ChirurgiaPub Date : 2024-04-01DOI: 10.21614/chirurgia.2024.v.119.i.2.p.191
Anca Bordianu, Ion Petre, Anca Bobircă, Florin Bobircă
{"title":"The Vascularized Omentum Lymph Node Transfer - A Key Point in the Lymphedema Management.","authors":"Anca Bordianu, Ion Petre, Anca Bobircă, Florin Bobircă","doi":"10.21614/chirurgia.2024.v.119.i.2.p.191","DOIUrl":"https://doi.org/10.21614/chirurgia.2024.v.119.i.2.p.191","url":null,"abstract":"<p><p><b>Background:</b> As an increased number of women beat breast cancer worldwide, the breast cancer related lymphedema has gained more attention recently. The vascularized omentum lymph node transfer has been approached as an useful tool for advanced and recurrent cases. The purpose of the paper is to emphasize the advantages and disadvantages of this method. <b>Materials and Methods:</b> This retrospective study consists of 17 patients known with breast cancer related lymphedema who received vascularized omentum lymph node transfer. Data was recorded between January 2022 and January 2023. Patients diagnosed with secondary lymphedema stage II or III, unresponsive to previous microsurgical lymphovenous bypass were included. <b>Results:</b> The most prevalent affected site was the left upper limb (59%), where edema was mainly identified in the forearm (75%). Nevertheless, more than half of the subjects have previously received lymphaticovenous anastomosis. The correlation between the stage of lymphedema and the postoperative reduction of the volume of the affected limb was -0.26, the slope to reached -0.33, with an intercept value of 2.64. The follow-up period showed reduced upper limb volume and an improved quality of life. Conclusion: Through an experienced hand, this versatile flap brings hope to breast cancer survivors with lymphedema.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"119 2","pages":"191-200"},"PeriodicalIF":0.6,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140921177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Helicobacter pylori Infection at Crossroads between Specialties.","authors":"Roxana Florentina Chivu, Florin Bobirca, Dan Dumitrescu, Cristina Alexandru, Traian Patrascu","doi":"10.21614/chirurgia.119.eC.2949","DOIUrl":"10.21614/chirurgia.119.eC.2949","url":null,"abstract":"<p><p><b>Background:</b> Helicobacter pylori (H. pylori) infection is one of the major current public health problems, its incidence being high worldwide. This condition is associated with other pathologies such as peptic ulcer or gastric cancer, causing a real challenge for specialists in the medical field. <b>Methods:</b>We conducted a retrospective study that includes a cohort of 275 patients who performed EGD and were tested for the presence of H. pylori by the stool antigen test, between July 2022 and December 2023. <b>Results:</b>The cohort had an average age of 62.79 ± 13.8 years old, with a male predominance 156 patients (56.7%) and the most frequent lesion is antral gastritis (149 cases, 54.2%). Gastric ulcer in those with positive tests in H. pylori had a double incidence compared to those in which the infection is not present (19.7% vs. 9.2%, p=0.012). <b>Conclusions:</b>: H. pylori infection still remains a condition that can be complicated by various pathological conditions that can evolve from a slight erosion of the gastric mucosa to digestive neoplasia that require complex multidisciplinary treatments, which is why understanding the mechanisms and applying therapeutic resources as soon as possible is essential.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"119 eCollection","pages":"1"},"PeriodicalIF":0.6,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140118930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
ChirurgiaPub Date : 2024-03-01DOI: 10.21614/chirurgia.2945
Anca Zgura, Catalin Savin, Luiza Tirca, Irina Balescu, Mihai Eftimie, Sorin Petrea, Adrian Hasegan, Bogdan Gaspar, Gabriel Petre Gorecki, Cristina Martac, Marilena Stoian, Nicolae Bacalbasa
