Varying negative appendectomy rates after laparoscopic appendectomy: a systematic review and meta-analysis.

PURPOSE: Appendicitis is a common cause of acute abdominal pain, and treatment with laparoscopy has become increasingly common during the past two decades. Guidelines recommend that normal appendices are removed if operated for suspected acute appendicitis. It is unclear how many patients are affected by this recommendation. The aim of this study was to estimate the rate of negative appendectomies in patients undergoing laparoscopic surgery for suspected acute appendicitis. METHODS: This study was reported following the PRISMA 2020 statement. A systematic search was conducted in PubMed and Embase for retrospective or prospective cohort studies (with n ≥ 100) including patients with suspected acute appendicitis. The primary outcome was the histopathologically confirmed negative appendectomy rate after a laparoscopic approach with a 95% confidence interval (CI). We performed subgroup analyses on geographical region, age, sex, and use of preoperative imaging or scoring systems. The risk of bias was assessed using the Newcastle-Ottawa Scale. Certainty of the evidence was assessed using GRADE. RESULTS: In total, 74 studies were identified, summing up to 76,688 patients. The negative appendectomy rate varied from 0% to 46% in the included studies (interquartile range 4-20%). The meta-analysis estimated the negative appendectomy rate to be 13% (95% CI 12-14%) with large variations between the individual studies. Sensitivity analyses did not change the estimate. The certainty of evidence by GRADE was moderate due to inconsistency in point estimates. CONCLUSION: The overall estimated negative appendectomy rate after laparoscopic surgery was 13% with moderate certainty of evidence. The negative appendectomy rate varied greatly between studies.

Effect of melatonin cream on acute radiation dermatitis in patients with primary breast cancer: A double-blind, randomized, placebo-controlled trial.

AIM: This was a double-blind, placebo-controlled randomized study investigating whether melatonin can protect against radiation dermatitis in women receiving radiation therapy for primary breast cancer. METHODS: Patients were included before radiation therapy and followed once weekly throughout treatment with a 3-week follow-up. Patients applied 1 g of cream to the irradiated skin twice daily, consisting of either 25 mg/g melatonin and 150 mg/g dimethyl sulfoxide, or placebo. Our outcomes were the Radiation Therapy Oncology Group's (RTOG) acute radiation morbidity scoring criteria for skin, a pixel analysis of erythema in clinical photographs, and patients' use of corticosteroid cream. Outcomes were evaluated once weekly throughout the trial. The primary outcomes were RTOG-score and pixel analysis at 2 weeks follow-up. Secondary outcomes were the use of corticosteroid cream and analyses of RTOG-scores and pixel analyses throughout the trial. RESULTS: Sixty-five patients were included, 17 dropped out, totaling 26 and 22 patients randomized to melatonin and placebo, respectively. RTOG-scores and pixel analyses at 2 weeks follow-up showed no difference p = .441 and p = .890, respectively). There was no difference in the use of corticosteroid cream (p = .055). Using logistic regression, the melatonin group had a higher likelihood of having a low RTOG-score (p = .0016). The logistic regression showed no difference between the groups for the pixel analyses. CONCLUSION: Our primary outcome showed no difference in RTOG-scores at 2 weeks follow-up, however, the RTOG-score over the entire duration of the study demonstrated a protective effect of melatonin. Further studies are warranted investigating higher doses of melatonin, and whether corticosteroids may influence the effect of melatonin cream against radiation dermatitis.

Risk of Reoperation for Recurrence After Elective Primary Groin and Ventral Hernia Repair by Supervised Residents.

Importance: Surgical training involves letting residents operate under supervision. Since hernia repair is a common procedure worldwide, it is a frequent part of the surgical curriculum. Objective: To assess the risk of reoperation for recurrence after elective primary groin and ventral hernia repair performed by supervised residents compared with that by specialists. Design, Setting, and Participants: This nationwide register-based cohort study included data from January 2016 to September 2021. Patients were followed up until reoperation, emigration, death, or the end of the study period. The study used data from the Danish Inguinal and Ventral Hernia Databases linked with data from the Danish Patient Safety Authority's Online Register via surgeons' unique authorization ID. The cohort included patients aged 18 years or older who underwent primary elective hernia repairs performed by supervised residents or specialists for inguinal, femoral, epigastric, or umbilical hernias. Hernia repairs were divided into the following 4 groups: Lichtenstein groin, laparoscopic transabdominal preperitoneal (TAPP) groin, open ventral, and laparoscopic ventral. Exposures: Hernia repairs performed by supervised residents vs specialists. Main Outcomes and Measures: Reoperation for recurrence, analyzed separately for all 4 groups. Results: A total of 868 specialists and residents who performed 31 683 primary groin and 7777 primary ventral hernia repairs were included in this study. The median age of patients who underwent hernia repair was 60 years (IQR, 48-70 years), and 33 424 patients (84.7%) were male. There was no significant difference in the adjusted risk of reoperation after Lichtenstein groin hernia repair (hazard ratio [HR], 1.26; 95% CI, 0.99-1.59), laparoscopic groin hernia repair (HR, 1.01; 95% CI, 0.73-1.40), open ventral hernia repair (HR, 0.89; 95% CI, 0.61-1.29), and laparoscopic ventral hernia repair (HR, 2.96; 95% CI, 0.99-8.84) performed by supervised residents compared with those by specialists. There was, however, a slightly increased unadjusted, cumulative reoperation rate after Lichtenstein repairs performed by supervised residents compared with those by specialists (4.8% vs 4.2%; P = .048). Conclusions and Relevance: The findings of this study suggest that neither open nor laparoscopic repair of groin and ventral hernias performed by supervised residents appeared to be associated with a higher risk of reoperation for recurrence compared with the operations performed by specialists. This indicates that residents may safely perform elective hernia repair when supervised as part of their training curriculum.

