Human visceral adipose tissue microvascular endothelial cell isolation and establishment of co-culture with white adipocytes to analyze cell-cell communication.

Communication between adipocytes and endothelial cells (EC) is suggested to play an important role in the metabolic function of white adipose tissue. In order to generate tools to investigate in detail the physiology and communication of EC and adipocytes, a method for isolation of adipose microvascular EC from visceral adipose tissue (VAT) biopsies of subjects with obesity was developed. Moreover, mature white adipocytes were isolated from the VAT biopsies by a method adapted from a previously published Membrane aggregate adipocytes culture (MAAC) protocol. The identity and functionality of the cultivated and isolated adipose microvascular EC (AMvEC) was validated by imaging their morphology, analyses of mRNA expression, fluorescence activated cell sorting (FACS), immunostaining, low-density lipoprotein (LDL) uptake, and in vitro angiogenesis assays. Finally, we established a new trans filter co-culture system (membrane aggregate adipocyte and endothelial co-culture, MAAECC) for the analysis of communication between the two cell types. EC-adipocyte communication in this system was validated by omics analyses, revealing several altered proteins belonging to pathways such as metabolism, intracellular transport and signal transduction in adipocytes co-cultured with AMvEC. In reverse experiments, induction of several pathways including endothelial development and functions was found in AMvEC co-cultured with adipocytes. In conclusion, we developed a robust method to isolate EC from small quantities of human VAT. Furthermore, the MAAECC system established during the study enables one to study the communication between primary white adipocytes and EC or vice-versa and could also be employed for drug screening.

One-year outcome after open inguinal hernia repair with self-fixated mesh: a randomized controlled trial.

PURPOSE: The aim of this study was to analyze pain after surgery with the use of self-fixated meshes, which are commonly used as an alternative for sutured mesh in open inguinal hernia repair. METHODS: This prospective randomized clinical trial was conducted from November 2018 to March 2021, with a follow-up duration of 12 months. Male patients, aged 18-85, and suitable for day case surgery, were included. The patients received the self-adhesive Adhesix™ mesh or the self-gripping Progrip™ mesh in open inguinal hernia surgery. The primary outcome was the number of additional follow-up visits due to post-operative pain. Secondary outcomes included intensity of pain, quality of life measures, and complications. RESULTS: Two hundred seventy patients were included in this trial, 132 with Adhesix™ (A group), and 138 with Progrip™ (P-group). All patients' medical records were reviewed 12 months after surgery, and 207 patients (76.2%) completed 12-month follow-up. The number of patients needing additional follow-up visits 3-12 months after surgery were comparable (A group 3/3.0%, P-group 6/5.6%). The numeric rating scale was low at 12 months after surgery (at rest A 0.21, P 0.34, at exercise A 0.78, P 0.90). The incidence of chronic pain, that is moderate or severe pain during exercise, was 5 patients (5.2%) with Adhesix™ and 8 patients (7.4%) with Progrip™ (P = 0.333). Two hernia recurrences (1.0%) were established, one in each group. CONCLUSION: At 1 year after hernia surgery, the use of self-gripping and self-adhesive meshes lead to successful pain reduction and quality of life improvement. CLINICALTRIALS: com NCT03734224.

The critical view of safety and bile duct injuries in laparoscopic cholecystectomy: a photo evaluation study on 1532 patients.

