Sexual dysfunction between laparoscopic and open inguinal hernia repair: a systematic review and meta-analysis.

PURPOSE: Sexual dysfunction after inguinal hernia complication is considered rare. However, its consequences impact on quality of life inevitably. Laparoscopic and open inguinal hernia repair may be comparable in terms of recurrent rate, overall complications, and chronic pain. Therefore, its complication is still questionable between these approaches. In this study, we compared sexual dysfunction and related complications between laparoscopic and open inguinal hernia repair. METHODS: Systematic review and meta-analysis of randomized controlled trials (RCTs) studies were performed to compare laparoscopic and open inguinal hernia repair. Risk ratio (RR) and 95% confidence intervals (95% CI) were used as pooled effect size measures. RESULT: Thirty RCTs (12,022 patients) were included. Overall, 6014 (50.02%) underwent laparoscopic hernia repair, and 6008 (49.98%) underwent open hernia repair. Laparoscopic approach provided non-significance benefit on pain during sexual activity (RR 0.57; 95% CI 0.18, 1.76), Vas deferens injury (RR 0.46; 95% CI 0.13, 1.63), orchitis (RR 0.84; CI 0.61,1.17), scrotal hematoma (RR 0.99; CI 0.62,1.60), and testicular atrophy (RR 0.46; CI 0.17,1.20). Meanwhile, the open inguinal hernia approach seems to perform better for cord seroma complications and testicular pain. CONCLUSION: There is no advantage of laparoscopic inguinal hernia repair over an open approach concerning sexual dysfunction. On the contrary, there is an increasing risk of cord seroma after laparoscopic inguinal hernia repair with statistical significance.

Interactive 3D Force/Torque Parameter Acquisition and Correlation Identification during Primary Trocar Insertion in Laparoscopic Abdominal Surgery: 5 Cases.

Laparoscopic procedures have become indispensable in gastrointestinal surgery. As a minimally invasive process, it begins with primary trocar insertion. However, this step poses the threat of injuries to the gastrointestinal tract and blood vessels. As such, the comprehension of the insertion process is crucial to the development of robotic-assisted/automated surgeries. To sustain robotic development, this research aims to study the interactive force/torque (F/T) behavior between the trocar and the abdomen during the trocar insertion process. For force/torque (F/T) data acquisition, a trocar interfaced with a six-axis F/T sensor was used by surgeons for the insertion. The study was conducted during five abdominal hernia surgical cases in the Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University. The real-time F/T data were further processed and analyzed. The fluctuation in the force/torque (F/T) parameter was significant, with peak force ranging from 16.83 N to 61.86 N and peak torque ranging from 0.552 Nm to 1.76 Nm. The force parameter was observed to positively correlate with procedural time, while torque was found to be negatively correlated. Although during the process a surgeon applied force and torque in multiple axes, for a robotic system, the push and turn motion in a single axis was observed to be sufficient. For minimal tissue damage in less procedural time, a system with low push force and high torque was observed to be advantageous. These understandings will eventually benefit the development of computer-assisted or robotics technology to improve the outcome of the primary trocar insertion procedure.

Mesh fixation technique in totally extraperitoneal inguinal hernia repair - A network meta-analysis.

Laparoscopic totally extra-peritoneal inguinal hernia repair is the standard option for inguinal hernia treatment. However, there are various types of mesh fixation and their relative uses are still controversial. This network meta-analysis was conducted to compare and rank the different fixations available for TEP. Medline and Scopus databases were search until February 1, 2017 and using randomized controlled trials comparing outcomes between different mesh fixation techniques were included. The results demonstrated that fifteen RCTs (n = 1783) were eligible for pooling. Five types of mesh fixation were used; metallic tack, no-fixation, absorbable tack, suture, and glue. Network meta-analysis that use metallic tack as the reference, indicated that suture and glue both carried a lower risk of recurrence with pooled risk ratios (RR) of 0.29 (95% CI 0.00, 18.81) and 0.29 (0.07, 1.30), respectively. For overall complications, absorbable tack had lower risk (0.63, 95% CI: 0.02, 16.13). However, none of these estimates reached statistical significance. So, this network meta-analysis suggests that glue and absorbable tack might be best in lowering recurrence risk and complications. However, a large scale RCT is still needed to confirm these results.