Celestial risk factors in groin hernia repair and random statistical association: a nationwide register-based study.

AIM: We aimed to investigate how celestial phenomena like zodiac signs, lunar phases, and Friday the 13th impacted the risk of reoperation after groin hernia repair. METHODS: We conducted a nationwide register-based study based on the Danish Hernia Database and Danish Patient Safety Authority's Online Register between 2000-2019. We included patients ≥18 years undergoing open Lichtenstein or laparoscopic groin hernia repair. The main outcomes were risk of reoperation after groin hernia repair in relation to patient and surgeon zodiac sign, lunar phase at the time of the repair, and Friday the 13th vs other Fridays. RESULTS: 151,901 groin hernias were included in the analysis of patient zodiac sign, and 25,075 groin hernias were included in the analysis of surgeon zodiac sign. Compared with the Sagittarius, there was a significantly higher risk of reoperation (HR [95% CI]) if the performing surgeon was born under the Capricorn (1.93 [1.16-3.12]); Pisces (1.68 [1.09-2.57]); Aries (1.61 [1.07-2.38]); Taurus (1.62 [1.04-2.54]); Cancer (2.21 [1.48-3.28]); or Virgo (1.71 [1.13-2.59]). Repairs performed under the waxing (1.23 [1.03-1.46]) and the new moon (1.54 [1.11-2.13]) had significantly higher risk of reoperation (HR [95% CI]) compared with the waning moon. Neither patient zodiac sign nor Friday the 13th affected risk of reoperation after groin hernia repair. CONCLUSIONS: Surgeons' zodiac sign and lunar phase significantly affected the risk of reoperation after groin hernia repair. Neither patients' zodiac sign nor Friday the 13th influenced on the risk of reoperation after groin hernia repair. This indicates why significant findings should be considered carefully to distinguish between random statistical association and cause-and-effect relations.

Quality-of-life outcomes following topical melatonin application against acute radiation dermatitis in patients with early breast cancer: A double-blind, randomized, placebo-controlled trial.

The aim of this double-blind, placebo-controlled, randomized study was to investigate whether topical melatonin administered during radiation therapy could increase the quality of life in patients with primary breast cancer. Patients were followed from the first radiation fraction until 3 weeks after the last. The patients applied 1 g of cream to the irradiated area of the skin twice daily, consisting of either 25 mg/g melatonin and 150 mg/g dimethyl sulfoxide, or a placebo cream. Outcomes were the European Organisation for Research and Treatment of Cancer's quality-of-life questionnaires for breast cancer (QLQ-C30 and QLQ-BR23) on the last day of radiation therapy. As a secondary outcome, we evaluated the breast symptom (BS) scores over the entire duration of the trial in a repeated measures linear model. We included 65 patients and had 17 drop-outs, thus totaling 26 and 22 patients in the melatonin and placebo groups, respectively. BS scores on the last day of radiation did not differ between groups (p = .333). However, the linear model analyzing BS for the entire duration showed that melatonin significantly decreased the symptoms (p = .001). There was no difference in the BS score on the last day of radiation, however, we found that the patients in the melatonin group had significantly lower BS scores over the entire duration of the trial.

Surgeon Volume and Risk of Reoperation after Laparoscopic Primary Ventral Hernia Repair: A Nationwide Register-Based Study.

BACKGROUND: Repairs of primary ventral hernias are common procedures but are associated with high recurrence rates. Therefore, it is important to investigate risk factors for recurrence to optimize current treatments. The aim of this study was to assess the impact of annual surgeon volume on the risk of reoperation for recurrence after primary ventral hernia repair. STUDY DESIGN: We conducted a nationwide register-based study with data from the Danish Ventral Hernia Database and the Danish Patient Safety Authority's Online Register linked via surgeons' authorization identification. We included patients 18 years and older, undergoing umbilical or epigastric hernia repair between 2011 and 2020. Annual surgeon volume was categorized into ≤ 9, 10 to 19, 20 to 29, and ≥ 30 cases. Patients were followed until reoperation, death, emigration, or end of the study period. RESULTS: We included 7,868 patients who underwent laparoscopic (n = 1,529 [19%]), open mesh (n = 4,138 [53%]), or open nonmesh (n = 2,201 [28%]) repair. There was an increased risk of reoperation after laparoscopic umbilical or epigastric hernia repair for surgeons with ≤ 9 (hazard ratio 6.57; p = 0.008), 10 to 19 (hazard ratio 6.58; p = 0.011), and 20 to 29 (hazard ratio 13.59; p = 0.001) compared with ≥ 30 cases/y. There were no differences in risk of reoperation after open mesh and open nonmesh repair in relation to annual surgeon volume. CONCLUSIONS: There was a significantly higher risk of reoperation after laparoscopic primary ventral hernia repair performed by lower-volume surgeons compared with high-volume surgeons. Additional research investigating how sufficient surgical training and supervision are ensured is indicated to reduce risk of reoperation after primary ventral hernia repair.