BACKGROUND: Laparoscopic cholecystectomy (LCC) carries a 0.3-1.8% risk of bile duct injury (BDI). This study investigated if intraoperative photo documentation of the critical view of safety (CVS) is related to lower rates of BDIs and postoperative complications in LCC. METHODS: Surgeons were instructed to take photos of the view before clipping the cystic duct and artery. Two independent raters scored the photos 0-6 using predefined criteria for CVS. Mean scores of ≥4.5 were satisfactory. RESULTS: The study consisted of 1532 patients undergoing LCC between April 2018 and October 2019. CVS was satisfactory in 354 (23.1%), unsatisfactory in 823 (53.7%), and photos were missing in 355 (23.2%) patients. Patients with satisfactory CVS had the lowest BDI rate compared with unsatisfactory CVS or missing photos (0.3% vs. 1.0% vs. 2.3%, p = 0.012). Four major BDIs (Strasberg D-E) occurred, but none in patients with satisfactory CVS. Patients with satisfactory CVS had the lowest postoperative complication rate compared with patients with unsatisfactory CVS or without photos (4.8% vs. 7.9 vs. 9.9%, p = 0.011). Of patients with acute cholecystitis, 15.7% had satisfactory CVS, whereas 26.8% without cholecystitis had satisfactory CVS (p < 0.001). CONCLUSION: Intraoperative photo documentation of satisfactory CVS is associated with lower rates of BDIs and complications.

Three-dimensional versus two-dimensional high-definition laparoscopy in transabdominal preperitoneal inguinal hernia repair: a prospective randomized controlled study.

BACKGROUND: Three-dimensional (3D) laparoscopy improves technical efficacy in laboratory environment, but evidence for clinical benefit is lacking. The aim of this study was to determine whether the 3D laparoscopy is beneficial in transabdominal preperitoneal laparoscopic inguinal hernia repair (TAPP). METHOD: In this prospective, single-blinded, single-center, superior randomized trial, patients scheduled for TAPP were randomly allocated to either 3D or two-dimensional (2D) TAPP laparoscopic approaches. Patients were excluded if secondary operation was planned, the risk of conversion was high, or the surgeon had less than five previous 3D laparoscopic procedures. Patients were operated on by 13 residents and 3 attendings. The primary endpoint was operation time. The study was registered in ClinicalTrials.gov (NCT02367573). RESULTS: Total 278 patients were randomized between 5th February 2015 and 23rd October 2017. Median operation time was shorter in the 3D group (56.0 min vs. 68.0 min, p < 0.001). 10 (8%) patients in 3D group and 6 (5%) patients in 2D group had clinically significant complications (Clavien-Dindo 2 or higher) (p = 0.440). Rate of hernia recurrence was similar between groups at 1-year follow-up. In the subgroup analyses, operation time was shorter in 3D laparoscopy among attendings, residents, female surgeons, surgeons with perfect stereovision, surgeons with > 50 3D laparoscopic procedures, surgeons with any experience in TAPP, patients with body mass indices < 30, and bilateral inguinal hernia repairs. CONCLUSION: 3D laparoscopy is beneficial and shortens operation time but does not affect safety or long-term outcomes of TAPP.

Three-dimensional versus two-dimensional high-definition laparoscopy in cholecystectomy: a prospective randomized controlled study.

BACKGROUND: While 3D laparoscopy increases surgical performance under laboratory conditions, it is unclear whether it improves outcomes in real clinical scenarios. The aim of this trial was to determine whether the 3D laparoscopy can enhance surgical efficacy in laparoscopic cholecystectomy (LCC). METHOD: This prospective randomized controlled study was conducted between February 2015 and April 2017 in a day case unit of an academic teaching hospital. Patients scheduled for elective LCC were assessed for eligibility. The exclusion criteria were: (1) planned secondary operation in addition to LCC, (2) predicted to be high-risk for conversion, and (3) surgeons with less than five previous 3D laparoscopic procedures. Patients were operated on by 12 residents and 3 attendings. The primary endpoint was operation time. All surgeons were tested for stereoaquity (Randot® stereotest). The study was registered in ClinicalTrials.gov (NCT02357589). RESULTS: A total of 210 patients were randomized; 105 to 3D laparoscopy and 104 to 2D laparoscopy. Median operation time as similar in the 3D and 2D laparoscopy groups (49 min vs. 48 min, p = 0.703). Operation times were similar in subgroup analyses for surgeon's sex (male vs. female), surgeon's status (resident vs. attending), surgeon's stereovision (stereopsis 10 vs. less than 10), surgeon's experience (performed 200 LCCs or below versus over 200 LCCs), or patient's BMI (≤ 25 vs. 25-30 vs. > 30). No differences in intra- or postoperative complications were noted between the 3D and 2D groups. CONCLUSION: 3D laparoscopy did not show any advantages over 2D laparoscopy in LCC.