{"title":"Prognostic Factors in Intrahepatic Cholangiocarcinoma - A Systematic Review.","authors":"Anca Zgura, Catalin Savin, Luiza Tirca, Irina Balescu, Mihai Eftimie, Sorin Petrea, Adrian Hasegan, Bogdan Gaspar, Gabriel Petre Gorecki, Cristina Martac, Marilena Stoian, Nicolae Bacalbasa","doi":"10.21614/chirurgia.2945","DOIUrl":"10.21614/chirurgia.2945","url":null,"abstract":"<p><p><b>Introduction:</b> intrahepatic cholangiocarcinoma (ICCA) are rare, aggressive cancers that develop in second order or smaller bile ducts. The aim of this review is to systematically review the most important prognostic factors affecting the long-term outcomes of these patients. <b>Material and Methods:</b> articles conducted on this issue, written in English, published between from January 2000 to December 2023 in Cochrane Library, PubMed, Embase, MedLine, Web of Science, Elsevier, Google Scholar were systematically researched and reviewed. <b>Results:</b> ICCA are usually late diagnosed cancers because of the asymptomatic character, and curative procedures are often not feasible, only 20 to 30% of patients being fit for surgery. With the prognostic of this aggressive malignancy being baleful, the most important risk factors but also prognosis factors seem to be represented by socioeconomic factors, morphological presentation, dimensions, number and extension of the tumor as well as resection margins. <b>Conclusions:</b> once these factors are widely recognized and identified in each case, the clinician will be able to find the best treatment for these patients in order to improve the long-term outcomes.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"119 Ahead of print","pages":"1-13"},"PeriodicalIF":0.8,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140130821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
ChirurgiaPub Date : 2024-03-01DOI: 10.21614/chirurgia.2963
Maria Serban, Irina Balescu, Sorin Petrea, Bogdan Gaspar, Lucian Pop, Valentin Varlas, Adrian Hasegan, Gabriel Petre Gorecki, Cristina Martac, Marilena Stoian, Nicolae Bacalbasa
{"title":"Is Marginal Donor an Efficient Solution for Expanding the Donor Pool for Liver Transplant?","authors":"Maria Serban, Irina Balescu, Sorin Petrea, Bogdan Gaspar, Lucian Pop, Valentin Varlas, Adrian Hasegan, Gabriel Petre Gorecki, Cristina Martac, Marilena Stoian, Nicolae Bacalbasa","doi":"10.21614/chirurgia.2963","DOIUrl":"https://doi.org/10.21614/chirurgia.2963","url":null,"abstract":"<p><p>Once the techniques of hepatobiliopancreatic surgery improved, liver transplantation widely extended in different hospitals; therefore, the need of grafts and automatically of liver donors reported a significant increase in the last decade. In this respect, attention was focused on increasing the liver donor pool. The aim of this review is to study the benefits of using marginal grafts in liver transplantation. With the advent of multiple methods of liver preservation, the use of grafts previously considered unsuitable has become possible. Thus, extended allocation criteria have emerged. However, the allocation of these grafts must be carefully considered and analyzed in the context of both recipient and donor factors.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"119 Ahead of print","pages":"1-10"},"PeriodicalIF":0.6,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140848416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Non-operative Management - The First Option in the Treatment of Blunt Liver and Spleen Trauma in Pediatric Patients.","authors":"Ioana Anca Stefanopol, Dumitru-Marius Danila, Cristina Voda-Chelmu, Raisa-Eloise Barbu, Horatiu Moisa, Camelia Busila, Liliana Baroiu","doi":"10.21614/chirurgia.2024.v.119.i.1.p.65","DOIUrl":"10.21614/chirurgia.2024.v.119.i.1.p.65","url":null,"abstract":"<p><strong>Aim: </strong>The aim of the present study is to assess some characteristics of blunt hepatic and splenic injuries in children, the non-operative management (NOM) procedures and efficiency, over a 5-year period in a tertiary hospital for children. <b>Materials and Methods:</b> We conducted a retrospective study on 32 patients with blunt liver and/or spleen injuries. Age, gender, mechanism of injury, hemoglobin and hematocrit levels, lenght of stay and bedrest, imaging diagnosis, hemostatics and transfusions, treatment, and discharge status were evaluated. <b>Results:</b> 58% of patients were males. Mean age was 10.7 years. The main mechanism of injury was motor vehicle accident. Ultrasound (US) and Computed Tomography (CT) found 56.2% patients with spleen injury and 43.8% with liver injuries. On US the most frequent injuries were lacerations, and on CT were splenic-grade III and hepatic-grade II. 84.4% of patients were hospitalized in Intensive Care Unit and 15.6% in the surgical unit. The mean hemoglobin and hematocrit were 10.91g/l and 33%, respectively.The treatment was non-operative for 84.4%, and operative for 15.6%. When discharged, 56.2% of patients were cured and 43.8% were improved.</p><p><strong>Conclusion: </strong>With a performing multidisciplinary team of surgeons, intensive care therapists and radiologists, NOM in pediatric patients with blunt liver and spleen injuries is safe and effective, may be conducted depending on the hemodynamic stability rather than the lesions' extension, and reduces the ICU lenght of stay, as well as the need for hemostatics and transfusion.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"119 1","pages":"65-75"},"PeriodicalIF":0.6,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140093504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
