1,721,336 research outputs found
Endoscopic retrograde appendicitis therapy: a starting point for a change of perspective in treating acute appendicitis (and beyond)
No full textInvited Commentary to "Safety and Feasibility of Primary Closure Following Laparoscopic Common Bile Duct Exploration for Treatment of Choledocholithiasis" by Lunjian Xiang et al
No full textLetter to the Editor- Evolving Trends in the Management of Acute Appendicitis During COVID-19 Waves: The ACIE Appy II Study
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Optimal Timing of Cholecystectomy for Severe Acute Pancreatitis and Understanding Complications and Comorbidities—Reply
No full textPrimary Segmental Omental Torsion, mimicking acute appendicitis
Full text linkPrimary segmental omental torsion (PSOT) is a very rare cause of acute abdominal pain, and it may often imitate the clinical picture of acute appendicitis. In instances of acute abdominal pain without anorexia, nausea, and vomiting, omental torsion should be included in the differential diagnosis. Any misdiagnosis may lead to major complications such as intraabdominal abscesses and adhesions. A 63-year-old overweight man with a body mass index (BMI) of 41 Kg/m2 presented to the emergency department on a remote island with acute abdominal pain. His medical history included type 2 diabetes mellitus managed with insulin, essential hypertension, osteoarthritis, and no previous abdominal operations. He reported a sharp pain originating in the epigastrium and the right hypochondrium that started five days prior. Physical examination revealed rebound tenderness and guarding across the abdomen with a positive McBurney sign. However, the patient did not report vomiting and was not nauseous. Vital signs were as follows: blood pressure 116/56 mmHg, heart rate 98 beats/min, respiratory rate 19 breaths/min, and a temperature of 38.2 0C. Laboratory results showed a white blood cell count of 10.6, neutrophils of 8.11, C-reactive protein (CRP) 74 mg/l, haemoglobin11.6 g/dl, and hematocrit 36.9%. Due to the absence of a radiographer at the hospital during that period, no imaging investigations were conducted. Diagnostic laparoscopy demonstrated diffused hemoperitoneum and necrotic mass at the site of the hepatic flexure. Initially suspected to be an advanced colon cancer, the decision was made to proceed with open surgery. The necrotic segment of the omentum was found at the right superior point of attachment of the omentum to the hepatic flexure. Consequently, the necrotic segment of the omentum was resected. A thorough investigation of the abdominal cavity did not detect any other abnormalities or pathologies. The patient recovered uneventfully and was transferred to the surgical ward. Torsion of the omentum is a very rare cause of acute abdominal pain. This case highlights the necessity of considering PSOT in the differential diagnosis of acute abdominal pain, especially in cases where symptoms are suggestive of appendicitis but diagnostic findings are negative
Systematic review with meta-analysis of studies comparing intraoperative neuromonitoring of recurrent laryngeal nerves versus visualization alone during thyroidectomy
No full textBackground: The role of intraoperative neuromonitoring (IONM) of the recurrent laryngeal
nerve (RLN) during thyroid surgery is still debatable. The aim of this meta-analysis was to
evaluate the potential improvement of IONM versus RLN visualization alone (VA) in
reducing the incidence of vocal cord palsy.
Methods: A literature search for studies comparing IONM versus VA during thyroidectomy
was performed. Studies were reviewed for primary outcome measures: overall, transient,
and permanent RLN palsy per nerve and per patients at risk; and for secondary outcome
measures: operative time; overall, transient and permanent RLN palsy per nerve at low and
high risk; and the results regarding assistance in RLN identification before visualization.
Results: Twenty studies comparing thyroidectomy with and without IONM were reviewed:
three prospective, randomized trials, seven prospective trials, and ten retrospective,
observational studies. Overall, 23,512 patients were included, with thyroidectomy performed
using IONM compared with thyroidectomy by VA. The total number of nerves at
risk was 35,513, with 24,038 nerves (67.7%) in the IONM group, compared with 11,475 nerves
(32.3%) in the VA group. The rates of overall RLN palsy per nerve at risk were 3.47% in the
IONM group and 3.67% in the VA group. The rates of transient RLN palsy per nerve at risk
were 2.62% in the IONM group and 2.72% in the VA group. The rates of permanent RLN
palsy per nerve at risk were 0.79% in the IONM group and 0.92% and in the VA group. None
of these differences were statistically significant, and no other differences were found.
Conclusions: The current review with meta-analysis showed no statistically significant difference
in the incidence of RLN palsy when using IONM versus VA during thyroidectomy.
However, these results must be approached with caution, as they weremainly based on data
coming from nonerandomized observational studies. Further studies including high-quality
multicenter, prospective, randomized trials based on strict criteria of standardization and
subsequent clustered meta-analysis are required to verify the outcomes of interest
Systematic review with meta-analysis of studies comparing single-incision laparoscopic colectomy and multiport laparoscopic colectomy.
No full textThere is currently a paucity of research comparing the clinical outcomes of single-incision laparoscopic colectomy (SILC) with those obtained with multiport laparoscopic colectomy (MLC). This meta-analysis aimed to examine whether SILC shows real benefits over MLC, especially in terms of feasibility, safety, and oncological adequacy.
METHODS:
A literature review of studies comparing SILC and MLC has been performed which looked at the following outcomes: mortality, morbidity, and oncological parameters of adequacy, as well as other potential benefits and drawbacks. Standardized mean difference for continuous variables and odds ratios for qualitative variables were calculated.
RESULTS:
Thirty studies comparing SILC and MLC were reviewed: two prospective randomized clinical trials (RCTs), eight prospective studies, and 20 retrospective comparative observational studies. Overall, in a cohort of 3502 patients who underwent surgery, SILC was used in 1068 cases (30.5 %) and MLC was used in 2434 cases (69.5 %). Mean intraoperative blood loss was significantly lower when the SILC procedure had been used (75.06 vs. 91.45 ml, P = 0.03); bowel function recovered significantly earlier in the SILC patients (1.96 vs. 2.15 days, P = 0.03); mean postoperative hospital stay was significantly shorter in the SILC group (5.55 vs. 6.60 days, P = 0.0005); and length of skin incision was significantly shorter in SILC patients (3.98 vs. 5.28 cm, P = 0.01). However, in the latter four outcomes, evidence of heterogeneity was found. In contrast, MLC showed significantly better results when compared to SILC in terms of distal free margins (12.26 vs. 10.98 cm, P = 0.01).
CONCLUSIONS:
SILC could be considered as a safe and feasible alternative to MLC in experienced hands. Further evidence for this surgical procedure should be assessed in the form of high-quality RCTs, with additional focus on its use in low rectal cancer resection
open colectomy for locally advanced T4 colonic cancer: meta-analysis of clinical and oncological outcomes
No full textLaparoscopy for perforated acute diverticulitis of the sigmoid colon: navigating the evidence
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