Improvement in the quality of life following cholecystectomy: a randomized multicenter study of health status (RAND-36) in patients with laparoscopic cholecystectomy versus minilaparotomy cholecystectomy.

PURPOSE: The assessment of the quality of life (QoL) in minilaparotomy cholecystectomy (MC) versus laparoscopic cholecystectomy (LC) with the ultrasonic dissection in both groups has not been addressed earlier. METHODS: Initially, 109 patients with non-complicated symptomatic gallstone disease were randomized to undergo either MC (n = 59) or LC (n = 50). RAND-36 survey was conducted preoperatively and at 4 weeks and 6 months postoperatively. The end point of our study was to determine differences in health status in MC versus LC groups. RESULTS: QoL improved significantly in both groups, and the recovery was similar in the two groups, except from the higher score in 'health change' subscale at 4 weeks in MC group [MC score 75.0 (25.0) vs. LC score 56.5 (23.2), p = 0.008]. The MC and LC groups combined, RAND-36 scores increased significantly in 'physical functioning' [combined mean (SD) preoperative score 80.5 (23.9) vs. 6-month postoperative score 86.5 (21.7), p = 0.015], 'vitality' [64.5 (19.2) vs. 73.5 (18.3), p = 0.001], 'health change' [43.0 (21.6) vs. 74.6 (25.4), p = 0.0001] and 'bodily pain' scores [57.7 (26.3) vs. 75.5 (25.5), p = 0.001], respectively. Four RAND-36 domains indicated statistically significant health status differences in comparing the preoperative and postoperative RAND-36 scores in LC and MC groups combined. CONCLUSIONS: Four RAND-36 domains indicated a significant positive change in QoL after cholecystectomy.

A randomized multicenter study of minilaparotomy cholecystectomy versus laparoscopic cholecystectomy with ultrasonic dissection in both groups.

OBJECTIVE: Ultrasonic dissection (UsD) has been used in laparoscopic cholecystectomy (LC), though it is not the golden standard technique. Applying UsD to cholecystectomy by minilaparotomy (MC) is less common and there are no prospective randomized trials comparing these two techniques. Therefore, we conducted the present study to investigate the use of the UsD in the MC versus the LC procedure. MATERIAL AND METHODS: Initially 104 patients with non-complicated symptomatic gallstone disease were randomized into MC (n = 53) or LC (n = 51) groups, both groups using UsD, over a period of 2 years (2013-2015). The study groups were similar in terms of age and American Society of Anesthesiologists (ASA) physical status score. RESULTS: The demographic variables and the surgical data were similar in the study groups. Similar low postoperative pain scores were reported in the two study groups during the first four hours after surgery. The incidence of nausea/vomiting was similar between the two study groups, 47% in the MC group versus 42% in the LC group. However, the patients in the MC group were treated more frequently with antiemetics, the incidence being 39% in the MC group versus 21% in the LC group (p = 0.02). The pain at rest at 24h after the surgery was similar in the two study groups, but the LC patients reported less pain at the normal activity, the mean of numerical rating scale (NRS) of 0-10 score being 3.9 in the MC group versus 2.9 in the LC group (p = 0.05), and the pain at the quick movement/coughing, the mean NRS being 4.9 in the MC group versus 3.2 in the LC group (p = 0.005). The length of sick leave was 17.4 days in the MC group and 14.4 days in the LC group (p = 0.05). CONCLUSION: Our results suggest that both MC and LC are feasible and safe options for mini-invasive cholecystectomy. A new finding with clinical relevance in the present work is a relatively similar short-term outcome in the MC and LC although the LC patients reported significantly lower pain score 24 hours postoperatively and a shorter convalescence.

