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Aesthetic Surgery Journal Jun 2023Abdominoplasty is a widely utilized cosmetic surgery procedure. Despite its popularity, seroma formation remains a prevalent complication. Seroma can lead to extended...
Abdominoplasty is a widely utilized cosmetic surgery procedure. Despite its popularity, seroma formation remains a prevalent complication. Seroma can lead to extended recovery time, increased medical appointments, and the potential for infection or the need for additional surgical revision. Preserving Scarpa's fascia may mitigate the risk of seroma in patients following abdominoplasty. The goal of this systematic review was to determine the impact of preserving Scarpa's fascia on the occurrence of seroma and total drain output following an abdominoplasty procedure. This review searched academic literature in MEDLINE (via PubMed), EMBASE (OvidSP), and the Cochrane Central Register of Controlled Trials (CENTRAL) for clinical and observational studies published in peer-reviewed journals, from March 2022 to November 2022, that evaluated the impact of preserving Scarpa's fascia on postoperative seroma and total drain output during abdominoplasty. The primary outcomes of interest were seroma and total drain output, with secondary outcomes of interest including hematoma, time to drain removal, length of hospital stay, wound dehiscence, and infection rate. The systematic review of 8 studies, involving 846 patients, found that the preservation of Scarpa's fascia during an abdominoplasty procedure was associated with decreased seroma occurrence, reduced drain output, faster drain removal, and fewer infections. However, it did not affect the incidence of hematoma, hospital stay duration, or wound dehiscence. The preservation of Scarpa's fascia during an abdominoplasty procedure should be considered as a routine practice, because it has been shown to result in reduced seroma incidence rates and faster drain removal.
Topics: Humans; Seroma; Abdominoplasty; Abdominal Wall; Postoperative Complications; Fascia
PubMed: 36747469
DOI: 10.1093/asj/sjad024 -
Cureus Dec 2022The Fibonacci sequence is undoubtedly found in nature such as in the spiral of galaxies and flower petals. Fibonacci numbers are a sequence in which each number is the... (Review)
Review
The Fibonacci sequence is undoubtedly found in nature such as in the spiral of galaxies and flower petals. Fibonacci numbers are a sequence in which each number is the sum of the two preceding ones. The ratio of two consecutive Fibonacci numbers, also called the golden proportion, approximately equals 1.618. We analyzed the existence of Fibonacci numbers and golden ratios in the field of hernia and abdominal wall reconstruction. We found substantial evidence of the use of the golden ratio in siting of the umbilicus. The Fibonacci numbers also showed up frequently in the anatomy of the abdominal wall. However, this was not as appropriate as the other instances in the human body or in nature.
PubMed: 36721618
DOI: 10.7759/cureus.33072 -
Diagnostics (Basel, Switzerland) Nov 2022This work aims to review recent literature on penetrating aortic ulcers (PAUs) and intramural hematomas (IMHs), in order to identify clinical and imaging factors... (Review)
Review
BACKGROUND
This work aims to review recent literature on penetrating aortic ulcers (PAUs) and intramural hematomas (IMHs), in order to identify clinical and imaging factors connected to aortic-related adverse events (AAE).
METHODS
We performed a systematic review according to the Preferred Reporting Items for Systematic review and Metanalyses (PRISMA) guidelines. An electronic search was conducted on Medline and Embase databases. We included articles reporting on PAUs and/or IMHs localized in the descending thoracic and/or abdominal aorta and analyzing clinical and/or radiological markers of AAE.
RESULTS
Of 964 records identified through database searching, 17 were incorporated in the present review, including 193 and 1298 patients with type B PAUs and IMHs, respectively. The 30-days aortic-related mortality (ARM) was 4.3% and 3.9% for PAUs and IMHs. A total of 21% of patients with IMHs underwent intervention during the follow-up period, and 32% experienced an AAE. PAU markers of AAE were minimum depth (ranging from 9.5 to 15 mm) and diameter (≥12.5 mm). Maximum aortic diameter (MAD) cut-off values ranging from 38 to 44.75 mm were related to AAE for IMHs, together with ulcer-like projection (ULP) of the aortic wall.
