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BJS Open Sep 2023Groin hernia repair is one of the most common operations performed globally, with more than 20 million procedures per year. The last guidelines on groin hernia...
BACKGROUND
Groin hernia repair is one of the most common operations performed globally, with more than 20 million procedures per year. The last guidelines on groin hernia management were published in 2018 by the HerniaSurge Group. The aim of this project was to assess new evidence and update the guidelines. The guideline is intended for general and abdominal wall surgeons treating adult patients with groin hernias.
METHOD
A working group of 30 international groin hernia experts and all involved stakeholders was formed and examined all new literature on groin hernia management, available until April 2022. Articles were screened for eligibility and assessed according to GRADE methodologies. New evidence was included, and chapters were rewritten. Statements and recommendations were updated or newly formulated as necessary.
RESULTS
Ten chapters of the original HerniaSurge inguinal hernia guidelines were updated. In total, 39 new statements and 32 recommendations were formulated (16 strong recommendations). A modified Delphi method was used to reach consensus on all statements and recommendations among the groin hernia experts and at the European Hernia Society meeting in Manchester on October 21, 2022.
CONCLUSION
The HerniaSurge Collaboration has updated the international guidelines for groin hernia management. The updated guidelines provide an overview of the best available evidence on groin hernia management and include evidence-based statements and recommendations for daily practice. Future guideline development will change according to emerging guideline methodology.
Topics: Adult; Humans; Hernia, Inguinal; Groin; Surgical Mesh; Abdominal Wall
PubMed: 37862616
DOI: 10.1093/bjsopen/zrad080 -
Journal of ISAKOS : Joint Disorders &... Oct 2023Groin pain is a common symptom in athletes. The complex anatomy of the area and the various terms used to describe the etiology behind groin pain have led to a confusing... (Review)
Review
Groin pain is a common symptom in athletes. The complex anatomy of the area and the various terms used to describe the etiology behind groin pain have led to a confusing nomenclature. To solve this problem, three consensus statements have been already published in the literature: the Manchester Position Statement in 2014, the Doha agreement in 2015, and the Italian Consensus in 2016. However, when revisiting recent literature, it is evident that the use of non-anatomic terms remains common, and the diagnoses sports hernia, sportsman's hernia, sportsman's groin, Gilmore's groin, athletic pubalgia, and core muscle injury are still used by many authors. Why are they still in use although rejected? Are they considered synonyms, or they are used to describe different pathology? This current concepts review article aims to clarify the confusing terminology by examining to which anatomical structures authors refer when using each term, revisit the complex anatomy of the area, including the adductors, the flat and vertical abdominal muscles, the inguinal canal, and the adjacent nerve branches, and propose an anatomical approach, which will provide the basis for improved communication between healthcare professionals and evidence-based treatment decisions.
Topics: Humans; Groin; Hernia, Inguinal; Athletic Injuries; Inguinal Canal; Pelvic Pain
PubMed: 37308079
DOI: 10.1016/j.jisako.2023.05.006 -
World Journal of Emergency Surgery :... Jul 2023Intra-abdominal infections (IAI) are among the most common global healthcare challenges and they are usually precipitated by disruption to the gastrointestinal (GI)... (Review)
Review
Intra-abdominal infections (IAI) are among the most common global healthcare challenges and they are usually precipitated by disruption to the gastrointestinal (GI) tract. Their successful management typically requires intensive resource utilization, and despite the best therapies, morbidity and mortality remain high. One of the main issues required to appropriately treat IAI that differs from the other etiologies of sepsis is the frequent requirement to provide physical source control. Fortunately, dramatic advances have been made in this aspect of treatment. Historically, source control was left to surgeons only. With new technologies non-surgical less invasive interventional procedures have been introduced. Alternatively, in addition to formal surgery open abdomen techniques have long been proposed as aiding source control in severe intra-abdominal sepsis. It is ironic that while a lack or even delay regarding source control clearly associates with death, it is a concept that remains poorly described. For example, no conclusive definition of source control technique or even adequacy has been universally accepted. Practically, source control involves a complex definition encompassing several factors including the causative event, source of infection bacteria, local bacterial flora, patient condition, and his/her eventual comorbidities. With greater understanding of the systemic pathobiology of sepsis and the profound implications of the human microbiome, adequate source control is no longer only a surgical issue but one that requires a multidisciplinary, multimodality approach. Thus, while any breach in the GI tract must be controlled, source control should also attempt to control the generation and propagation of the systemic biomediators and dysbiotic influences on the microbiome that perpetuate multi-system organ failure and death. Given these increased complexities, the present paper represents the current opinions and recommendations for future research of the World Society of Emergency Surgery, of the Global Alliance for Infections in Surgery of Surgical Infection Society Europe and Surgical Infection Society America regarding the concepts and operational adequacy of source control in intra-abdominal infections.