The plasma 8-OHdG levels and oxidative stress following cholecystectomy: a randomised multicentre study of patients with minilaparotomy cholecystectomy versus laparoscopic cholecystectomy.

OBJECTIVE: The aim of the study was to evaluate the role of 8-OHdG (8-hydroxy-2'-deoxyguanosine) detecting oxidative stress response following cholecystectomy in a randomised multicentre study of patients with minilaparotomy cholecystectomy (MC) versus laparoscopic cholecystectomy (LC). METHODS: Initially, 106 patients with non-complicated symptomatic gallstone disease were randomised into MC (n = 56) or LC (n = 50) groups. Plasma levels of the oxidative stress marker 8-OHdG measured at three time points; before (PRE), immediately after (POP1) and 6 h after operation (POP2). RESULTS: The demographic variables and the surgical data were similar in the study groups. The plasma oxidative stress marker 8-OHdG concentrations following surgery in the MC versus LC patients were quite similar. There was no significant correlation between the individual values of the11-point numeric rating pain scale (NRS) versus the plasma 8-OHdG post-operatively in the MC and LC patients. However, there was a statistically significant correlation between the individual values of the plasma 8-OHdG (PRE) versus IL-10 (PRE) for the MC and LC patients (r = 0.214, p = 0.037). There was also a statistically significant correlation between the individual values of the plasma 8-OHdG (POP2) versus IL-1ß (POP2) for the MC and LC patients (r = 0.25, p = 0.01). CONCLUSION: Our results suggest that the oxidative stress marker 8-OHdG concentrations following surgery in MC versus LC patients were quite similar. A new finding with possible clinical relevance is a correlation between the individual plasma values of the 8-OHdG versus anti-inflammatory interleukin IL-10 and 8-OHdG versus IL-1ß (proinflammatory) in the MC and LC patients suggesting that inflammation and oxidative stress are related.

Inflammatory response to surgical trauma in patients with minilaparotomy cholecystectomy versus laparoscopic cholecystectomy: a randomised multicentre study.

OBJECTIVE: The aim of the study was to evaluate the inflammatory response to surgical trauma in minilaparotomy cholecystectomy (MC) compared to laparoscopic cholecystectomy (LC). Assessment of inflammatory response to surgical trauma in MC has not been addressed properly. Therefore, we investigated five interleukins (IL) and C-reactive protein (CRP) in MC versus LC group in a prospective randomised trial. METHODS: Initially, 106 patients with non-complicated symptomatic gallstone disease were randomised into MC (n = 56) or LC (n = 50) groups. Plasma levels of five interleukins (IL-1ß, IL-1ra, IL-6, IL-8, IL-10) and hs-CRP were measured at three time points; before operation (PRE), immediately after operation (POP1) and six hours after operation (POP2). The primary end-point of the study was to compare the plasma levels of five interleukins and CRP in LC versus MC group. RESULTS: The demographic variables and the surgical data were similar in the study groups. The patients in the MC group had higher elevation of the CRP mean values post-operatively (p = 0.01). However, the patients in the MC group had higher elevation of the IL-1ra mean values post-operatively, the mean pre-/post-operative IL-1ra values being 299/614 pg/ml in the MC group versus 379/439 pg/ml in the LC group (p = 0.003). There was no statistical significance in IL-6 mean values between the MC and LC groups pre- and post-operatively (POP1). However, the patients in the MC group had higher IL-6 mean values six hours post-operatively (POP2), the mean IL-6 values being 27.6 pg/ml in the MC group versus 14.8 pg/ml in the LC group (p = 0.037). In addition, the patients in the MC group had higher elevation of the IL-6 mean values post-operatively, the mean pre-/post-operative IL-6 values being 4.1/27.6 pg/ml in the MC group versus 3.8/14.8 pg/ml in the LC group (p = 0.04). There was no statistical significance in IL-8, IL-10, and IL-1ß mean values between the MC and LC groups pre- and post-operatively. CONCLUSION: Our results suggest that the inflammatory response in MC versus LC groups was similar based on the IL-8, IL-10, and IL-1ß values. A new finding with possible clinical relevance in the present work is higher relative elevation of the IL-1ra and IL-6 mean values post-operatively in the MC group.