Comparison of Superficial Surgical Site Infection Between Delayed Primary Versus Primary Wound Closure in Complicated Appendicitis: A Randomized Controlled Trial.

OBJECTIVE: To compare superficial surgical site infection (SSI) rates between delayed primary wound closure (DPC) and primary wound closure (PC) for complicated appendicitis. BACKGROUND: SSI is common in appendectomy for complicated appendicitis. DPC is preferentially used over PC, but its efficacy is still controversial. METHODS: A multicenter randomized controlled trial was conducted in 6 hospitals in Thailand, enrolling patients with gangrenous and ruptured appendicitis. Patients were randomized to PC (ie, immediately wound closure) or DPC (ie, wound closure at postoperative days 3-5). Superficial SSI was defined by the Center for Disease Control criteria. Secondary outcomes included postoperative pain, length of stay, recovery time, quality of life, and cost of treatment. RESULTS: In all, 303 and 304 patients were randomized to PC and DPC groups, and 5 and 4 patients were lost to follow-up, respectively, leaving 300 and 298 patients in the modified intention-to-treat analysis. The superficial SSI rate was lower in the PC than DPC groups [ie, 7.3% (95% confidence interval 4.4, 10.3) vs 10% (95% CI 6.6, 13.3)] with a risk difference (RD) of -2.7% (-7.1%, 1.9%), but this RD was not significant. Postoperative pain, length of stay, recovery times, and quality of life were nonsignificantly different with corresponding RDs of 0.3 (-2.5, 3.0), -0.1 (-0.5, 0.3), -0.2 (-0.8, 0.4), and 0.02 (-0.01, 0.04), respectively. However, costs for PC were 2083 (1410, 2756) Baht cheaper than DPC (∼$60 USD). CONCLUSIONS: Superficial SSI rates for the PC group were slightly lower than DPC group, but this did not reach statistical significance. Costs were significantly lower for the PC group.

Effect of alverine citrate plus simethicone in colonoscopy: a randomized controlled trial.

Colonoscopy is the standard procedure for screening, and surveillance of colorectal cancer, including the treatment for colonic lesions. Colonic spasm is an important problem from colonoscopy that affects both surgeons and patients. The spasm also might be the cause of longer cecal intubation time, difficulty of the procedure, and increased pain. Previous reports indicated that antispasmodic agents can decrease such symptoms. Therefore, we conducted this study to investigate the cecal intubation time of antispasmodic agents. A single blinded randomized controlled trial was conducted from 01/11/2020 to 31/08/2021. One hundred four patients were allocated to antispasmodic agent group and control group, in 1:1 ratio. The efficacy of median (range) cecal intubation time showed similar results of 5 (2, 14) and 5 (2, 15) minutes with no statistically significant difference. The mean scores of all domains i.e., pain, spasm, cleanliness, and difficulty were better in the antispasmodic agent group about 2.6 (1.4), 1.8 (0.8), 2.4 (0.9), and 2.0 (0.9), respectively, than control group but there were spasm and cleanliness showed statistically significant difference. Moreover, the satisfaction scores showed better efficacy in decreased spasm, decreased difficulty, and increased cleanliness than control group. Prescribing of antispasmodic drugs before colonoscopy might be the choice of treatment for the patients. The antispasmodic drugs will be beneficial to both of the patient and the doctor.

Prognostic value of ABCG2 in moderately and poorly differentiated intrahepatic cholangiocarcinoma.