ChirurgiaPub Date : 2024-02-01DOI: 10.21614/chirurgia.2024.v.119.i.1.p.5
Mihnea-Ioan Ionescu, Samantha Ip, Jessica K Barrett, George Follows, Andrew J Butler, Lisa M Sharkey
{"title":"Risk Factors Associated with PTLD Related Mortality in Adult Multivisceral Transplant Recipients - A Single Centre Cohort Study.","authors":"Mihnea-Ioan Ionescu, Samantha Ip, Jessica K Barrett, George Follows, Andrew J Butler, Lisa M Sharkey","doi":"10.21614/chirurgia.2024.v.119.i.1.p.5","DOIUrl":"10.21614/chirurgia.2024.v.119.i.1.p.5","url":null,"abstract":"<p><p><b>Background:</b> PTLD is a heterogeneous group of lymphoproliferative diseases which can add significant mortality following multivisceral transplantation (MVTx). Our study aimed to identify potential risk factors of mortality in adult MVTx recipients who developed PTLD. <b>Methods:</b> All adult recipients of intestinal-containing grafts transplanted in our institution between 2013 and 2022, and who developed PTLD, were included in the study. <b>Results:</b> PTLD-associated mortality was 28.6% (6/21). Increased relative risk of mortality was associated with Stage 3 ECOG performance score (p=0.005; HR 34.77; 95%CI 2.94-410.91), if the recipients had a splenectomy (p=0.036; HR 14.36; 95%CI 1.19-172.89), or required retransplantation (p=0.039; HR 11.23; 95% CI 1.13-112.12). There was a significant trend for increased risk of PTLD mortality with higher peak EBV load (p=0.008), longer time from MVTx to PTLD diagnosis (p=0.008), and higher donor age (p 0.001). Peak LDH before treatment commencement was significantly higher in the mortality group vs the survival group (520.3 +- 422.8 IU/L vs 321.8 +- 154.4 IU/L; HR 1.00, 95%CI 1.00 to 1.01, p=0.019). Peak viral load prior to treatment initiation (Cycle Threshold (CT) cutoff = 32) correlated with the relative risk of death in MVTx patients who developed PTLD [29.4 (3.5) CTs in survivors compared to 23.0 (4.0) CTs in the mortality group]. <b>Conclusions:</b> This is the first study to identify risk factors for PTLD-associated mortality in an adult MVTx recipient cohort. Validation in larger multicentre studies and subsequent risk stratification according to these risk factors may contribute to better survival in this group of patients.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"119 1","pages":"5-20"},"PeriodicalIF":0.6,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140093506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
ChirurgiaPub Date : 2024-02-01DOI: 10.21614/chirurgia.2024.v.119.i.1.p.76
Mihai Alexandru Preda, Gabriela Musat, Codrut Sarafoleanu
{"title":"Surgical Endoscopic Treatment of Odontogenic Sinusitis.","authors":"Mihai Alexandru Preda, Gabriela Musat, Codrut Sarafoleanu","doi":"10.21614/chirurgia.2024.v.119.i.1.p.76","DOIUrl":"10.21614/chirurgia.2024.v.119.i.1.p.76","url":null,"abstract":"<p><p><b>Introduction:</b> Odontogenic sinusitis is a frequent disease of the maxillary sinus, resulting from a dental inflammatory condition or a foreign body migrated in the sinus cavity. We performed a clinical retrospective study aimed to review the two surgical endoscopic approaches for odontogenic maxillary sinusitis middle and inferior meatotomy, in terms of realistic indications, efficacy, outcomes, and possible complications. <b>Materials and Methods:</b> In our study, we included a number of 400 patients with odontogenic maxillary sinusitis divided into two groups, treated in our hospital over five years, from January 2019 to December 2023. The patients included in this research were over 18 years old, diagnosed with odontogenic maxillary sinusitis, and underwent either middle meatal antrostomy or inferior meatotomy. <b>Results:</b> We examined the medical records of 400 patients. The vast majority of patients had a history of dental interventions, and the most affected tooth was the first maxillary molar. The symptoms at admission were typical for sinusitis: nasal obstruction, anterior or posterior rhinorrhea, hyposmia to anosmia, cacosmia, and pain or facial pressure. 