Recurrence Factors of Groin Hernia: a systematic Review.

BACKGROUND: Groin hernia repair is a common intervention and reoperation rate for recurrence reachs 15%. Recurrence can be attributed to patients related factors  or influenced by the surgical technique. Furthermore, treating recurrence can be challenging with the risk ratio of developing a second recurrence equal to 2,7. Identifying those factors is the first step to improve hernia repair results. AIM: This systematic review aimed to identify  recurrence risk factors of groin hernia and to determine adequate treatment for recurrence. METHODS: We conducted a literature search on the Pubmed and Cochrane databases. Keywords used were: "inguinal hernia", "groin hernia", "recurrence" and  "surgical repair". Were included meta-analyses,  systematic reviews, randomized and non-randomized clinical trials, from 2008 to 2017, with their available  english full text which methodoly was evaluated. RESULTS: We identified 67 articles. Twenty-four articles were not eligible. Three articles were not available in full-text. We analyzed 40 articles. After evaluation of the methodology, six articles were excluded: these were randomized trials with a Jadad score inferior to 3. We finally selected 34 articles. The qualitative analysis of the literature revealed that heredity, female gender, obesity and smoking were general recurrence factors of groin hernia  with a level 2 of evidence. Non mesh-repair and « TEP ¼ approach for unilateral inguinal hernia favor groin hernia recurrence with a level 1 of evidence. Nor the surgical approach (laparoscopic, open), nor the mesh type, nor its fixation does affect recurrence with a level 1 of evidence. In treating  groin hernia recurrence, the inverted approach (anterior-posterior and posterior-anterior) recommended in the guidelines is questionable. CONCLUSION: This systematic review allowed us to recommand weigh loss and smoking cessation for patients undergoing groin hernia surgery. As concerns groin hernia recurrence treatment, the inverted approach (anterior-posterior and posterior-anterior) recommended in the guidelines is questionable. The choice of the adequate technique depends on the primary repair and also includes the surgeon preferences.

Predictive factor of recurrence after curative resection for stage I-II colon cancer.

BACKGROUND: Colon cancer has become a common malignant neoplasm in Tunisia. Patients with negative lymph node have a 5 years recurrence rate of 21.1%. Studies reporting the prognostic factors of recurrence for patients with stage I-II colon cancer are limited. AIM: This study aimed to determine factors predicting recurrence for patients with stage I-II colon cancer after curative resection. METHODS: This was a retrospective cohort study. Were included patients who underwent curative surgery for stage I or II colon cancer. Enrolled variables were subdivided into: Pre-operative, Intraoperative and Post-operative variables. Main outcome measures were local recurrence and distant metastasis detected during follow-up. RESULTS: Eighteen men and 17 women with median age of 61 years, ranging from 33 to 89, were enrolled in this study. Twenty-eight patients out of 35 were classified T3 and T4 colon cancer. The mean number of lymph nodes harvested was 16.23 (median= 17; range: 4-44). Ten patients (28%) had colloid component in the tumor. At a median follow-up of 23 months (range: 6-56 months), recurrence was observed in five cases (14%). Variables associated to recurrence were Carcinoembryonic antigen level (p= 0.03), serum albumin level (p=0.029) and the presence of colloid component (0.02). Multivariate logistic regression retained colloid component as the only predictive factor of recurrence (OR=1.2, 95%CI [1.019-1.412], p=0.028). CONCLUSIONS: This study showed that the percentage of mucinous component equal or greater than 25% was the only predictive factor of recurrence for curatively resected, stages I and II, colon cancer.

Laparoscopic Versus Open Complete Mesocolon Excision in Right Colon Cancer: A Systematic Review and Meta-Analysis.