AIMS: Intrahepatic cholangiocarcinoma (ICC) is a primary hepatic malignancy derived from cholangiocytes. The survival rate of ICC patients is very low, and conventional chemotherapy is not effective in prolonging long-term survival. Adenosine 5'-triphosphate (ATP)-binding cassette (ABC) transporters mediate the transport of various substances in several cellular processes. The expression of ABCB1, ABCC1 and ABCG2 has been implicated in multidrug resistance and poor prognosis in several types of cancer. The aim of this study was to examine their expression in normal cholangiocytes and ICC tissues. METHODS AND RESULTS: Immunohistochemistry was employed to evaluate the expression of these transporters in 60 cases of ICC with respect to clinicopathological features and patient outcome. The proportions of cases with loss of ABCB1, ABCC1 and ABCG2 expression were 93.3%, 68.3% and 50%, respectively. Only the loss of ABCG2 was related to a worse prognosis (P = 0.031), and was associated with lymph node involvement (P = 0.003) and higher tumour grade (P = 0.028). Furthermore, multivariate analysis showed that the loss of ABCG2 expression was an independent prognostic factor in patients with moderately or poorly differentiated ICC (P = 0.02). CONCLUSIONS: These results suggest that ABCG2 may be involved in cholangiocarcinogenesis; the loss of its expression may enhance tumour progression and contribute to aggressive growth of ICC.

The prognostic significance of microvessel density in intrahepatic cholangiocarcinoma.

OBJECTIVE: Intrahepatic cholangiocarcinoma (IHCC) is the second most common primary cancer of the liver Tumor angiogenesis seem to play an important role in tumor growth and prognosis of cancer patients. The purpose of the present study was to determine the prognostic value of tumor microvessel density (MVD) in patients with IHCC. MATERIAL AND METHOD: Clinicopathological prognostic factors, recurrence rate, and survival in 22 patients with IHCC who underwent liver resection for IHCC were reviewed. Tumor MVD was estimated using immunohistochemical methods. Overall probabilities of recurrence and survival were estimated using Kaplan-Meier methods. Prognostic significance ofMVD and other factors was tested using Cox proportional hazards regression. RESULTS: There was no significant association between any clinicopathologic factors (age, sex, tumor markers, and pathologic factors including MVD) and time-to-tumor recurrence. The only prognostic factor associated with survival was tumor stage. MVD was neither a significant survival predictor nor a predictor of tumor recurrence. CONCLUSION: The only factor associated with poor prognosis in patients with IHCC in the present study was higher tumor stage. MVD was not a significant prognostic factor in patients with IHCC.

Direct suppression of human islet dedifferentiation, progenitor genes, but not epithelial to mesenchymal transition by liraglutide.

ß-cell dedifferentiation has been accounted as one of the major mechanisms for ß-cell failure; thus, is a cause to diabetes. We study direct impacts of liraglutide treatment on ex vivo human dedifferentiated islets, and its effects on genes important in endocrine function, progenitor states, and epithelial mesenchymal transition (EMT). Human islets from non-diabetic donors, were purified and incubated until day 1 and day 4, and were determined insulin contents, numbers of insulin (INS+) and glucagon (GCG+) cells. The islets from day 3 to day 7 were treated with diabetic drugs, the long acting GLP-1 receptor agonist, liraglutide. As observed in pancreatic islets of type 2 diabetic patients, ex vivo dedifferentiated islets showed more than 50% reduced insulin contents while number of glucagon increased from 10% to about 20%. ß-cell specific genes: PDX1, MAFA, as well as ß-cell functional markers: GLUT1 and SUR1, were significantly depleted more than 40%. Notably, we found increased levels of glucagon regulator, ARX and pre-glucagon transcripts, and remarkably upregulated progenitor expressions: NEUROG3 and ALDH1A identified as ß-cell dysfunction markers in diabetic models. Hyperglucagonemia was often observed in type 2 patients that could lead to over production of gluconeogenesis by the liver. Liraglutide treatments resulted in decreased number of GCG+ cells, increased numbers of GLP-1 positive cells but did not alter elevated levels of EMT marker genes: ACTA2, CDH-2, SNAIL2, and VIM. These effects of liraglutide were blunted when FOXO1 transcripts were depleted. This work illustrates that ex vivo human isolated islets can be used as a tool to study different aspects of ß-cell dedifferentiation. Our novel finding suggests a role of GLP-1 pathway in beta-cell maintenance in FOXO1-dependent manner. Importantly, dedifferentiated islets ex vivo is a useful model that can be utilized to verify the actions of potential drugs to diabetic ß-cell failure.