80% of the patients in the study underwent middle meatal antrostomy, while 20% underwent inferior meatotomy. There were no significant differences between these two approaches in terms of efficacy, complication rates, recovery, or relapses. The complications that occurred after the surgical treatment were minor and with a very low frequency. The most reported were middle meatus synechiae and the persistence of the meatotomy ostium, with mucus recirculation (in patients with inferior meatotomy). <b>Conclusions:</b> Endoscopic surgical treatment of odontogenic maxillary sinusitis can be done as middle or inferior meatotomy, each having specific indications. The maxillary antrostomy is preferred in the majority of cases, as it is a procedure in which the natural ostium of the maxillary sinus is enlarged, thereby maintaining the natural drainage pathway of the sinus. However, the inferior meatotomy is preferred in the case of foreign bodies or maxillary sinus retention cysts localized at the level of the sinus floor or in the alveolar or lateral recesses, or as part of a combined approach (inferior and middle meatotomy), when the ablation of a \"fungus ball\" is required.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"119 1","pages":"76-86"},"PeriodicalIF":0.6,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140093507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Cryostripping Versus Conventional Safenectomy in Chronic Venous Disease Treatment: A Single Center Retrospective Cohort Study.","authors":"Sergiu-Ciprian Matei, Daniela Radu-Teodorescu, Marius Sorin Murariu, Cristina Ștefania Dumitru, Sorin Olariu","doi":"10.21614/chirurgia.2024.v.119.i.1.p.56","DOIUrl":"10.21614/chirurgia.2024.v.119.i.1.p.56","url":null,"abstract":"<p><strong>Aim: </strong>This study presents a comparative analysis of cryostripping to conventional saphenectomy. <b>Materials and Methods:</b> The study included 2191 patients admitted in the Phlebology Department, 1st Surgical Department, Emergency County Hospital Timisoara, between September 2013 and April 2023, between September 2013 and April 2023, who underwent saphenectomy by cryostripping (1327 patients) or conventionally (864 patients). We compared the duration and costs of the procedure, hospitalization period, post-operative results, method feasibility, as well as the technical advantages of cryostripping compared to conventional surgery. <b>Results:</b> A smaller proximal incision, compared to the classic operation, as well the fact that distal counter incision is not necessary, represents technical advantages of this procedure. Average duration of the intervention was 41 +- 12.8 minutes, consumables costs were about 52 +- 10 EUR/intervention, with an average hospitalization period was 1.05 +- 0.41 days. The post-operative results were favourable, early complications rate being reduced (ecchymoses Phi; 2 cm - 33.23%; hematoma - 2.11%; deep vein thrombosis - 0.15%; transient paresthesias 3.01%). Compared to classic saphenectomy, the costs of consumables/intervention are similar, intervention time, hospitalization period and complication rate being statistically significantly lower. An advantage of the method is the fact that the cryo-probes can be sterilized, being reusable; from the economic point of view, the technique perfectly fits in both public hospitals and private clinics. <b>Conclusions:</b> Cryostripping is a radical surgical procedure which bring a significant number of advantages compared to the classic saphenectomy, being an effective alternative in CVD treatment.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"119 1","pages":"56-64"},"PeriodicalIF":0.6,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140093501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
ChirurgiaPub Date : 2024-02-01DOI: 10.21614/chirurgia.2024.v.119.i.1.p.102
Victor Gheorghe Radu, Diana Teodora Cucu
{"title":"L3W3 Incisional Hernia with LOD - Robotic eTEP-TAR Repair (with video).","authors":"Victor Gheorghe Radu, Diana Teodora Cucu","doi":"10.21614/chirurgia.2024.v.119.i.1.p.102","DOIUrl":"10.21614/chirurgia.2024.v.119.i.1.p.102","url":null,"abstract":"<p><p>video width=\"640\" height=\"480\" controls controlsList=\"nodownload\" poster=\"https://www.revistachirurgia.ro/pdfs/video/Victor_Gheorghe_Radu_L3W3_Incisional_Hernia.jpg\" style=\"margin-top: -20px;\" source src=\"https://www.revistachirurgia.ro/pdfs/video/Victor_Gheorghe_Radu_L3W3_Incisional_Hernia.mp4\" type=\"video/mp4\" Your browser does not support the video tag. /video <b>Introduction:</b> The Rives-Stoppa procedure has emerged as the preferred method for ventral hernia repair, and the principles of this technique are similarly applied in minimally invasive surgery using the eTEP (enhanced view totally