A prospective, randomized multicenter study comparing conventional laparoscopic cholecystectomy versus minilaparotomy cholecystectomy with ultrasonic dissection as day surgery procedure--1-year outcome.

OBJECTIVE: The long-term outcome between laparoscopic cholecystectomy (LC) and minilaparotomy cholecystectomy (MC) with ultrasonic dissection (UsD) technique has not been compared in randomized trials. Therefore, we investigated the outcome after conventional LC and MC with UsD in 78 patients (ClinicalTrials.gov Identifier: NCT0172340). MATERIAL AND METHODS: Initially 88 patients with non-complicated symptomatic gallstone disease were randomized into MC (n = 44) or LC (n = 44) over a period of 2 years (2010-2012) and 78 of them (89%) were reached for a follow-up interview at 12 months after the surgery. RESULTS: Baseline parameters were similar in the two groups, and 1/44 MCs and 2/44 LCs were converted to open laparotomy. The prevalence of chronic post-surgical pain (CPSP) one year after the procedure was quite similar in the two groups: 3/36 (8%) in the MC group and 2/42 (5%) in the LC group (p = 0.502). Residual abdominal symptoms were common, but the proportion was similar in both groups (28% in MC and 33% in LC group, p = 0.665). Both groups were very satisfied with the cosmetic outcome (numeric rating scale, p = 0.470). The Quality of life (QoL) improved 34/36 (94%) in the MC group and 33/42 (79%) in the LC group (p = 0.046) and all patients in both groups were satisfied with the operation overall. CONCLUSION: Day-case MC and LC patients have a quite similar one-year outcome with no significant difference regarding residual abdominal symptoms, cosmetic satisfaction, QoL or CPSP.

A prospective, randomized study comparing minilaparotomy and laparoscopic cholecystectomy as a day-surgery procedure: 5-year outcome.

BACKGROUND: The long-term outcome between laparoscopic cholecystectomy (LC) and minilaparotomy (MC) has not been compared in randomised trials as day-surgery procedures. We therefore investigated the outcome after day-case LC and MC in 48 patients. METHODS: Initially 60 patients with noncomplicated symptomatic gallstone disease were randomly allocated to a day-case MC (n = 29) or LC (n = 31) over a period of 2 years (2006-2008), and 48 of them (80 %) were reached for a follow-up interview 5.8 (4.8-6.9) years after the surgery. RESULTS: Baseline parameters were similar in the two groups: 1 of 21 MCs and 2 of 27 LCs were converted to open laparotomy. The prevalence of chronic postsurgical pain (CPSP) 5 years after the procedure was quite similar in the two groups: 3 of 21 (14 %) in the MC group and 1 of 27 (4 %; p = 0.2). Residual abdominal symptoms were common, but the proportion was similar in both groups (43 % in MC and 30 % in LC group, p = 0.26). In the MC group 100 % and in the LC group 89 % (18/21) were satisfied with the cosmetic outcome (p = 0.11). Quality of life (QoL) improved for 16 of 21 (76 %) in the MC group and 26 of 27 (96 %) in the LC group (p = 0.38), and patients in both groups were satisfied with the operation overall. CONCLUSIONS: Day-case MC and LC patients have a quite similar long-term outcome with no significant difference regarding residual abdominal symptoms, cosmetic satisfaction, QoL, or CPSP.

Minilaparotomy cholecystectomy with ultrasonic dissection versus conventional laparoscopic cholecystectomy: a randomized multicenter study.