Comparison of postoperative complications between open and laparoscopic appendectomy: An umbrella review of systematic reviews and meta-analyses.

BACKGROUND: Laparoscopic appendectomy (LA) has been popular for decades because of shorter hospitalization and return to routine activity. However, complications (e.g., surgical site infection [SSI] and intra-abdominal abscess [IAA]) relative to open appendectomy (OA) are still debated. We therefore conducted an umbrella review to systematically appraise meta-analyses (MAs) comparing SSI and IAA between LA and OA. METHODS: Meta-analyses that included only randomized controlled trials were identified from MEDLINE and Scopus databases from inception until July 2018. Their findings were described, the number of overlapping studies was assessed using corrected covered area, and excess significant tests were also assessed. Finally, effect sizes of SSI and IAA were repooled. RESULTS: Ten MAs were eligible; SSI was reported in all MAs and IAA in 8 MAs. Surgical site infection rate was 48% to 70% lower in LA than OA, but conversely, IAA rate was 1.34 to 2.20 higher in LA than OA. Overlapping included studies for SSI and IAA were 61% and 54%, respectively, indicating that less information was added across MAs. However, there was no evidence of bias from excess significant tests when pooling SSI or IAA estimates. The risk ratios (95% confidence interval) comparing LA versus OA were repooled in adults and children yielding risk ratios of 0.56 (0.47-0.67) and 0.40 (0.25-0.65) for SSI, and 1.20 (0.88-1.63) and 1.05 (0.61-1.80) for IAA. CONCLUSION: Evidence from this umbrella review indicates that LA carries a significantly lower risk of SSI but likely a higher risk of IAA than OA. LEVEL OF EVIDENCE: Systematic review/meta-analysis, level I.

Mesh position for hernia prophylaxis after midline laparotomy: A systematic review and network meta-analysis of randomized clinical trials.

BACKGROUND: Mesh can be used to prevent incisional hernia (IH) occurrence. However, the effect of various mesh positions has never been compared. This study aimed to compare and rank the effect and safety of various mesh-augmented fascia closure techniques on hernia prophylaxis in midline laparotomy. METHODS: MEDLINE and SCOPUS were searched from inception to December 2019. Randomized clinical trials (RCTs) were eligible if they met the following criteria: comparison of any of the following interventions: onlay (OM), retrorectus (RM), preperitoneal (PM), intraperitoneal mesh (IM) augmentation, and primary suture closure (PSC); and reporting on any of these outcomes: IH, wound infection, seroma, hematoma, and dehiscence. Two independent reviewers extracted data and assessed the risk of bias. A two-stage random-effect network meta-analysis was performed, then intervention effects were pooled and ranked accordingly. RESULTS: A total of 20 RCTs were eligible. Only OM and RM showed a significantly lower risk of IH than PSC with pooled risk ratios (RRs), 95% confidence intervals (95%CI) of 0.24 (0.12, 0.46) and 0.32 (0.16, 0.66), and number needed to treat (NNTs) of 4 and 5, respectively. However, OM showed a significantly higher risk of seroma than PSC (RR 2.21 (1.44, 3.39) with a number needed to harm (NNH) of 14). Most mesh placements showed a higher risk of wound infection, except for RM, but none of these was significantly different. All mesh techniques, except RM, showed a reduction in dehiscence, but again these were not significantly different. CONCLUSIONS: OM and RM provided the most effective IH prevention relative to PSC. However, OM had a higher rate of seroma than RM and PSC. Other complications, including wound infection, hematoma, and dehiscence, were not significantly observed among these fascia closure techniques.

Recurrence outcome of lymph node ratio in gastric cancer after underwent curative resection: A retrospective cohort study.