CONCLUSIONS
Despite data heterogeneity in the literature, this PAU- and IMH-focused review has highlighted the imaging and clinical markers of disease progression, thus identifying patients that could benefit from an early intervention in order to reduce the AAE rate.
PubMed: 36359569
DOI: 10.3390/diagnostics12112727 -
SAGE Open Medicine 2022To systematically summarize the burden of gastroschisis and omphalocele in Sub-Saharan Africa. (Review)
Review
OBJECTIVE
To systematically summarize the burden of gastroschisis and omphalocele in Sub-Saharan Africa.
METHODS
Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, systematically reviewed and meta-analyzed literatures from Medline (PubMed), Cochrane Library, HINARI, and Google Scholar that investigated at the prevalence of major congenital abdominal wall malformation. The pooled prevalence of major abdominal wall defects was estimated using a weighted inverse variance random-effects model. The Q statistic and the I statistics were used to examine for heterogeneity among the included studies. The funnel plot and Egger's regression test were used to check for publication bias.
RESULTS
A total of 1951 studies were identified; 897 from PubMed, 26 from Cochrane Library, 960 from Google Scholar, and 68 from other sources. Fourteen articles that met the eligibility criteria were selected for this meta-analysis with 242,462 total enrolled participants and 4693 births with congenital anomaly. The pooled prevalence of ompahalocele among congenital defect patients in Sub-Saharan Africa was found to be 4.47% (95% confidence interval: 3.04-5.90; I = 88.3%; p < 0.001). The pooled prevalence of omphalocele among births with congenital defect was found to be 4.04% (95% confidence interval: 2.62-5.46) in cross-sectional studies and 4.43% (95% confidence interval: 306-5.81) in cohort studies. The average prevalence of omphalocele among births with congenital defect was found to be 8% (95% confidence interval: 5.53-10.47) in Uganda and 6.65% (95% confidence interval: 4.18-9.13) in Nigeria. The pooled prevalence of gastroschisis among congenital birth defect in Sub-Saharan Africa was found to be 3.22% (95% confidence interval: 1.83-4.61; I = 33.1%; p = 0.175).
CONCLUSION
Based on this review, the pooled prevalence of omphalocele and gastroschisis in sub-Saharan Africa are high. Therefore, a perinatal screening program for congenital anomalies should be implemented. In addition, early referral of suspected cases of congenital anomalies is required for better management until advanced diagnostic centers are established in various locations of Sub-Saharan Africa.
PubMed: 36161211
DOI: 10.1177/20503121221125536 -
Anesthesia and Analgesia Nov 2022The prevalence of pregnant people with opioid use disorder (OUD), including those receiving medications for opioid use disorder (MOUD), is increasing. Challenges...
A Systematic Scoping Review of Peridelivery Pain Management for Pregnant People With Opioid Use Disorder: From the Society for Obstetric Anesthesia and Perinatology and Society for Maternal Fetal Medicine.
