No difference in incidence of port-site hernia and chronic pain after single-incision laparoscopic cholecystectomy versus conventional laparoscopic cholecystectomy: a nationwide prospective, matched cohort study.

BACKGROUND: Conventional laparoscopic cholecystectomy (CLC) is regarded as the gold standard for cholecystectomy. However, single-incision laparoscopic cholecystectomy (SLC) has been suggested to replace CLC. This study aimed at comparing long-term incidences of port-site hernia and chronic pain after SLC versus CLC. METHODS: We conducted a matched cohort study based on prospective data (Jan 1, 2009-June 1, 2011) from the Danish Cholecystectomy Database with perioperative information and clinical follow-up. Consecutive patients undergoing elective SLC during the study period were included and matched 1:2 with patients subjected to CLC using pre-defined criteria. Follow-up data were obtained from the Danish National Patient Registry, mailed patient questionnaires, and clinical examination. A port-site hernia was defined as a repair for a port-site hernia or clinical hernia located at one or more port sites. RESULTS: In total, 699 patients were eligible and 147 patients were excluded from the analysis due to pre-defined criteria. The rate of returned questionnaires was 83%. Thus, 552 (SLC, n = 185; CLC, n = 367) patients were analyzed. The median observation time was 48 months (range 1-65) after SLC and 48 months (1-64) after CLC (P = 0.940). The total cumulated port-site hernia rate was 4 % and 6 % for SLC and CLC, respectively (P = 0.560). Incidences of moderate/severe chronic pain were 4 % and 5 % after SLC and CLC, respectively (P = 0.661). CONCLUSIONS: We found no difference in long-term incidence of port-site hernia or chronic pain after SLC versus CLC.

Biologic treatment or immunomodulation is not associated with postoperative anastomotic complications in abdominal surgery for Crohn's disease.

OBJECTIVES: There are concerns that biologic treatments or immunomodulation may negatively influence anastomotic healing. This study investigates the relationship between these treatments and anastomotic complications after surgery for Crohn's disease. PATIENTS AND METHODS: Retrospective study on 417 operations for Crohn's disease performed at four Danish hospitals in 2000-2007. Thirty-two patients were preoperatively treated with biologics and 166 were on immunomodulation. In total, 154 were treated with corticosteroids of which 66 had prednisolone 20 mg or more. RESULTS: Anastomotic complications occurred at 13% of the operations. There were no difference in patients on biologic treatment (9% vs. 12% (p = 0.581)) or in patients on immunomodulation (10% vs. 14% (p = 0.263)). Patients on 20 mg prednisolone or more had more anastomotic complications (20% vs. 11% (p = 0.04)). Anastomotic complications were more frequent after a colo-colic anastomosis than after an entero-enteric or entero-colic (33% vs. 12% (p = 0.013)). Patients with anastomotic complications were older (40 years vs. 35 years (p = 0.014)), had longer disease duration (7.5 years vs. 4 years (p = 0.04)), longer operation time (155 min vs. 115 min (p = 0.018)) and more operative bleeding (200 ml vs. 130 ml (p = 0.029)). Multivariate analysis revealed preoperative treatment with prednisolone 20 mg or more, operation time and a colo-colic anastomosis as negative predictors of anastomotic complications. CONCLUSIONS: Preoperative biologic treatment or immunomodulation had no influence on anastomotic complications. The study confirms previous findings of corticosteroids and a colo-colic anastomosis as negative predictors and also that surgical complexity, as expressed by bleeding and operation time, may contribute to anastomotic complications.

Fewer urological complications after laparoscopic inguinal hernia repair without indwelling catheter.

INTRODUCTION: The number of procedures involving transabdominal preperitoneal laparoscopic surgery for inguinal hernia (TAPP) has increased in Denmark. Optimized perioperative regimens are needed. MATERIAL AND METHODS: This retrospective, single-institution study included consecutive patients during an eight-year period from 1 January 2002 to 31 December 2007 (period I) and from 1 January 2008 to 31 December 2009 (period II). In period II, perioperative indwelling catheter (Foley catheter) was not used routinely. Furthermore, the surgical technique was adjusted, a small team of dedicated TAPP surgeons was established, and two of the surgeons attended prearranged surgical training programmes. Additionally, period II patients were enrolled into structured patient protocols. The primary endpoint was complications within the first 30 days after surgery, and we also registered the rate of reoperation due to recurrence. RESULTS: A total of 684 patients underwent TAPP surgery for 946 inguinal hernias. From period I to II, the number of TAPP surgeons was reduced to a third and two surgeons received TAPP training. During period I, minor urological complications were observed in 5% (confidence interval (CI) 3.1-6.9%) compared with 1% in period II (0.0-2.5%). The overall morbidity rate was 13%. Serious complications were observed in 3% (CI 3.1-6.9%) of the cases in period I and in 2% (0.0-2.5%) of the cases in period II. For the entire eight-year study period, the cumulative rate of re-operation due to recurrence was 2%. CONCLUSION: TAPP without routine use of an indwelling catheter may reduce the risk of urological complications.

Ischemic proctosigmoiditis due to retroperitoneal hematoma.

Gastrointestinal ischemia is caused by ischemic colitis in 50-60% of cases and is associated with high morbidity and mortality among patients. Ischemic proctosigmoiditis is a very rare disorder with only few cases reported. Due to collateral blood supply the rectum is only affected in 2-5% of all cases of ischemic colitis. We report a rare case of ischemic proctosigmoiditis caused by a retroperitoneal hematoma due to a pelvic fracture.