INTRODUCTION: D2 dissection has been regarded as the standard procedure for locally advanced gastric cancer (GC). Number of lymph nodes (LN) harvested is an important factor for accurate staging. The number of LN retrieved and the metastasis LN status are also important factors to determine the prognosis. This study aims to evaluate whether lymph node ratio (LNR) could be a prognostic indicator of GC patients following curative resection. PATIENTS AND METHODS: Single center retrospective cohort study of GC patients underwent curative resection from January 1995 to December 2016 was conducted. The patients were categorized into 3 groups based on LNR (0.00-0.35, >0.35-0.75, and >0.75-1.00) and 2 groups based on number of LN retrieved (<15 and ≥ 15). Kaplan-Meier method was used to estimate recurrence-free survival. Cox-regression were used to determine the association between LNR/other factors and the disease recurrence. RESULTS: One-hundred fifty-three patients were included in analysis. Univariate analysis showed that LNR >0.35, pathologic LN stages (pN) 2-3, higher number of LN metastasis, and TNM stage III were significantly recurrence risk factors. After adjusting for several covariates, LNR >0.35 still was significant predictor (adjusted HR [95%CI], 8.53 [1.97, 36.86]; p = 0.004) while number of LN retrieved or number of metastasis LN were not. CONCLUSION: LNR could be a strong indicator for the recurrence of GC after curative resection while the number of LN retrieved or metastasis did not predict the recurrence. Future studies, such as prospective studies, are needed to confirm and identify the optimum LNR cut-off.

Deep venous thrombosis in surgical intensive care unit: prevalence and risk factors.

BACKGROUND: Critically ill patients are at high risk for developing venous thromboembolism. The objective of this study was to determine the prevalence of, and risk factors for, lower extremity deep vein thrombosis (DVT) among critically ill surgical patients in Thailand. MATERIALS AND METHODS: Patients older than 15 years who were admitted to a surgical intensive care unit (ICU) of a tertiary care hospital were enrolled. Bilateral lower extremity compression Doppler ultrasonographic examination was performed to detect DVT within 14 days of ICU admission. Demographic data, primary disease, operative intervention, co-morbidities, acute physiology and chronic health evaluation (APACHE) II score and the length of ICU stay were tested for association with the presence of DVT. RESULTS: Among the 190 first-time admitted ICU patients with a mean APACHE II score of 9.2 +/- 6.0 (range, 0-29), 20 patients had DVT (prevalence of 10.5%). Thromboprophylaxis was not given to any patient. The only independent and significant risk factor for DVT was a longer ICU stay. Age, sex, APACHE II score, presence of comorbidities and operative intervention were not associated with the presence of DVT. CONCLUSION: The prevalence of DVT in critically ill patients in a Thai surgical ICU was approximately 10.5%. Further research is needed to evaluate the risks and benefits of venous thromboprophylaxis in Thai patients.

The efficacy of antibiotic treatment versus surgical treatment of uncomplicated acute appendicitis: Systematic review and network meta-analysis of randomized controlled trial.

BACKGROUND: The efficacy of antibiotics in appendicitis remains controversial, and physicians are not confident in prescribing antibiotics as the first line treatment. This network meta-analysis was conducted to assess the efficacy and safety of individual antibiotics in uncomplicated appendicitis. METHODS: Randomized controlled trials (RCTs) were identified from MEDLINE and SCOPUS databases since inception to July 2017. STUDIES: Network meta-analysis was applied to estimate treatment effects and safety. Probability of being the best treatment was estimated using surface under the cumulative ranking curve (SUCRA). RESULTS: Among 9 RCTs meeting our inclusion criteria. A network meta-analysis indicated that those receiving antibiotics had about 12-32% lower chance of treatment success and lower risk of complication about 23-86%, especially Beta-lactamase than appendectomy. The overall appendicitis recurrence rate in the antibiotic group was about 18.2%. The SUCRA indicated that appendectomy was ranked first for treatment success and least complications, followed by Beta-lactamase. CONCLUSIONS: Appendectomy is still the most effective treatment in uncomplicated appendicitis but it carries complications. Beta-lactamase, might be an alternative treatment if there are any contraindications for operation.

A cohort study of prognostic factors associated with recurrence or metastasis of gastrointestinal stromal tumor (GIST) of stomach.