Topics: Female; Humans; Male; Surgeons; Abdominal Cavity; Intraabdominal Infections
PubMed: 37480129
DOI: 10.1186/s13017-023-00509-4 -
Internal Medicine (Tokyo, Japan) Dec 2023
Topics: Humans; Abdomen; Intestinal Obstruction; Peritonitis
PubMed: 37062740
DOI: 10.2169/internalmedicine.1743-23 -
Ugeskrift For Laeger Apr 2024A focused point-of-care abdominal ultrasound is an examination performed at the patient's location and interpreted within the clinical context. This review gives an... (Review)
Review
A focused point-of-care abdominal ultrasound is an examination performed at the patient's location and interpreted within the clinical context. This review gives an overview of this examination modality. The objective is to rapidly address predefined dichotomised questions about the presence of an abdominal aortic aneurysm, gallstones, cholecystitis, hydronephrosis, urinary retention, free intraperitoneal fluid, and small bowel obstruction. FAUS is a valuable tool for emergency physicians to promptly confirm various conditions upon the patients' arrival, thus reducing the time to diagnosis and in some cases eliminating the need for other imaging.
Topics: Humans; Ultrasonography; Aortic Aneurysm, Abdominal; Hydronephrosis; Abdomen; Gallstones; Cholecystitis; Intestinal Obstruction; Urinary Retention; Point-of-Care Systems
PubMed: 38704706
DOI: 10.61409/V10230649 -
Ugeskrift For Laeger Mar 2024
Topics: Humans; Spleen; Adrenalectomy; Abdomen; Liver; Laparoscopy
PubMed: 38445345
DOI: 10.61409/V72013 -
International Journal of Surgery... Feb 2024During laparoscopic surgery, the operating surgeon grasps sections of the gastrointestinal tract (GIT), including delicate structures, with long (270 mm) 5 mm diameter...
BACKGROUND
During laparoscopic surgery, the operating surgeon grasps sections of the gastrointestinal tract (GIT), including delicate structures, with long (270 mm) 5 mm diameter graspers. These grasping instruments increase the risk of iatrogenic damage due to crushing of the grasped tissue. This risk is increased significantly by diseases such as bacterial peritonitis and inflammatory bowel disease and reduced but not abolished by using parallel-closing laparoscopic instruments. This study describes the design and laboratory testing of fully developed and tested smart graspers capable of reducing the grasping force used for inflamed tissues and hollow viscera.
MATERIALS AND METHODS
In an ISO 13485-certified mechanical laboratory and CAD machine workshop, the authors have designed, developed, and evaluated a smart gasper capable of exerting a preselected uniform grasping force on the gastrointestinal tract and other structures/ tissues, through a mechanism incorporated in the handle of the instrument. This enables the control and graded reduction of the grasping force by the incorporation of a compression spring. The authors named the new instrument the force-adjustable parallel-occlusion grasper (FA-POG) because, in addition to applying a uniform force on the grasped bowel/tissue, it also enables the surgeon to select the force before grasping, depending on its physical condition, and pathological state.
RESULTS
FA-POG differs from traditional pinch-occlusion grasper in two respects: it exerts a uniform force on the grasped tissue/bowel and enables the operating surgeon to select and apply a predetermined uniform grasping force, ranging from 1 to 5 N, depending on the pathological condition of the bowel/structure. The ISO 13485-certified and fully developed prototype has been subjected to various grasping in-vitro tests using freshly harvested porcine small-bowel segments obtained from a local abattoir, using Instron tensiometry.