BACKGROUND: Laparoscopic complete mesocolon excision (LCME) for right colonic cancer improves oncological outcomes. This systematic review and meta-analysis aimed to compare intraoperative, postoperative, and oncological outcomes after LCME and open total mesocolon excision (OCME) for right-sided colonic cancers. METHODS: Literature searches of electronic databases and manual searches up to January 31, 2019, were performed. Random-effects meta-analysis model was used. Review Manager Version 5.3 was used for pooled estimates. RESULTS: After screening 1334 articles, 10 articles with a total of 2778 patients were eligible for inclusion. Compared to OCME, LCME improves results in terms of overall morbidity (OR = 1.48, 95% CI 1.21 to 1.80, p = 0.0001), blood loss (MD = 56.56, 95% CI 19.05 to 94.06, p = 0.003), hospital stay (MD = 2.18 day, 95% CI 0.54 to 3.83, p = 0.009), and local (OR = 2.12, 95% CI 1.09 to 4.12, p = 0.03) and distant recurrence (OR = 1.63, 95% CI 1.23-2.16, p = 0.0008). There was no significant difference regarding mortality, anastomosis leakage, number of harvested lymph nodes, and 3-year disease-free survival. Open approach was significantly better than laparoscopy in terms of operative time (MD = - 34.76 min, 95% CI - 46.01 to - 23.50, p < 0.00001) and chyle leakage (OR = 0.41, 95% CI 0.18 to 0.96, p = 0.04). CONCLUSIONS: This meta-analysis suggests that LCME in right colon cancer surgery is superior to OCME in terms of overall morbidity, blood loss, hospital stay, and local and distant recurrence with a moderate grade of recommendation due to the retrospective nature of the included studies.

Mini-Invasive management of concomitant gallstones and common bile duct stones : where is the evidence ( Review article).

BACKGROUND: The ideal mini-invasive management of common bile duct stones (CBDS) with concomitant gallbladder stones is debatable. This article aims to review the management of this condition during the last decade using the mini-invasive approach. METHODS: A database research in Medline, Embase, Cochrane and Google Scholar during the period between January 2009 to December 2018 was performed. The keywords used were «ERCP¼, «common bile duct exploration¼, «endoscopic sphincterotomy¼, «laparoscopic surgery¼, «laparoscopic cholecystectomy¼, «choledocholithiasis¼, «common bile duct stones¼ «meta-analysis¼ and «randomized clinical trials¼. RESULTS: There were 14 studies comparing mini-invasive procedures. There were nine meta-analysis, three reviews articles and two randomized clinical trials. We concluded to the absence of difference between the group laparoscopic cholecystectomy (LC) with a laparoscopic exploration of CBD (LECBD) and LC with endoscopic retrograde cholangiopancreatography (ERCP) in terms of mortality, morbidity, stones extraction success rate and duration of hospital stay. LC + ERCP is superior in terms of conversion and treatment cost. Concerning LC with a preoperative ERCP versus LC with postoperative ERCP, based on the literature data, no conclusions could be drawn. Concerning LC with LECBD versus LC with preoperative ERCP, we conclude to the absence of difference in terms of mortality, morbidity and conversion rate. Given the discordance of the results, in terms of successful extraction rate of stones, operating time and duration of hospital stay we cannot conclude to the superiority of one technique. Concerning LC with LECBD versus LC with postoperative ERCP, we conclude the absence of difference in terms of mortality, morbidity, the success rate of stones extraction, duration of hospital stays and conversion rate. Concerning LC with intraoperative ERCP versus LC with preoperative ERCP, we concluded to the absence of difference in terms of mortality, morbidity and rate of success stones extraction. The LC + intraoperative ERCP was superior in terms of hospital stay duration and conversion rate. Concerning one-stage versus two-stage treatment, we concluded to the absence of difference in terms of mortality, morbidity, the success rate of stone extraction, the conversion rate and the duration of hospital stay. CONCLUSIONS: One-stage or two-stages procedures are feasible and safe with equivalent efficacy. Surgeons must be aware of the different difficulties of these procedures and should be judicious in their use of different techniques.