TIPP repair was associated with a reduced risk of developing chronic groin pain(RR,0.48;95%CI,0.26,0.89;z=2.33;P<0.02)without influencing the incidence of inguinal hernia recurrence(RR,0.18;95%CI,0.36,1.83;z=0.51;P=0.61).Risk of developing postoperative complications and moderate-to-severe postoperative pain was similar following TIPP repair and LR.In addition,duration of operation was statistically similar in both groups.Conclusion:TIPP repair for inguinal hernia is associated with lower risk of developing chronic groin pain.It is comparable with LR in terms of risk of hernia recurrence,postoperative complications,duration of operation and intensity of postoperative pain.

小肠恶性黑色素瘤表现为空肠憩室穿孔:病例报告及文献复习

Although usually harmless and asymptomatic,jejuno-ileal diverticulae are associated with various non-specific gastrointestinal symptoms,and rarely cause surgical emergencies.This case report describes the presentation and management of a patient with an acute abdomen,whose jejunal diverticulum was perforated.Unexpectedly,histopathological assessment demonstrated malignant melanoma lining the diverticulum.Whether this was primary or metastatic is discussed,together with a synopsis of the literature on small bowel diverticulae.