extraperitoneal) approach. It appears that the eTEP approach offers excellent outcomes in terms of less post-operative pain, faster recovery, and shorter hospital stays for patients undergoing abdominal wall reconstruction (AWR). It's important to note that there are some contra-indications of this procedure. In general, laparoscopic eTEP may not be suitable for cases with large hernias and loss of domain where the working space is limited. In such cases, alternative approaches, such as using a robotic platform, may be considered to ensure an adequate working space for abdominal wall reconstruction (AWR). A robotic platform can create a working space by using the robotic arms as a \"laparo-lift,\" enabling the AWR to be performed. Case Report: In this case, we have a 65-year-old female patient with a BMI of 28.5 who presents with a large incisional hernia with LOD. This hernia is located on the right flank and occurred after a Jalaguier incision. The CT scan provided valuable information regarding the size of the hernia, the remaining volume of the abdominal cavity, and the content of the hernia sac. Based on these radiological details, the LOD diagnosis was confirmed using the Sabbagh equation, which revealed that the hernia volume accounted for 46.47% of the total peritoneal volume. Based on the location, size of the defect, and the EHS classification for incisional hernias, the diagnosis for this case is a Complex incisional hernia of L3 right W3 with LOD. The protocol for optimization in this case involves chemo-relaxation, which refers to the injection of botulinum toxin A (BTA) into the large lateral muscles of the abdomen. This is done approximately 6 weeks before the surgery. Based on the successful reduction of the hernia during the consultation, the decision has been made to perform the Abdominal Wall Reconstruction (AWR) procedure using the robotic eTEP-TAR technique. Conclusion: The post-operative course was favorable, with the patient experiencing early active mobilization, reduced pain, and early return of bowel movement. The patient was discharged the day after the surgery.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"119 1","pages":"102-105"},"PeriodicalIF":0.6,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140093503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
ChirurgiaPub Date : 2024-02-01DOI: 10.21614/chirurgia.2024.v.119.i.1.p.87
Rares Trisca, Valentin Oprea, Mihai Toma, Carmen Elena Bucuri, Bogdan Stancu, Ovidiu Grad, Claudia Gherman
{"title":"The Effectiveness of Cyanoacrylates versus Sutures for Mesh Fixation after Lichtenstein Repair (SCyMeLi STUDY) A Systematic Review and Meta-Analyze of Randomized Controlled Trials.","authors":"Rares Trisca, Valentin Oprea, Mihai Toma, Carmen Elena Bucuri, Bogdan Stancu, Ovidiu Grad, Claudia Gherman","doi":"10.21614/chirurgia.2024.v.119.i.1.p.87","DOIUrl":"10.21614/chirurgia.2024.v.119.i.1.p.87","url":null,"abstract":"<p><p><b>Background:</b> Chronic postoperative inguinal pain (CPIP) is still the most frequent complication after open Lichtenstein repair and any strategy to reduce its incidence and implications is a step forward to better outcomes. Between the means of mesh fixation atraumatic glue fixation has been explored as such possibility. A meta-analysis of randomized controlled trials comparing the performance of cyanoacrylate glue versus sutures fixation was conducted. <b>Methods:</b> the meta-analysis was conducted according to the PRISMA guidelines. Randomized controlled trials (RCTs) published between January 2000 and December 2021 were searched for in MEDLINE, PubMed, Web of Science, and Google Scholars. The quality of RCTs and the potential risk of bias were assessed using MINORS criteria and the Cochrane risk of bias tool. <b>Results:</b> of 269 papers the meta-analysis was performed on 19 RCTs including 3578 patients. In the glue fixation group, the operation was shorter (mean pooled difference 6 minutes; SE = 0.47; 95% CI = - 6.77 - - 4.92; t test = -12.36; p 0.0001) and immediate postoperative pain was lower (2.37% vs 13.3%OR - 0.158; 95% CI = 0.064 0.386; p = 0.0001). There was no difference in terms of chronic pain, recurrence rate and wound events. Conclusion: glue fixation of mesh in elective Lichtenstein repair of inguinal hernia seems to be a valid choice for a painful and safe procedure without increasing risk of recurrence.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"119 1","pages":"87-101"},"PeriodicalIF":0.6,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140093508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}