Assessment of Three Distinct Approaches to Postoperative Pain in Laparoscopic Inguinal Hernia Repair, a Randomized Prospective Study.

Background: Contemporarily, transabdominal preperitoneal repair (TAPP) procedure in inguinal hernia treatment is counted among the routine minimal invasive general surgery practices. Increased patient's comfort, namely less postoperative pain, is considered to be its greatest advantage. However, pain following surgery can still be an important problem. Port site local anesthetic injection (PSLAI), iliohypogastric-/ilioinguinal nerve block (IINB), and preperitoneal local anesthetic spraying (PLAS) are relatively new techniques with sparse data to address this issue. Therefore, we conducted this prospective study to evaluate these three methods in patients who underwent TAPP for inguinal hernia repair. Methods: A total of 99 patients were enrolled and randomized equally into three groups. Every patient received a patient-controlled analgesia (PCA) device. PCA usage, total analgesic demands, and numerical rating scale values were recorded at 2, 6, 12, and 24 hours postoperatively (p.o). Results: Patients' demographic data (age, gender, BMI) did not reveal any significant difference between groups (P > .05). Procedure duration was found to be significantly longer in IINB group compared with others (p < .05). Number of PCA usages, total analgesic demand, additional analgesic requirement did not differ significantly between groups at 24-hour p.o (P > .05). PLAS group was found to have less average NSR score compared with other groups at 24 hours p.o (p < .05). Conclusions: All three procedures show promising outcomes with PLAS technique appearing to be slightly superior in terms of pain management in the immediate postoperative period. However, to reach a conclusion more randomized controlled trials covering various aspects and techniques of minimal invasive approach to inguinal hernia repair should be published.

Clinicopathological outcomes of microsatellite instability in colorectal cancer.

AIMS: This study aims to evaluate the histopathological features and prognostic parameters of tumors with microsatellite instability (MSI) compared with those without MSI in patients who underwent surgery for colorectal cancer (CRC). SETTING AND DESIGN: Follow-up for CRC at Istanbul Sultan 2. Abdulhamid Han Training and Research Hospital was retrospectively evaluated between March 2017 and March 2021. METHODS AND MATERIAL: The patients were divided into two groups: those with and without MSI. Groups were compared in survival parameters. As a secondary result, groups were compared in pathological parameters such as stage, tumor diameter, degree of differentiation, and lymphovascular, and perineural invasion. STATISTICAL ANALYSIS USED: Survival calculations were performed using the Kaplan-Meier analysis method. The effects of various prognostic factors related to tumor and patient characteristics on disease-free and overall survival (OS) were investigated by log-rank test. RESULTS: Two hundred fourteen patients were analyzed. The median age of the patients was 66 (30-89), and 59.3% (n = 127) were male. There were 25 patients in the MSI group and 189 patients in the non-MSI group. We found that MSI tumors had a significantly higher differentiation degree than non-MSI tumors and larger tumor diameters. MSI tumors frequently settled in the proximal colon, and more lymph nodes were removed in the resection material. MSI tumors had longer disease-free survival, cancer-specific survival, and overall survival. CONCLUSIONS: By diagnosing microsatellite instability, CRCs can be divided into two groups. The histopathological features of the tumor and the prognosis of the disease differ between these groups. MSI can be a predictive marker in the patient's follow-up and treatment.

Nonspecific low back pain in a group of young adult men.

AIM: Low back pain (LBP) is a common symptom that causes enormous social, psychological, and economical problems. We studied LBP occurrence in a group of young adults referred to an army hospital for a planned health check and evaluated possible causative factors by prospective questionnaires. MATERIAL AND METHODS: This article is based on a prospective study of 871 novice soldiers of the Turkish Army. Studied factors were combined in the form, which was filled by 5 doctors on the basis of self-reports, interview and physical examination of the participants. They were evaluated by factors; low back pain episodes, monthly income, smoking habits, BMI, labor conditions, and educational status. RESULTS: The median age of the studied population was 21.14±1.4. Complains regarding LBP were observed in 325 (37%) of participants. Twelve participants had pain episodes up to 10 points. 83.69% of the participants with LBP had psychological problems. Heavy lifting and driving for long periods were determined as serious risk factors. CONCLUSION: Determining the impact factors of LBP in primary care groups can help to prevent development of more serious problems.