CONCLUSIONS
The authors designed and α/β tested a parallel-occlusion gasper that enables the operating surgeon to select the force before grasping. This grasper design consists of end-effectors jaws with a 4-bar linkage mechanism for wide, uniform parallel-occlusion force, surpassing traditional scissor-type laparoscopic graspers. It incorporates a force-level controller knob, based on a spring-loaded mechanism, enabling surgeon-preselected grip force to prevent excessive grasping. The authors validated the design experimentally using porcine small-bowel segments, optimizing teeth for maximum grip friction to minimize slippage.
Topics: Animals; Swine; Equipment Design; Laparoscopy; Abdomen; Intestine, Small; Microsurgery
PubMed: 37995091
DOI: 10.1097/JS9.0000000000000911 -
BJS Open Sep 2023The open abdomen is an innovation that greatly improved surgical understanding of damage control, temporary abdominal closure, staged abdominal reconstruction, viscera... (Review)
Review
BACKGROUND
The open abdomen is an innovation that greatly improved surgical understanding of damage control, temporary abdominal closure, staged abdominal reconstruction, viscera and enteric fistula care, and abdominal wall reconstruction. This article provides an evidence-informed, expert, comprehensive narrative review of the open abdomen in trauma, acute care, and vascular and endovascular surgery.
METHODS
A group of 12 international trauma, acute care, and vascular and endovascular surgery experts were invited to review current literature and important concepts surrounding the open abdomen.
RESULTS
The open abdomen may be classified using validated systems developed by a working group in 2009 and modified by the World Society of the Abdominal Compartment Syndrome-The Abdominal Compartment Society in 2013. It may be indicated in major trauma, intra-abdominal sepsis, vascular surgical emergencies, and severe acute pancreatitis; to facilitate second look laparotomy or avoid or treat abdominal compartment syndrome; and when the abdominal wall cannot be safely closed. Temporary abdominal closure and staged abdominal reconstruction methods include a mesh/sheet, transabdominal wall dynamic fascial traction, negative pressure wound therapy, and hybrid negative pressure wound therapy and dynamic fascial traction. This last method likely has the highest primary fascial closure rates. Direct peritoneal resuscitation is currently an experimental strategy developed to improve primary fascial closure rates and reduce complications in those with an open abdomen. Primary fascial closure rates may be improved by early return to the operating room; limiting use of crystalloid fluids during the surgical interval; and preventing and/or treating intra-abdominal hypertension, enteric fistulae, and intra-abdominal collections after surgery. The majority of failures of primary fascial closure and enteroatmospheric fistula formation may be prevented using effective temporary abdominal closure techniques, providing appropriate resuscitation fluids and nutritional support, and closing the abdomen as early as possible.
CONCLUSION
Subsequent stages of the innovation of the open abdomen will likely involve the design and conduct of prospective studies to evaluate appropriate indications for its use and effectiveness and safety of the above components of open abdomen management.
Topics: Humans; Acute Disease; Intra-Abdominal Hypertension; Prospective Studies; Pancreatitis; Peritoneum; Fistula
PubMed: 37882630
DOI: 10.1093/bjsopen/zrad084 -
Frontiers in Immunology 2023To date, studies of tissue-resident immunity have mainly focused on innate immune cells and T cells, with limited data on B cells. B-1 B cells are a unique subset of B... (Review)
Review
To date, studies of tissue-resident immunity have mainly focused on innate immune cells and T cells, with limited data on B cells. B-1 B cells are a unique subset of B cells with innate-like properties, enriched in murine pleural and peritoneal cavities and distinct from conventional B-2 cells in their ontogeny, phenotype and function. Here we discuss how B-1 cells represent exemplar tissue-resident immune cells, summarizing the evidence for their long-term persistence & self-renewal within tissues, differential transcriptional programming shaped by organ-specific environmental cues, as well as their tissue-homeostatic functions. Finally, we review the emerging data supporting the presence and homeostatic role of B-1 cells across non-lymphoid organs (NLOs) both in mouse and human.
Topics: Humans; Animals; Mice; B-Lymphocyte Subsets; B-Lymphocytes; Cues; Homeostasis; Peritoneal Cavity
PubMed: 37744333
DOI: 10.3389/fimmu.2023.1106294