OBJECTIVE: Cholecystectomy by minilaparotomy (MC) or by laparoscopy (LC) has been shown to have equal results of both early and late recovery. Although, the ultrasonic dissection (UsD) technique has seen used in LC, the technique is rarely used in MC. MATERIAL AND METHODS: Initially, 88 patients with uncomplicated symptomatic gallstones were randomized into MC with UsD (n = 44) or conventional LC (n = 44) over a 2-year period (2010-2012). The two groups were similar in terms of age and American Society of Anesthesiologists (ASA) physical status score. Results. Both groups were similar in terms of the operative time and the time in the operation theatre, the success of day-surgery and satisfaction with the procedure. The MC group had significantly less postoperative pain than the LC group, p = 0.002, and the MC group used less analgesics doses during the first 24 h: 2.8 (1.2) doses vs. 3.8 (1.4) doses, p = 0.003. The convalescence needed was 3 days shorter in the MC group, 7 (3) days, than that in the LC-group, 10 (8) days, p = 0.024. In the MC group 4 patients and in the LC group 11 (p = 0.046) required more than 14 days of sick leave. In the MC group there was one and in the LC group two conversions to open surgery. CONCLUSION: The patients in the MC group had less early postoperative pain and had a shorter convalescence than the patients in the LC group.

Ten-year outcome after minilaparotomy versus laparoscopic cholecystectomy: a prospective randomised trial.

BACKGROUND: Laparoscopic cholecystectomy (LC) and minilaparotomy cholecystectomy (MC) are the two most commonly performed mini-invasive surgical techniques for the treatment of symptomatic gallstone disease, but the long-term outcome after these two procedures has not been compared in prospective clinical trials. We therefore investigated the outcome after LC and MC in 127 patients operated at Kuopio University Hospital. PATIENTS AND METHODS: Initially 157 patients with uncomplicated symptomatic gallstones were randomised to MC (n = 85) or LC (n = 72) over a 5-year period (1998-2004), and 127 of them (81 %), 69/85 with MC and 58/72 with LC, were reached for a follow-up interview 10.5 (7.3-13.6) years after the surgery. RESULTS: Baseline and surgical parameters were similar in the two groups; 3/69 MCs and 2/58 LCs were converted to open laparotomy. The prevalence of chronic post-surgical pain 10 years after procedure was similar in the two groups: 5/69 (7 %) in the MC group and 1/58 (2 %) in the LC group (p = 0.14). Residual abdominal symptoms were common, but less frequent in the MC group (14/69; 20 %) than in the LC group (21/58 patients; 36 %) (p = 0.039). In the MC group 63/69 (91 %) and 57/58 (98 %) in the LC group (p = 0.059) were satisfied with the cosmetic outcome. CONCLUSION: Our results suggest a relatively similar long-term outcome after MC and LC.

The Critical View of Safety in Laparoscopic Cholecystectomy: User Trends Among Residents and Consultants.

BACKGROUND: The Critical View of Safety (CVS) aims at preventing bile duct injuries (BDIs) in laparoscopic cholecystectomy (LCC). This study investigated CVS utilization among surgeons. METHODS: Photos from LCCs were scored for satisfactory CVS. Rates of satisfactory CVS, BDIs, and postoperative complications among residents and consultants were compared. A lecture on CVS was given halfway through the study. RESULTS: The study comprised 1532 patients. Residents had higher rates of satisfactory CVS in elective LCCs compared with consultants (34.9% vs. 23.0%, P <0.001), but not in emergency LCCs (18.4% vs. 15.0%, P =0.252). No significant differences in BDIs or postoperative complications emerged between residents and consultants. After the lecture, elective LCCs were photographed more frequently (80.3% vs. 74.0%, P =0.032), but rates of satisfactory CVS, BDIs, and postoperative complications remained unchanged. CONCLUSIONS: Utilization of CVS can be affected by a single lecture but affecting rates of satisfactory CVS may require stronger interventions.

Pilonidal disease treatment by radial laser surgery (FiLaC™): The first Finnish experience.

