Comparison of open and endoscopic posterior component separation with transversus abdominis release: a propensity score-matched study.

BACKGROUND: Posterior component separation with transversus abdominis release (TAR) is considered to be the optimal technique for large incisional ventral hernia repair. Endoscopic TAR (eTAR) that gets all the benefits of minimally invasive surgery (MIS) gives a possibility to enhance results of the treatment. The aim of our study was to make the comparison between open and endoscopic TAR procedures with an emphasis on frequency and severity of postoperative complications in comparable groups. MATERIALS AND METHODS: All patients had midline incisional hernia and underwent either open (open TAR group) or endoscopic (eTAR group) Rives-Stoppa repair in combination with bilateral transversus abdominis release in Moscow City Hospital №1 from January 2018 to December 2022. A propensity score matching (PSM) was used to make groups comparable. Postoperative complications were classified according to Clavien-Dindo Classification, and Comprehensive complication index was calculated. RESULTS: We performed 133 open and endoscopic TAR separation for midline incisional hernia. After PSM analysis 51 patients were matched to each group. Overall surgical morbidity in the open TAR group (56.9%) was statistically significantly higher than in the eTAR group (29.4%) (p = 0.009). There were more severe complications (Clavien IIIa-V) in the open TAR group (11.8% vs. 0%, p = 0.027). Length of hospital stay after surgery was shorter in eTAR group (p < 0.001). The Comprehensive complication index in the open TAR group was significantly higher than in eTAR group, 8.7 (0-20.9) vs. 0 (0-8.7) (p = 0.011). CONCLUSION: Based on the data from our study, the entire MIS procedure including endoscopic TAR is a safe and optimal technique for surgery of midline incisional ventral hernia, requiring TAR separation in terms of reducing the rate of postoperative complications, their severity and hospital length of stay, compared to open TAR procedure.

Surgeons know that they don't know about the safe use of surgical energy: an international study reveals that the knowledge gap persists.

INTRODUCTION: The rate of electrosurgery complications is 0.1-2.1%. More than 10 years ago, SAGES pioneered a well-structured educational program (FUSE) aimed to teach about the safe use of electrosurgery. This inspired the development of similar training programs around the globe. Still, the knowledge gap persists among surgeons, possibly due to the lack of judgment. AIM: To investigate factors affecting the level of expertise in electrosurgical safety and their correlation with self-assessment scores among surgeons and surgical residents. MATERIALS AND METHODS: We conducted an online survey consisting of 15 questions that could be thematically broken down into 5 blocks. We analyzed how the objective scores were correlated with the self-assessment scores, professional experience, past participation in training programs, and work at a teaching hospital. RESULTS: A total of 145 specialists took part in the survey, including 111 general surgeons and 34 s-year surgical residents from Russia, Belarus, Ukraine, and Kirgizia. Only 9 (8.1%) surgeons scored "excellent," 32 (28.8%) scored "good," and 56 (50.4%) scored "fair." Of all surgical residents participating in the study, only 1 (2.9%) scored "excellent," 9 (26.5%) scored "good," and 11 (32.4%) scored "fair." The test was failed by 14 surgeons (12.6%) and 13 (38.2%) residents. The difference between the trainees and the surgeons was statistically significant. Our multivariate logistic model identified 3 significant factors predisposing to successful performance on the test: past training in the safe use of electrosurgery, professional experience, and work at a teaching hospital. Of all study participants, those with no past training in the safe use of electrosurgery, and non-teaching surgeons were the most realistic about their competencies. CONCLUSION: We have identified alarming gaps in the knowledge of electrosurgical safety among surgeons. Faculty staff and experienced surgeons scored higher, but past training was the most influential factor in improving knowledge of electrosurgical safety.

Risk factors of venous thromboembolism after incisional ventral hernia repair.