BACKGROUND: Gastrointestinal stromal tumor (GIST) is the most common mesenchymal neoplasm of the gastrointestinal tract. The major risk factors of recurrence and metastasis are mitotic index and tumor size. This study investigates the risk of recurrence and metastasis in solely gastric GIST. The primary outcome is to evaluate risk of recurrence and metastasis. The secondary outcome is to analyse survival rates of patients who have recurrence and metastasis after curative resection. METHOD: A cohort of patients who underwent curative resection of gastric GIST between January 2006 to December 2016 was reviewed. The diagnosis was confirmed with positive CD34, DOG1 or KIT (CD117) immunohistochemistry. Risk factors of recurrence and metastasis were analyzed. RESULTS: Sixty-eight patients who received curative resection and diagnosed as gastric GIST were included in this study. Twenty (29.41%) had recurrence or metastasis. The median follow up time was 31.95 months. The mostcommon type of surgery was partial gastric resection. There were statistically-significant differences between mitotic index 6 HPF or 6 HPF in tumor size 0-5 cm, 5-10 cm and 10 cm and the risk of recurrence or metastasis (p-value 0.036). In tumors sized 6-10 cm, patients with mitotic index 6 HPF had longer survival than patients with mitotic index 6 HPF (p-value 0.0147). CONCLUSION: The factor that determines the outcome of recurrence or metastasis in solely gastric GIST is high mitotic index count. Patients who have abdominal pain may be suspected as advanced disease. The type of operation and tumor size are not associated with recurrence or metastasis.

Prognostic significance of microvessel density in breast cancer of Thai women.

OBJECTIVE: Angiogenesis is important in the process of tumor growth and progression of breast cancer Microvessel density (MVD) is the most commonly used technique to quantify intratumoral angiogenesis in breast cancer. In the present study, the authors investigated the prognostic indicator of intratumoral MVD in predicting overall survival, disease recurrence, and distance metastasis of breast cancer. MATERIAL AND METHOD: Two hundred patients who were diagnosed as invasive breast cancer from January 2000 to December 2004 were included in the present study, but only 64 patients had complete pathological specimens and tumor receptor studies. Representative paraffin sections of the primary tumor including the tumor border were immunostained with a monoclonal anti-CD34 antibody. The area of highest vascular density ("hot spot") was identified and the average count of three hot spots in each tumor was used for analyses. The distribution of MVD was categorized into high and low MVD as more than 76 and less than 76 respectively. Overall survival probability was estimated by the Kaplan-Meier method. A multivariate Cox regression was employed to examine the relationship between MVD and disease outcomes while adjusting for other concomitant variables. RESULT: The tumor size and more advanced disease have correlated with poor outcomes of invasive breast cancer. Tumor size is a poor predictor for local recurrence [Harzard ratio 1.02 (95% CI 0.99-1.04)] and more disease staging have correlated with distance metastases [Harzard ratio 1.48 (95% CI 0.98-2.24)]. The cancer staging only predicted poor outcome in invasive breast cancer in overall recurrence [Harzard ratio 1.51 (95% CI 1.05-2.16)]. MVD is not correlated with both tumor recurrence and distance metastases [Hazard ratio for local recurrence 1.01 (95% CI 0.99-1.04) and Harzard ratio 1.00 (95% CI 0.97-1.02)]. CONCLUSION: The microvessel density (MVD) has not predicted poor outcomes of invasive breast cancer in Thai woman.

Colonic detoxification among patients attending general surgical clinics: an epidemiological study.