The prevalence of pregnant people with opioid use disorder (OUD), including those receiving medications for opioid use disorder (MOUD), is increasing. Challenges associated with pain management in people with OUD include tolerance, opioid-induced hyperalgesia, and risk for return to use. Yet, there are few evidence-based recommendations for pain management in the setting of pregnancy and the postpartum period, and many peripartum pain management studies exclude people with OUD. This scoping review summarized the available literature on peridelivery pain management in people with OUD, methodologies used, and identified specific areas of knowledge gaps. PubMed and Embase were comprehensively searched for publications in all languages on peripartum pain management among people with OUD, both treated with MOUD and untreated. Potential articles were screened by title, abstract, and full text. Data abstracted were descriptively analyzed to map available evidence and identify areas of limited or no evidence. A total of 994 publications were imported for screening on title, abstracts, and full text, yielding 84 publications identified for full review: 32 (38.1%) review articles, 14 (16.7%) retrospective studies, and 8 (9.5%) case reports. There were 5 randomized controlled trials. Most studies (64%) were published in perinatology (32; 38.1%) journals or anesthesiology (22; 26.2%) journals. Specific areas lacking trial or systematic review evidence include: (1) methods to optimize psychological and psychosocial comorbidities relevant to acute pain management around delivery; (2) alternative nonopioid and nonpharmacologic analgesia methods; (3) whether or not to use opioids for severe breakthrough pain and how best to prescribe and monitor its use after discharge; (4) monitoring for respiratory depression and sedation with coadministration of other analgesics; (5) optimal neuraxial analgesia dosing and adjuncts; and (6) benefits of abdominal wall blocks after cesarean delivery. No publications discussed naloxone coprescribing in the labor and delivery setting. We observed an increasing number of publications on peripartum pain management in pregnant people with OUD. However, existing published works are low on the pyramid of evidence (reviews, opinions, and retrospective studies), with a paucity of original research articles (<6%). Opinions are conflicting on the utility and disutility of various analgesic interventions. Studies generating high-quality evidence on this topic are needed to inform care for pregnant people with OUD. Specific research areas are identified, including utility and disutility of short-term opioid use for postpartum pain management, role of continuous wound infiltration and truncal nerve blocks, nonpharmacologic analgesia options, and the best methods to support psychosocial aspects of pain management.
Topics: Pregnancy; Female; Humans; Pain Management; Analgesics, Opioid; Perinatology; Anesthesia, Obstetrical; Retrospective Studies; Opioid-Related Disorders; Analgesics; Naloxone
PubMed: 36135926
DOI: 10.1213/ANE.0000000000006167 -
Medicine Sep 2022To explore the risk factors of bile duct injury in laparoscopic cholecystectomy (LC) in China through meta-analysis. (Meta-Analysis)
Meta-Analysis
BACKGROUND
To explore the risk factors of bile duct injury in laparoscopic cholecystectomy (LC) in China through meta-analysis.
METHODS
The study commenced with a search and selection of case-control studies on the risk factors for bile duct injury in LC in China using the following databases: PubMed, EMBASE, ScienceNet.cn, CNKI, Wanfang Data, and VIP. Data were extracted from the collected documents independently by 2 researchers, following which a meta-analysis of these data was performed using Revman 5.3.
RESULTS
The compilation of all data from a total of 19 case-control studies revealed that among 41,044 patients, 458 patients experienced bile duct injury in LC, accounting for the incidence rate of 1.12% for bile duct injury. The revealed risk factors for bile duct injury were age (≥40 years) (odds ratio [OR] = 6.23, 95% CI [95% confidence interval]: 3.42-11.33, P < .001), abnormal preoperative liver function (OR = 2.01, 95% CI: 1.50-2.70, P < .001), acute and subacute inflammation of gallbladder (OR = 8.35, 95% CI: 5.32-13.10, P < .001; OR = 4.26, 95% CI: 2.73-6.65, P < .001), thickening of gallbladder wall (≥4 mm) (OR = 3.18, 95% CI: 2.34-4.34, P < .001), cholecystolithiasis complicated with effusion (OR = 3.05, 95% CI: 1.39-6.71, P = .006), and the anatomic variations of the gallbladder triangle (OR = 11.82, 95% CI: 6.32-22.09, P < .001). However, the factors of gender and overweight (body mass index ≥ 25 kg/m2) were not significantly correlated with bile duct injury in LC.
CONCLUSIONS
In the present study, age (≥40 years), abnormal preoperative liver function, gallbladder wall thickening, acute and subacute inflammation of the gallbladder, cholecystolithiasis complicated with effusion, and anatomic variations of the gallbladder triangle were found to be closely associated with bile duct injury in LC.