BACKGROUND AND OBJECTIVE: Pilonidal disease is common, and it afflicts especially young adults, causing disability. Several types of treatment methods are applicable, but no consensus exists regarding the best method. The aim of our study was to assess the novel radial laser probe treatment in pilonidal disease and report the success rate and recurrence rate. METHODS: We studied retrospectively 86 patients who, according to our hospital patient records, underwent radial laser probe surgery between January 2017 and September 2019. RESULTS: In a mean follow-up time of 14 months, the success rate at 2 months was 86%. Most operations were done under local anesthesia on a day-surgery basis. The recovery time was rapid, and median sick leave was 12 days. Of those initially successfully treated, 3% developed a recurrence. Altogether 17% of the patients underwent a re-operation. Spillage of pus during surgery, however, reduced the success rate to 53%. CONCLUSIONS: Radial laser probe treatment is a quick, safe, and minimally invasive treatment choice for pilonidal disease, especially when no active infection is present.

A Finnish Version of RAND-36-Item Health Survey Versus Structured Interview 8 Years Postoperatively.

BACKGROUND/AIM: The aim was to assess the 8-year health status after minicholecystectomy (MC) versus laparoscopic cholecystectomy (LC) for gallstone disease (GS) by using the RAND-36 Health Survey. PATIENTS AND METHODS: Initially, 88 patients with symptomatic GS disease were randomized to undergo either MC (n=44) or LC (n=44). RAND-36 survey was performed 8 years postoperatively. RESULTS: In three RAND-36 domains (social functioning, role physical, role emotional) MC procedure was significantly better than LC. In MC patients, the 8-year postoperative scores of social functioning (p<0.001), role physical (p=0.002) and role emotional (p<0.001) were significantly higher than the age- and gender -adjusted Finnish reference scores. CONCLUSION: The Finnish version of the RAND-36 survey can be used as a valid and reliable method for measuring the quality of life and long-term outcome of cholecystectomy patients following surgery.

RAND-36-Item Health Survey: A Comprehensive Test for Long-term Outcome and Health Status Following Surgery.

BACKGROUND/AIM: The aim of this study was to assess the 3-year health status of cholecystectomy patients by the RAND-36 Survey. PATIENTS AND METHODS: Initially, 110 patients with symptomatic gallstone disease were randomized to undergo either minicholecystectomy (MC) (n=58) or laparoscopic cholecystectomy (LC) (n=52). RAND-36 survey was performed preoperatively, 4 weeks, 6 months and 3 years following surgery. RESULTS: RAND-36 scores improved in several RAND-36 domains in MC and LC groups with a similar postoperative course over the 3-year study period. In addition, at the 3-year follow-up telephone interview, no significant differences in patient-reported outcome measures between MC and LC patients were shown. The linear mixed effect model was used to test the overall significance of the RAND-36 survey during a 36-month follow-up period and the overall p-values were statistically significant in vitality, mental health (0.03), role physical and bodily pain domains. CONCLUSION: During the three years following cholecystectomy, four RAND-36 domains remained significantly higher, indicating a significant positive change in quality of life. RAND-36-Item Health Survey is a comprehensive test for analyzing long-term outcome and health status after cholecystectomy.

Lower Incidence of Postoperative Pain after Open Inguinal Hernia Surgery with the Usage of Synthetic Glue-Coated Mesh (Adhesix®).