BACKGROUND: Colonic detoxification is a popular form of "alternative medicine". OBJECTIVE: To study the epidemiology of colonic detoxification in general surgical outpatients. MATERIAL AND METHOD: Questionnaires consisting of items measuring demographic variables, methods and resources of colonic detoxification, factors associated with the preference to undergo colonic detoxification, and results of colonic detoxification were administered to general surgical outpatients. Patients were classified as having colorectal and non-colorectal conditions. RESULTS: One thousand nine hundred and thirty nine questionnaires were distributed and returned Ninety-one patients (4.7%) had colonic detoxification. More female patients performed colonic detoxification than male patients (83.5% vs. 16.5%). The mean age of patients who performed colonic detoxification was 50.0 +/- 11.3 years (range 22-71 years). Coffee was the most commonly used substance for colonic detoxification (90.1%). The majority of patients performed the procedures by themselves (73.6%). The frequency of procedures was 1-5 times per month in 26.4% of patients. Seventy eight percent of patients felt better, while 17.6% felt the same and 4.4% felt worse after the procedure. The patients who performed colonic detoxification had more colorectal problems than those who did not; the risk ratio was 1.35 (95% CI, 0.82 to 2.22), but this was not statistically significant (p = 0.241). In subgroup analysis, cancer was the significant preferential factor in patients who performed colonic detoxification (risk ratio = 1.55 (95% CI, 1.13-2.14), and p-value = 0.011). The complication rate of colonic detoxification was 2.19% (rectal bleeding). CONCLUSION: The presented article was the first study of colonic detoxification in a Thai population. The result of the present study suggests that colorectal conditions are not related to the performance of colonic detoxification.

Clinical results of biologic prosthesis: A systematic review and meta-analysis of comparative studies.

BACKGROUND: Biologic prosthesis (BP) has been reported as a safe alternative to polytetrafluoroethylene (PTFE) in vascular reconstruction. However, efficacy of BP remains controversial. We, therefore, conducted a systematic review to summarize previous available evidences comparing the BP and PTFE in terms of clinical outcomes. MATERIALS AND METHODS: A literature search of the MEDLINE and Scopus was performed to identify comparative studies reporting outcomes of BP, PTFE, and/or autologous veins graft (VG) in vascular access for hemodialysis or femoropopliteal bypass. The outcome of interest was graft patency. Two reviewers independently extracted data. Meta-analysis with a random-effect model was applied to pool a risk ratio (RR) across studies. RESULTS: Among 584 articles identified, 11 studies (4 randomized controlled trials (RCT) and 7 cohorts) comprising 2627 patients were eligible for pooling. Seven studies compared BP with PTFE and 3 studies compared PTFE with VG. Among BP vs PTFE, pooling based on 3 RCTs yielded the pooled RR of 1.54 (95% CI: 1.10, 2.16), indicating 54% higher graft patency in VG than PTFE. Adding the 7 cohorts in this pooling yield similar results with the pooled RR of 1.29 (95% CI: 1.15, 1.45). The pooled RR of graft patency for BP vs VG was 0.74 (95% CI, 0.55, 1.00), indicating 26% lower graft patency in BP than VG. CONCLUSIONS: Our first meta-analysis indicated that the biosynthetic prosthesis might be benefit over PTFE by increasing graft patency. An updated meta-analysis or a large scale randomized control trial is required to confirm this benefit.

Quality of life after great saphenous vein ablation in Thai patients with great saphenous vein reflux.

BACKGROUND/OBJECTIVE: To determine the quality of life (QoL) in Thais after intervention for great saphenous vein (GSV) reflux. METHODS: Patients with Clinical Etiologic Anatomic Pathophysiologic classes 2 and 3 were enrolled in this study. QoL was measured using the EuroQol descriptive system (EQ-5D) questionnaire, and patients chose to receive either endovenous treatment or surgery after consulting with their surgeons. The QoL before the intervention, at 1 week, and at 1 month after the intervention were evaluated. Patients who reported "no problem" in each domain of the EQ-5D questionnaire before and 1 month after the intervention were compared. Utility gain was estimated from the questionnaire and compared between clinical classes. The proportion of worsening QoL at 1 week after the intervention was compared between patients receiving endovenous procedures and surgery. RESULTS: A total of 83 patients-56 received endovenous procedures [23 received ultrasound-guided foam sclerotherapy (UGFS) and 33 received radiofrequency ablation (RFA)] and 27 received surgery-were enrolled. QoLs were significantly better in all domains after the intervention: pain/discomfort (58%), mobility (42%), anxiety/depression (38%), usual activities (19%), and self-care (9%). Utility gain was 0.255 (95% confidence interval: 0.197-0.313) and higher in class 3. At 1 week after the intervention, surgery had significantly higher patients with worse mobility scores. Among endovenous procedures, UGFS had higher patients with worse pain/discomfort scores than RFA at 1 week after the intervention (16% vs. 0%, p = 0.025). CONCLUSION: GSV ablation for GSV reflux in Thai patients with CEAP C2 and C3 categories significantly improves both physical and mental QoL; patients who received endovenous procedures were found to have better early physical QoL.

