Short-term outcomes of minimally invasive techniques in posterior component separation for ventral hernia repair: a systematic review and meta-analysis.

INTRODUCTION: The objective of this study was to perform a systematic review and meta-analysis to summarize various approaches in performing minimally invasive posterior component separation (MIS PCS) and ascertain their safety and short-term outcomes. METHODS: A systematic literature searches of major databases were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines to identify studies that provided perioperative characteristics and postoperative outcomes of MIS PCS. Primary outcomes for this study were: surgical site events (SSE), surgical site occurrence requiring procedural intervention (SSOPI), and overall complication rates. A random-effect meta-analysis was conducted which allows computation of 95% CIs using simple approximation and incorporates inverse variance method with logit transformation of proportions. RESULTS: There were 14 studies that enrolled 850 participants that were included. The study identified rate of SSE, SSOPI, and overall rate of complications of all MIS TAR modifications to be 13.4%, 5.7%, and 19%, respectively. CONCLUSIONS: Our study provides important information on safety and short-term outcomes of MIS PCS. These data can be used as reference when counseling patients, calculating sample size for prospective trials, setting up targets for prospective audit of hernia centers. Standardization of reporting of preoperative characteristics and postoperative outcomes of patients undergoing MIS PCS and strict audit of the procedure through introduction of prospective national and international registries can facilitate improvement of safety of the MIS complex abdominal wall reconstruction, and help in identifying the safest and most cost-effective modification.

Fascial defect closure versus bridged repair in laparoscopic ventral hernia mesh repair: a systematic review and meta-analysis of randomized controlled trials.

PURPOSE: Several studies have examined effectiveness of primary fascial defect closure (FDC) versus bridged repair (no-FDC) during laparoscopic ventral hernia mesh repair (LVHMR). The purpose of this study was to systematically review and meta-analyse randomized controlled trials (RCTs) which compared safety and effectiveness of two techniques. METHODS: Systematic literature searches (EMBASE, MEDLINE, PubMed, and CINAHL) were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines using predefined terms. RCTs comparing FDC and no-FDC in LVHMR were identified and retrieved. Primary outcomes were risk of recurrence and risk of major complications analyzed as a single composite outcome. Secondary outcomes were risks of seroma formation, clinical or radiologically confirmed eventration, incidence of readmission to hospital, postoperative changes in quality of life (QoL), and postoperative pain. Random effects modeling to summarize statistics were performed. The risk of bias was assessed using Cohrane's Risk of Bias tool 2. RESULTS: Three RCTs that enrolled total of 259 patients were included. There was clinical heterogeneity present between studies related to patients' characteristics, hernia characteristics, and operative techniques. There was no difference found in primary outcomes, risks of seroma formation, eventration, and chronic pain. There is conflicting evidence on how both techniques affect postoperative QoL or early postoperative pain. CONCLUSIONS: Both techniques were detected to have equal safety profile and do not differ in risk of recurrence, seroma formation, risks of clinical or radiological eventration. Giving uncertainty and clinical equipoise, another RCT examining FDC vs no-FDC laparoscopic mesh repair separately for primary and secondary hernias using narrow inclusion criteria for hernia size on well-defined population would be ethical and pragmatic. PROSPERO REGISTRATION: CRD42021274581.

[Cryopreserved substance, isolated from human fetal liver, restore biochemical processes in acute liver failure]. / Kriokonservirovannye preparaty, vydelennye iz pechenploda cheloveka, vosstanavlivaiut biokhimicheskie protsessy pri ostroi pechenochnoi nedostatochnosti.

Recovery processes dynamics in liver when treating experimental acute hepatic insufficiency (AHI) of various etiology by using cryopreserved biopreparations, obtained from human embryo liver of different terms of development (10-12 weeks), human fetuses (22-24 week of development).

[The use of cryopreserved hepatocytes in the combined treatment of patients with acute liver failure]. / Primenenie kriokonservirovannykh gepatotsitov v kompleksnom lechenii bol'nykh s ostroi pechenochnoi nedostatochnost'iu.

Shown in the paper is employment of one of the modern modalities of treatment of acute hepatic insufficiency (AHI)--that of "cell dialysis" involving the use of freeze-preserved hepatocytes. Hepatic insufficiency develops as a result of poisoning with hepatotrophic poisons (chlorinated hydrocarbons, poisonous mushrooms). The principle of commonly practised hemodialysis is the basis of "cell dialysis" but it was hepatocytes mixture in Hank's solution that was used as a dialysis solution. The time-related course was studied of clinical, laboratory findings. The inclusion of "cell dialysis" into the complex of active methods of detoxication was found to bring about an appreciable decline in mortality among AHI patients together with a reduction of their hospital stay.