Chronic groin pain after inguinal hernia mesh repair is a common problem. Mesh fixation without sutures has been suggested to have several advantages over the traditional suture fixation. The aim of this study was to compare two self-adhering meshes, the glued Adhesix® (AH) and the gripping Parietene ProGrip® (PP), and evaluate their impact on postoperative chronic pain and overall recovery. Two consultant surgeons performed altogether 393 open inguinal hernia operations at the Helsinki University Hospital during 2014 to 2015. The two groups, AH (n = 169) and PP (n = 224) were similar and comparable in terms of demographic data. The data were collected and analyzed from the patients' medical records in the hospital's register. The patients were followed up for a period of 19 months (5-31 months). The number of patient contacts due to postoperative pain was significantly less common in the AH group than in the PP group, 4/169 (2.4%) versus 19/224 (8.5%) patients, respectively (P = 0.011). The duration of pain was under three months for most patients, only two patients in the PP group had pain for over one year. The pain was treated most patients with anti-inflammatory painkillers, whereas injections of a local anesthetic and corticosteroid, and chronic pain medication was needed in some cases. It seems that the use of glue-coated mesh (Adhesix®) was associated with less postoperative visits due to pain compared with the self-fixating mesh with absorbable anchoring system (ProGrip®). Further studies with long-term follow-up are needed to confirm these results.

Gallstone Patients with Enhanced Oxidative Stress Biomarker Superoxide Dismutase (SOD1) Plasma Levels Have Significantly Lower Number of Postoperative Analgesic Oxycodone Doses: A Prospective Study with Special Reference to Cancer Patients.

BACKGROUND/AIM: Oxidative stress biomarker superoxide dismutase (SOD1) plasma levels in operated gallstone patients versus cancer patients are unknown. In addition, the number of analgesic doses during the first 24 h postoperatively (NAD24) in gallstone patients operated with laparoscopic cholecystectomy (LC) or minicholecystectomy (MC) is unreported. The aim of the study was to determine a correlation between the plasma SOD1 levels in the LC and MC patients versus cancer patients. PATIENTS AND METHODS: Initially, 114 patients with symptomatic gallstone disease were randomized into LC (n=54) or MC (n=60) groups. The plasma levels of the SOD1 marker were measured just before, immediately after (POP1) and 6 h after the operation (POP2). RESULTS: The median plasma SOD1 levels preoperatively and following surgery in the LC and MC patients versus cancer patients were statistically insignificant (p=0.90, p=0.88, p=0.21, respectively). The median plasma levels of SOD1 increased immediately after operation (POP1) and the postoperative elevation between the preoperative (PRE) and the POP1 values in the SOD1 marker were statistically significant (p=0.027). Then the median plasma levels of SOD1 marker decreased 6 h postoperatively (POP2) and the decrease between the POP1 and POP2 values in the SOD1 marker were statistically highly significant (p<0.001). There is a highly significant inverse correlation between the individual values of the NAD24 and plasma SOD1 values postoperatively in LC and MC patients (r=-0.335, p=0.011). CONCLUSION: The plasma SOD1 levels preoperatively and following surgery in the LC and MC patients versus cancer patients were quite similar. Cholecystectomy patients with enhanced levels of SOD1 appeared to have significantly lower number of analgesic oxycodone doses during the first 24 h postoperatively (NAD24).

Comparison of the quality of life after minilaparotomy cholecystectomy versus laparoscopic cholecystectomy: a prospective randomized study.

BACKGROUND: Earlier studies comparing minilaparotomy cholecystectomy with laparoscopic cholecystectomy did not find significant differences between the MC and the LC groups in operating times and patients' recovery. OBJECTIVES: To compare the postoperative quality of life between the MC and LC groups. METHODS: The 157 patients with uncomplicated symptomatic gallstones, confirmed by ultrasound, were randomized to two groups: 85 for MC and 72 for LC. The study was prospective and randomized but not blinded or consecutive. The study groups were similar in patients' age, gender, body mass index, American Association of Anesthesiology physical fitness classification, and the operating surgeon. Patients were reevaluated 4 weeks after operation using the RAND-36 quality of life questionnaire. RESULTS: The RAND-36 questionnaire did not identify statistically significant differences between the study groups in general health perceptions, physical functioning, emotional well-being, social functioning, energy, bodily pain, and role functioning/emotional score. Only the role functioning/physical score was slightly higher in the LC group (P= 0.038). CONCLUSIONS: The results of this study showed that the MC procedure is a good alternative to the LC procedure, when postoperative quality of life is measured.