BACKGROUND: The problem of venous thromboembolic events (VTE) after incisional hernia repair remains relevant. According to the literature the frequency of VTE ranges from 0.2 to 4.2%. The data on risk factors of VTE in this cohort of patients are scarce. Aim of our study is to find frequency and risk factors for VTE development in patients who underwent surgery for incisional ventral hernia. MATERIALS AND METHODS: There were 240 patients enrolled in our retrospective study. We included patients, who were operated for incisional hernia in Saveljev University Surgery Clinic from January 2018 to December 2019. Compression duplex ultrasound of lower extremity veins was performed within median 3 days (min 1 day, max 7 days) after surgery for all participants. The primary endpoint was the occurrence of the VTE event, including deep venous thrombosis (DVT) and pulmonary embolism (PE). RESULTS: VTE was detected in 19 patients, which accounted for 7.9% in analyzed cohort. All patients received standard pharmacological prophylaxis. There were 3 (1.3%) proximal, 16 (6.7%) distal DVT, in one patient (0.4%) distal thrombosis was complicated by symptomatic pulmonary embolism. In multivariate Cox proportional hazard model was found that component separation (HR 3.99, 95% CI 1.14-14.0, p = 0.03), duration of operation in hours (HR 1.67. 95% CI 1.13-2.5, p = 0.011) and body mass index (HR 1.13, 95% CI 1.02-1.2, p = 0.02) were statistically significant risk factors. CONCLUSION: The incidence of postoperative VTE in patients after incisional hernia repair is high with a predominant distal DVT as a thrombotic event. Component separation, duration of operation and body mass index are statistically significant factors of VTE in patients undergoing surgery for incisional hernia.

[Safety in electrosurgery: results of the All-Russian survey]. / Bezopasnost' v elektrokhirurgii: rezul'taty obshcherossiiskogo oprosa urovnya znanii.

OBJECTIVE: To assess the level of knowledge in electrosurgical safety among specialists in the Russian Federation. MATERIAL AND METHODS: An Internet survey was devoted to the issues of electrosurgical safety. The questionnaire consisted of 15 questions in 5 items. Data were collected for 2 months. Data analysis included final assessment of respondents, correlation of results with their own assessment of knowledge and parameters of surgical experience, the fact of training and belonging to the department. Question design, survey and presentation of results were performed in accordance with the CHERRIES (Check list of Reporting Results of Internet E-Surveys) criteria for Internet surveys. RESULTS: Survey enrolled 231 specialists. Excellent rating was given to 13 (5.6%) respondents, good - 66 (28.3%), satisfactory - 105 (45.1%) respondents. Forty-nine (21.03%) respondents did not overcome the passing score (7) and showed unsatisfactory knowledge of electrosurgical safety. Mean score among all participants was 8.6±2.6 (median 8 points, interquartile range [7-11]) or 53.3% of maximum value (15). In multivariate logistic model, significant factors were the completed course in electrosurgical safety (OR 2.26, 95% CI 1.30-3.97; p=0.004), experience of work (OR 1.03, 95% CI 1.01-1.05; p=0.011) and work in the department (OR 1.74, 95% CI 1.03-2.95; p=0.038). Respondents who did not take the course (positive significant correlation r=0.1629, p=0.02674) and non-departmental employees (r=0.1655, p=0.031) assess the level of knowledge more adequately with respect to real results. Respondents with completed course (r=0.1078, p=0.4659) and departmental staff (r=0.1411, p=0.2699) are prone to overestimate self-assessment (positive insignificant correlation of their own assessment and received points). CONCLUSION: We found significant knowledge gaps in electrosurgical safety among various practitioners. The main causes are no mandatory specialized courses on electrosurgical safety and insufficient motivation of specialists for self-education due to false ideas about their own level of knowledge.

[Endoscopic retro-muscular alloplasty for primary and postoperative ventral hernias: our initial experience]. / Éndoskopicheskaia retromuskuliarnaia alloplastika pri pervichnykh i posleoperatsionnykh ventral'nykh gryzhakh: nash pervyi opyt.