Topics: Abdominal Injuries; Adult; Bile Duct Diseases; Bile Ducts; China; Cholecystectomy, Laparoscopic; Cholecystolithiasis; Humans; Inflammation; Intraoperative Complications; Risk Factors
PubMed: 36123939
DOI: 10.1097/MD.0000000000030365 -
The British Journal of Surgery Nov 2022Incisional hernia is a frequent complication of abdominal wall incision. Surgical technique is an important risk factor for the development of incisional hernia. The aim...
BACKGROUND
Incisional hernia is a frequent complication of abdominal wall incision. Surgical technique is an important risk factor for the development of incisional hernia. The aim of these updated guidelines was to provide recommendations to decrease the incidence of incisional hernia.
METHODS
A systematic literature search of MEDLINE, Embase, and Cochrane CENTRAL was performed on 22 January 2022. The Scottish Intercollegiate Guidelines Network instrument was used to evaluate systematic reviews and meta-analyses, RCTs, and cohort studies. The GRADE approach (Grading of Recommendations, Assessment, Development and Evaluation) was used to appraise the certainty of the evidence. The guidelines group consisted of surgical specialists, a biomedical information specialist, certified guideline methodologist, and patient representative.
RESULTS
Thirty-nine papers were included covering seven key questions, and weak recommendations were made for all of these. Laparoscopic surgery and non-midline incisions are suggested to be preferred when safe and feasible. In laparoscopic surgery, suturing the fascial defect of trocar sites of 10 mm and larger is advised, especially after single-incision laparoscopic surgery and at the umbilicus. For closure of an elective midline laparotomy, a continuous small-bites suturing technique with a slowly absorbable suture is suggested. Prophylactic mesh augmentation after elective midline laparotomy can be considered to reduce the risk of incisional hernia; a permanent synthetic mesh in either the onlay or retromuscular position is advised.
CONCLUSION
These updated guidelines may help surgeons in selecting the optimal approach and location of abdominal wall incisions.
Topics: Humans; Abdominal Wall; Abdominal Wound Closure Techniques; Incisional Hernia; Laparotomy; Suture Techniques; Practice Guidelines as Topic
PubMed: 36026550
DOI: 10.1093/bjs/znac302 -
Frontiers in Surgery 2022Ventral hernia repair is one of the most commonly performed surgical procedures worldwide. To reduce the risk of complications, pre- and intra-operative strategies have... (Review)
Review
BACKGROUND
Ventral hernia repair is one of the most commonly performed surgical procedures worldwide. To reduce the risk of complications, pre- and intra-operative strategies have received increasing focus in recent years. To assess possible preventive surgical strategies, this European Hernia Society endorsed project was launched. The aim of this review was to evaluate the current literature focusing on pre- and intra-operative strategies for surgical site occurrences (SSO) and specifically surgical site infection (SSI) in ventral hernia repair.
METHODS
A systematic review was conducted and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Databases used were Pubmed and Web of Science. Original retrospective or prospective human adult studies describing at least one intra-operative intervention to reduce SSO after ventral hernia repair were considered eligible.
RESULTS
From a total of 4775 results, a total of 18 papers were considered suitable after full text reading. Prehospital chlorhexidine gluconate (CHG) scrub appears to increase the risk of SSO in patients undergoing ventral hernia repair, while there is no association between any type of surgical hat worn and the incidence of postoperative wound events. Intraoperative measures as prophylactic negative pressure therapy, surgical drain placement and the use of quilt sutures seem beneficial for decreasing the incidence of SSO and/or SSI. No positive effect has been shown for antibiotic soaking of a synthetic mesh, nor for the use of fibrin sealants.
CONCLUSION
This review identified a limited amount of literature describing specific preventive measures and techniques during ventral hernia repair. An advantage of prophylactic negative pressure therapy in prevention of SSI was observed, but different tools to decrease SSIs and SSOs continuously further need our full attention to improve patient outcomes and to lower overall costs.
