PURPOSE: Magnetic anal sphincter (MAS) augmentation is a novel surgical option for the treatment of fecal incontinence. Current clinical evidence is conflicting. The purpose of this meta-analysis was to report the safety profile, potential benefits, and the functional efficacy of this device. METHODS: The study followed the PRISMA guidelines. Literature databases (Medline, Scopus, Web of Science, CENTRAL) were screened for eligible articles. The primary endpoint was the pooled effect of MAS in the Cleveland Clinic Incontinence Score (CCIS) score. Quality evaluation was based on the ROBINS-I and Risk of Bias 2 tool. RESULTS: Overall, 8 studies with 205 patients were included. MAS resulted in a significant reduction of CCIS values (p = 0.019), and improvement only in the embarrassment domain of FIQoL scores (p = 0.034). The overall morbidity rate was 61.8%. Postoperative adverse events included MAS explantation in 12%, infection in 5.1%, pain in 10% and obstructed defecation in 5.8% of patients. CONCLUSION: The application of MAS in patients with fecal incontinence results in the improvement of some clinical parameters with a notable morbidity rate. Due to several study limitations, further, high-quality RCTs are required to delineate the efficacy and safety of MAS.
Fecal Incontinence , Humans , Anal Canal/surgery , Device Removal , Fecal Incontinence/surgery , Magnetic Phenomena , Quality of Life , Treatment Outcome
PURPOSE: The aim of the present study was to evaluate the pooled efficacy of percutaneous tibial nerve stimulation (PTNS) in patients with low anterior resection syndrome (LARS). MATERIAL AND METHODS: This study was based on the Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA guidelines. The primary endpoint was the pooled effect size of PTNS in LARS score (LARSS). Secondary endpoints included incontinence (Fecal Incontinence Score-FIC, Obstructive Defecation Syndrome-ODS), sexual functionality and quality of life (QoL) questionnaires, and manometric evaluations. Continuous outcomes were reported as weighted mean difference (WMD), with the corresponding 95% confidence interval (95% CI). Quality evaluation was performed via the National Institutes of Health (NIH) quality assessment tool. RESULTS: Overall, 5 studies were included. PTNS resulted to reduced LARSS values (WMD: - 5.68, 95%CI: - 7.73, - 3.63, p < 0.001). A similar effect was noted in St Mark's FIC (p < 0.001) and ODS (p = 0.02) score. An improvement in several QoL scales was found. There was no effect in sexual functionality and manometric measurements. Compared to sham, PTNS significantly improved LARSS. CONCLUSIONS: The application of PTNS in patients with LARS results in an improvement in multiple clinical parameters, including defecation functionality and quality of life. Due to several study limitations, further high quality RCTs are required to delineate the exact efficacy of PTNS.
Rectal Neoplasms , Transcutaneous Electric Nerve Stimulation , Humans , Transcutaneous Electric Nerve Stimulation/methods , Quality of Life , Low Anterior Resection Syndrome , Postoperative Complications , Treatment Outcome , Tibial Nerve/physiology
We report the rare case of an acalculous, gangrenous cholecystitis on a, previously healthy, outpatient COVID-19 adult. The 53-year-old patient presented to the emergency department due to epigastric pain and fever and was admitted to the COVID-19 department. Due to clinical and laboratory deterioration, a computed tomography scan was performed that confirmed the diagnosis of acalculous cholecystitis. The patient was submitted to laparoscopic cholecystectomy. Intraoperatively, a gangrenous gallbladder was identified. Immunohistology validated the presence of specimen wall vasculitis and vessel thrombosis.
Laparoscopic cholecystectomy has been established as the gold-standard method to deal with symptomatic cholelithiasis and cholecystitis. Although, like any other surgical procedure, it may have complications that affect the mortality and morbidity of patients. More specifically, the cystic artery pseudoaneurysm is considered a rare complication of laparoscopic cholecystectomy, which despite its rarity, may be fatal for the patient. Herein, we present the case of a 67-year-old man with a ruptured iatrogenic cystic artery pseudoaneurysm in the early postoperative period after laparoscopic cholecystectomy that converted to open wherein a cholecystostomy catheter was placed. The patient was hospitalized in our surgical unit, and he was treated with cystic artery embolization initially and secondary with elective open cholecystectomy.
Parastomal hernia is the most common complication after surgical procedures that lead to the creation of a stoma. Most commonly in the hernia sac, there is omentum or small intestine or colon. The presence of the stomach as hernia's content is a rare event. Herein, we present the case of a 68-year-old woman, who was hospitalized in our surgical unit with incomplete gastric obstruction due to herniation of the stomach into a parastomal hernia and who was managed conservatively.