AIM: To define optimal surgical approach for middle primary and postoperative ventral hernias. MATERIAL AND METHODS: We have presented the first results of endoscopic retro-muscular alloplasty in 8 patients with umbilical hernia and postoperative ventral hernia combined with rectus abdominis muscles diastase. RESULTS: One patient had seroma above mesh implant that was evacuated under ultrasonic control. Absent hernial protrusion and reduced diastase were noted in all patients. There were no symptoms of recurrence, purulent-septic complications and venous thromboembolic complications. Mortality was absent. CONCLUSION: Further experience and analysis of long-term results are necessary to determine the role of this technique in anterior abdominal wall hernias management.

[The characteristics of the clinical course of malaria in Ethiopia]. / Kharakteristika klinicheskogo techeniia maliarii v Efiopii.

The high incidence of malaria in Ethiopia is due to a number of natural and social factors. The 1988-1989 surveys of 525 patients among this country's indigenous population showed that its great proportion suffered from severe falciparum malaria, including that caused by the chloroquine-resistant strains Plasmodium falciparum. The severity of falciparum malaria seems to be determined by the low immunity of inhabitants in the hyperendemic areas and by late effective therapy. The lack of antimalarial drugs alternative to chloroquine will facilitate fatal malignant malaria.

[The course of malignant forms of tropical malaria in the native population of endemic foci in Ethiopia]. / Techenie zlokachestvennykh form tropicheskoi maliarii u korennogo naseleniia éndemicheskikh ochagov Efiopii.

In the hyperendemic areas of Ethiopia there is severe tropical malaria, "cerebral malaria" which is frequently followed by complications as malaria coma or malaria algide. The authors followed up the clinical course and causes of malaria coma in 25 patients, including in 10 dead subjects. The development of malaria coma is chiefly associated with untimely diagnosis, patients' late admissions, and inadequate prehospital treatment. The current and past diseases may be regarded as factors aggravating the disease.

[Current treatment methods for malaria patients]. / Sovremennye metody lecheniia bol'nykh maliariei.

The paper gives a review of present-day drugs effective against malaria, provides the result of a clinical trial of melloquine, fansidar, fansimeph, chlorochine in diverse malaria forms. The choice of the drug should be individual, basing on the disease severity, form and resistance of tropical malaria causative agent.

[Clinico-laboratory and morphologic characteristics of the tropical splenomegaly syndrome]. / K kliniko-laboratornoi i morfologicheskoi kharakteristike sindroma tropicheskoi splenomegalii.

A follow-up of 142 patients with the syndrome of tropical splenomegaly in Mulago Hospital in Uganda made it possible to study a clinical course, the informative value of hematological, some biochemical and immunological indices, morphological changes of liver biopsy specimens in this syndrome. Over a 10-year period 9020 autopsy records were studied for comparative assessment of a histological picture and causes of death in Mulago Hospital. The syndrome of tropical splenomegaly was diagnosed in 88 (0.98%) of them. The main diagnostic criteria were proposed for this pathology. This pathology should be denoted as the syndrome of tropical splenohepatomegaly.

[Treatment of imported tropical malaria caused by chloroquine-resistant strains of P. falciparum]. / O lechenii zavoznoi tropicheskoi maliarii, vyzvannoi khlorokhinoustoichivymi shtammami P. falciparum.

The chloroquine-resistant strains P. falciparum are widely spread in the countries of South-East Asia, Latin America. Since the middle of the 70s the strains also occurred in Eastern Africa. The given paper is concerned with 4 patients suffering from imported chloroquine-resistant tropical malaria. Of these, 3 patients come from Africa, and one from Vietnam. In the latter patient, the disease ran a grave course and was attended by coma, acute renal insufficiency, hepatitis, and hemolytic anemia. The patient was registered as having grade III resistance of P. falciparum to chloroquine. The schedules of the disease treatment including quinine with fansidar, metakelphin (or with sulphalene and chloridine), mafloquine or tetracycline are presented.