Developing and validating of Ramathibodi Appendicitis Score (RAMA-AS) for diagnosis of appendicitis in suspected appendicitis patients.

Background: Diagnosis of appendicitis is still clinically challenging where resources are limited. The purpose of this study was to develop and externally validate Ramathibodi Appendicitis Score (RAMA-AS) in aiding diagnosis of appendicitis. Methods: A two-phase cross-sectional study (i.e., derivation and validation) was conducted at Ramathibodi Hospital (for derivation) and at Thammasat University Hospital and Chaiyaphum Hospital (for validation). Patients with abdominal pain and suspected of having appendicitis were enrolled. Multiple logistic regression was applied to develop a parsimonious model. Calibration and discrimination performances were assessed. In addition, our RAMA-AS was compared with Alvarado's score performances using ROC curve analysis. Results: The RAMA-AS consisted of three domains with seven predictors including symptoms (i.e., progression of pain, aggravation of pain, and migration of pain), signs (i.e., fever and rebound tenderness), and laboratory tests (i.e., white blood cell count (WBC) and neutrophil). The model fitted well with data, and it performed better discrimination than the Alvarado score with C-statistics of 0.842 (95% CI 0.804, 0.881) versus 0.760 (0.710, 0.810). Internal validation by bootstrap yielded Sommer's D of 0.686 (0.608, 0.763) and C-statistics of 0.848 (0.846, 0.849). The C-statistics of two external validations were 0.853 (0.791, 0.915) and 0.813 (0.736, 0.892) with fair calibrations. Conclusion: RAMA-AS should be a useful tool for aiding diagnosis of appendicitis with good calibration and discrimination performances.

Comparative study of tailor-made mesh plug herniorrhaphy versus Lichtenstein herniorrhaphy versus Bassini operation: a prospective clinical trial.

OBJECTIVE: Operations to cure inguinal hernia are among the most common surgical procedures. However, the most effective surgical technique for inguinal hernia repair is unknown, and the recurrence at 5 years varies between 1% and 10%. Surgical techniques and implanted materials are crucial to the result of and costs associated with hernia repair. The objective of this study was to determine whether the tailor-made mesh plug for inguinal hernia repair was as effective and safe as other methods of herniorrhaphy. METHODS: Of 94 patients who had a primary diagnosis of inguinal hernia prospectively included in the study, 25 were treated with tailor-made mesh plug herniorrhaphy, 26 with Lichtenstein herniorrhaphy and 36 with the Bassini operation. The primary outcome was the recurrence of hernia at 1 year, and secondary outcomes included surgical complications and hospital stay. RESULTS: There was no postoperative mortality in this study. Three patients had recurrence after Bassini operation, but there was no recurrent hernia after Lichtenstein or mesh plug herniorrhaphy. Groin swelling and ecchymosis were found in two patients (1 tailor-made mesh plug, 1 Lichtenstein herniorrhaphy). No surgical site infection occurred. Mean operating time was 60 minutes (range, 45-75 minutes) for tailor-made mesh plug herniorrhaphy, 82 minutes (range, 30-120 minutes) for Lichtenstein herniorrhaphy, and 82 minutes (range, 30-135 minutes) for the Bassini operation. CONCLUSION: Tailor-made mesh plug herniorrhaphy is a safe operation. The mesh plug material (Mersilene) was cheap. The recurrence rate was lower with tailor-made mesh plug herniorrhaphy than with the Bassini operation, but equal to that with Lichtenstein herniorrhaphy. Postoperative complications did not differ among all operations.