PubMed: 35910469
DOI: 10.3389/fsurg.2022.847279 -
Journal of Vascular Surgery Jan 2023At present, the rupture risk prediction of abdominal aortic aneurysms (AAAs) and, hence, the clinical decision making regarding the need for surgery, is determined by... (Review)
Review
OBJECTIVE
At present, the rupture risk prediction of abdominal aortic aneurysms (AAAs) and, hence, the clinical decision making regarding the need for surgery, is determined by the AAA diameter and growth rate. However, these measures provide limited predictive information. In the present study, we have summarized the measures of local vascular characteristics of the aneurysm wall that, independently of AAA size, could predict for AAA progression and rupture.
METHODS
We systematically searched PubMed and Web of Science up to September 13, 2021 to identify relevant studies investigating the relationship between local vascular characteristics of the aneurysm wall and AAA growth or rupture in humans. A quality assessment was performed using the ROBINS-I (risk of bias in nonrandomized studies of interventions) tool. All included studies were divided by four types of measures of arterial wall characteristics: metabolism, calcification, intraluminal thrombus, and compliance.
RESULTS
A total of 20 studies were included. Metabolism of the aneurysm wall, especially when measured by ultra-small superparamagnetic iron oxide uptake, and calcification were significantly related to AAA growth. A higher intraluminal thrombus volume and thickness had correlated positively with the AAA growth in one study but in another study had correlated negatively. AAA compliance demonstrated no correlation with AAA growth and rupture. The aneurysmal wall characteristics showed no association with AAA rupture. However, the metabolism, measured via ultra-small superparamagnetic iron oxide uptake, but none of the other measures, showed a trend toward a relationship with AAA rupture, although the difference was not statistically significant.
CONCLUSIONS
The current measures of aortic wall characteristics have the potential to predict for AAA growth, especially the measures of metabolism and calcification. Evidence regarding AAA rupture is scarce, and, although more work is needed, aortic wall metabolism could potentially be related to AAA rupture. This highlights the role of aortic wall characteristics in the progression of AAA but also has the potential to improve the prediction of AAA growth and rupture.
Topics: Humans; Risk Factors; Aortic Rupture; Aortography; Aortic Aneurysm, Abdominal; Thrombosis; Aorta, Abdominal
PubMed: 35843510
DOI: 10.1016/j.jvs.2022.07.008 -
JPRAS Open Sep 2022This is a paucity of data regarding plastic surgeons' opinions on robotic-assisted surgery (RAS). We developed a questionnaire aimed to survey plastic surgeons regarding... (Review)
Review
BACKGROUND
This is a paucity of data regarding plastic surgeons' opinions on robotic-assisted surgery (RAS). We developed a questionnaire aimed to survey plastic surgeons regarding training in robotics, concerns about widespread implementation, and new research directions.
METHODS
A survey was created using Google Forms and sent to practicing plastic surgeons and trainees. Responses regarding desired conference proceedings about robotics, robotic residency training, and perceived barriers to implementation were elicited. Survey responses were utilized to direct a systematic review on RAS in plastic surgery.
RESULTS
The survey received 184 responses (20.4%; 184/900). The majority (92.8%) of respondents were/are plastic surgery residents, with the most common fellowships being microsurgery (39.2%). Overall, 89.7% of respondents support some integration of robotics in the future of plastic surgery, particularly in pelvic/perineum reconstruction (56.4%), abdominal reconstruction (46.5%), microsurgery (43.6%), and supermicrosurgery (44.2%). Many respondents (66.1%) report never using a robot in their careers. Respondents expressed notable barriers to widespread robotic implementation, with cost (73.0%) serving as the greatest obstacle. A total of 10 studies (pelvic/perineum = 3; abdominal = 3; microsurgery = 4) were included after full-text review.
CONCLUSIONS
Evidence from our survey and review supports the growing interest and utility of RAS within the plastic and reconstructive surgery (PRS) and mirrors the established trend in other surgical subspecialties. Cost analyses will prove critical to implementing RAS within PRS. With validated benefits, plastic surgery programs can begin creating dedicated curricula for RAS.
PubMed: 35812356
DOI: 10.1016/j.jpra.2022.05.006