A single-center prospective study on the efficiency of negative pressure wound therapy versus conventional wound therapy in the postoperative management of devitalized and infected wounds.

INTRODUCTION: In this study, we aim to present the benefits of using negative pressure wound therapy, particularly with respect to the speed up of recovery time of devitalized and infected post-operative wounds, cost-effectiveness of local healing, pain relief during treatment, and returning to work and resuming normal daily activities at an earlier time. MATERIALS AND METHODS: This was a prospective study performed in General Surgery Clinic, between 2016-2018. The study comprised 67 patients divided into two groups: A (29 patients who underwent negative pressure wound therapy) and B (38 patients who underwent conventional wound therapy). RESULTS: The average age of patients included in group A was 64.2 ± 12.3 years and in group B, 63.2 ± 9.7 years (p=0.440). The wounds were located on the foot, thigh, abdomen, and other areas, and the average length of stay in hospital was 33 ± 18 days for group A versus 17 ± 14 days for group B (p=0.042) but with an average local healing time of 12 ± 5 days in group A versus 44 ± 17 days in group B (p<0.001). The average cost of hospitalization was higher in group A: 17,868 ± 9,560 RON (3,834 ± 2,051 euros) compared to group B: 6,025 ± 4,137 RON (1,292 ± 887 euros) (p=0.443) but the average cost of local healing was lower in group A: 5,437 ± 2,238 RON (1,166 ± 480 euro) compared to group B: 6,840 ± 3,520 RON (1,467 ± 755 euro) (p=0.005). CONCLUSIONS: The treatment of devitalized and infected post-operative wounds by using negative pressure wound therapy reduces local and complete healing time by approximately 30%, local healing costs by 26%, and allows better pain management during treatment with minimal complications. KEY WORDS: Negative pressure wound Therapy, Conventional wound therapy, Local healing, average cost.

Influence of the learning curve on the immediate postoperative pain intensity after laparoscopic inguinal hernioplasty.

Introduction: Inguinal hernia repairs represent one of the most commonly performed surgical operations worldwide. As more experience has been gained over the past decades with laparoscopic techniques, they are now widely used also for the repair of primary and unilateral inguinal hernias, representing a safe and effective alternative. One of the major concerns of patients undergoing inguinal hernia repair is postoperative pain and socio-professional reintegration. Aim of study: This study started from the hypothesis that the learning curve could influence postoperative pain intensity after laparoscopic inguinal hernioplasty. Methods: A retrospective - comparative study was performed, including a general surgeon's first consecutive cases (n=87) of TAPP (transabdominal preperitoneal procedure) hernioplasty procedures with implantation of self-gripping surgical prosthesis were investigated. Results: The evaluation of clinical and surgical aspects resulted in similar values in case of the studied groups. A reduction in surgical time was observed in case of patients operated after completing the learning curve (p = 0.0005) On the first postoperative day patients complained mostly about persistent and severe type of pain. Average Pain Index calculated with help of Simple Numeric Pain Scale resulted in similar values. Length of analgesic treatment showed no significant differences. Although higher intensity pain was mostly caracteristic in case of patients operated during the learning process, no significant relationship between learning curve and postoperative pain intensity were highlited. Conclusion: TAPP can be a safe technique for young surgeons as well, with the right study program the procedure can be mastered safely.

The Impact of the COVID-19 Pandemic on Colorectal Cancer Patients in a Tertiary Center in Romania. Single Center Retrospective Study.

Background: The novel coronavirus, SARS-COV-2, was first reported in Wuhan, China in the end of 2019. To curb its spread, social distancing measures and new safety regulations were implemented which led to major disruptions in colorectal cancer care. It is however unknown how it influenced the Romanian colorectal cancer care. Methods and Material: We assessed the demographical, clinical, intraoperative and pathological data of our colorectal cancer patients, 302 in total, between 15.03.2019-14.03.2021. The first year's data was considered as the control group and the second one, the study (pandemic) group. Results: We observed a 12% decrease in colorectal cancer hospitalizations in the first year, 38,6% in the first six months. The rate of emergency admissions, colo/ileostomy formatting procedures, palliative resections, clinical metastasis was higher in the pandemic group. More advanced locoregional invasion, a higher tumor stage, higher rate of vascular, perineural invasion, positive resection margin, and a higher lymph node yield was seen after the restrictions were implemented. Conclusion: The COVID-19 pandemic and the response against it had a major effect on the colorectal cancer care in our country. The outcomes of these worse clinical and pathological findings are unknown, but it is important to do further research in this field. We think colorectal cancer care should have an absolute priority in future pandemics.

Elderly Patients with Colorectal Cancer - A Predisposed Category for Postoperative Complications.

Introduction: Colorectal cancer (CRC) is among the leading causes of cancer-related deaths around the world. Elderly patients are often considered as a high-risk category of patients, predisposed for postoperative complications. Materials and methods: 138 patients aged over 75 years and diagnosed with colorectal cancer were retrospectively reviewed. Patients were divided in two groups, as follows: Study Group including patients who developed postoperative complications, and Control Group including patients without problems in the postoperative period. There were compared clinical, preoperative, surgical, postoperative and oncological data. The aim of study was to determine possible risk factors for short-term postoperative complications and analyze of the influence of postoperative complications on survival. Results: Risk factors as male gender, obesity, heart failure, diabetes type II, severe anemia, low total protein level, ASA III-IV classification, emergency surgery, prolonged surgical intervention, increased intraoperative blood loss, prolonged hospital stay, distal localization of tumors, TNM stages III-IV, surgery for digestive cancer and non-cancerous major abdominal surgery in the medical history were identified. Conclusion: The surgical treatment of colorectal cancer in the aging population still remains a challenge, these category of patients should benefit of special attention in order to ensure a chance to minimize or avoid these complications.

Endoscopic sphincterotoMy for delayIng choLecystectomy in mild acute biliarY pancreatitis (EMILY study): protocol of a multicentre randomised clinical trial.

INTRODUCTION: According to the literature, early cholecystectomy is necessary to avoid complications related to gallstones after an initial episode of acute biliary pancreatitis (ABP). A randomised, controlled multicentre trial (the PONCHO trial) revealed that in the case of gallstone-induced pancreatitis, early cholecystectomy was safe in patients with mild gallstone pancreatitis and reduced the risk of recurrent gallstone-related complications, as compared with interval cholecystectomy. We hypothesise that carrying out a sphincterotomy (ES) allows us to delay cholecystectomy, thus making it logistically easier to perform and potentially increasing the efficacy and safety of the procedure. METHODS/DESIGN: EMILY is a prospective, randomised, controlled multicentre trial. All patients with mild ABP, who underwent ES during the index admission or in the medical history will be informed to take part in EMILY study. The patients will be randomised into two groups: (1) early cholecystectomy (within 6 days after discharge) and (2) patients with delayed (interval) cholecystectomy (between 45 and 60 days after discharge). During a 12-month period, 93 patients will be enrolled from participating clinics. The primary endpoint is a composite endpoint of mortality and recurrent acute biliary events (that is, recurrent ABP, acute cholecystitis, uncomplicated biliary colic and cholangitis). The secondary endpoints are organ failure, biliary leakage, technical difficulty of the cholecystectomy, surgical and other complications. ETHICS AND DISSEMINATION: The trial has been registered internationally ISRCTN 10667869, and approved by the relevant organisation, the Scientific and Research Ethics Committee of the Hungarian Medical Research Council (EKU/2018/12176-5). TRIAL REGISTRATION NUMBER: ISCRTN 10667869; Pre-results.

Is Awareness Enough to Bring Patients to Colorectal Screening?

BACKGROUND: The aim of the study was to assess the awareness of colorectal cancer (CRC) patients about CRC screening methods and to investigate the relationship between awareness, socio-demographic characteristics and the stage in which patients with CRC are diagnosed. METHODS: The observational cross-sectional study included 275 CRC patients admitted between 2014 and 2016 to two surgical clinics from Tîrgu Mures, Romania. Study variables were collected via face-to-face interview and from patients' observation sheets. RESULTS: Only 41.5% of the patients heard about cancer screening and 6.5% about specific CRC screening methods. Mass-media was the major source of information (85.1%) followed to a much lesser extent (14.9%) by family, friends, and colleagues. Health professionals did not contribute at all to informing patients about screening methods. Awareness about screening methods was statistically associated with the patients' residence, age, and educational achievement, but not with the stage of CRC. CONCLUSION: The level of awareness of CRC screening methods was very low among the CRC patients included in the study but it could not predict the stage in which malignancy was diagnosed, suggesting that awareness alone is not enough to bring patients to undergo early CDC screening procedures.

Laparoscopic gastric plication for the treatment of morbid obesity by using real-time imaging of the stomach pouch.

BACKGROUND: Bariatric surgery is a continuously evolving field. Laparoscopic greater curvature plication is a new investigational procedure used to treat patients with morbid obesity. The demand for this operation from the obese patients is also rising. The problem is that during gastric plication the exact dimensions and volume of the pouch are not known so frequently it is too large or too tight thus compromising the results. The aim of the study was to identify the parameters that can improve the outcomes after this procedure. METHODS: We performed laparoscopic greater curvature plication in 75 obese patients during 2013-2015. The last 25 patients underwent surgery with a modified surgical technique using real-time imaging of the stomach pouch. The inclusion criteria for the 25 patients enrolled in this case series were the usual, body mass index higher than 40 or higher than 35 but with comorbidities along with the option of the patients for laparoscopic gastric plication. The operative technique was enhanced by using a computerized device and special intragastric catheters during the procedure that permitted real-time imaging of the gastric geometry. With this new operative approach we obtained the desired volume of the gastric remnant and we avoided strictures, obstruction or irregular shape of the pouch, problems that otherwise could have compromised the outcomes. RESULTS: We found an increased excess weight loss of 55% at six month and 65% over a 12-month follow-up period with alleviation of comorbidities. There were no major complications (gastric outlet obstructions or leaks) and less minor complications (nausea and vomiting) than in the patients operated with classic gastric plication procedure. CONCLUSIONS: This study shows that in case of laparoscopic gastric plication the use of our modified operative technique has better outcomes than in the classical setting. This is a new operative approach in the bariatric literature which can lead to greater acceptance of gastric plication among bariatric surgeons. The target population is represented by the obese patients who want to obtain similar results to those after gastric bypass and sleeve gastrectomy but are concerned about removing a part of their stomach and the postoperative complications that may occur, especially leaks and nutritional complications. KEY WORDS: Gastric geometry, Laparoscopic gastric plication, Morbid obesity, Real-time imaging.