Critical view of the myopectineal orifice: a scoring system to objectively evaluate transabdominal preperitoneal inguinal hernia repair.

BACKGROUND: More than 20 million inguinal hernia repair (IHR) procedures are performed worldwide every year. The critical view of the myopectineal orifice (CV of the MPO) is a stepwise guide to the achievement and standardization of minimally invasive IHR (MI IHR). We propose a scoring system as an objective method for fulfillment of the CV of the MPO. METHODS: The scoring system was employed for evaluation of the transabdominal preperitoneal (TAPP) technique in 15 video-recorded procedures. Two variants of the score were used: the simple CV of the MPO score (s-CVMPO score) and the extended CV of the MPO score (e-CVMPO score). The inter-rater agreement and internal consistency for both scores and the correlation between the two scores were assessed. RESULTS: Inter-rater agreement with respect to satisfactory/unsatisfactory achievement of the CV of the MPO was high for both the s-CVMPO and e-CVMPO scores (κ = 1, p < 0.001). The Finn coefficient for inter-rater agreement was 0.97 for the s-CVMPO score and 0.99 for the e-CVMPO score (p < 0.001 for both). Both the s-CVMPO and e-CVMPO scores showed internal consistency with Cronbach's α of 0.89 and 0.87, respectively. The correlation coefficient between the two scores for the average score of each procedure was ρ = 0.96 (p < 0.001). CONCLUSION: The CVMPO score is a reliable tool for expert evaluation of TAPP repair. Implementing the CVMPO score facilitates objective assessment of the safety and quality of the procedure.

¿Día o noche? El momento ideal para realizar la colecistectomía / Day or night? The right time to perform cholecystectomy

Introducción. La frecuencia de complicaciones postquirúrgicas de la colecistectomía realizada en la noche es un tema de controversia, siendo que se ha reportado una frecuencia mayor durante el horario nocturno. El objetivo de este estudio fue analizar la presentación de colecistectomía difícil dependiendo de la hora en que se realizó la cirugía, además de otras complicaciones, estancia intrahospitalaria postquirúrgica, reingreso a 30 días y reintervención. Métodos. Se realizó un estudio retrospectivo, observacional, analítico y transversal, comparando la presentación de colecistectomía difícil y su frecuencia en horario diurno (8:00 am a 7:59 pm) y nocturno (8:00 pm a 7:59 am), además de seroma, absceso, hematoma, fuga biliar, biloma, estancia intrahospitalaria postquirúrgica, reingreso a 30 días y reintervención. Resultados. Se incluyeron en el estudio 228 pacientes, 117 operados durante el día (52 %) y 111 durante la noche (48 %). La colecistectomía difícil se presentó 26 % vs 34 % de los casos intervenidos en el día y la noche, respectivamente. La complicación más frecuente fue seroma (14 %). La estancia hospitalaria media fue de 2,7 días en cirugías diurnas y de 2,5 en cirugías nocturnas; hubo 3 % de reintervenciones y 6 %, respectivamente. También hubo 2 % de reingresos a los 30 días entre los pacientes operados en el día y 3 % entre los operados en la noche. Conclusiones. La frecuencia de colecistectomía difícil y las complicaciones, la estancia intrahospitalaria postquirúrgica, el reingreso a 30 días y la necesidad de reintervención, no tuvieron diferencias significativas respecto al horario de la cirugía.

Introduction. The frequency of post-surgical complications of cholecystectomy performed overnight is a matter of controversy, and a higher rate has been reported during the night shift. The objective of this study was to analyze the presentation of difficult cholecystectomy depending on the time the surgery was performed, in addition to other complications, postoperative hospital stay, 30-day readmission, and reintervention. Methods. A retrospective, observational, analytical and cross-sectional study was carried out, comparing the presentation of difficult cholecystectomy and its frequency during daytime (8:00 am to 7:59 pm) and at night (8:00 pm to 7:59 am), in addition of seroma, abscess, bile leak, biloma, hematoma, post-surgical hospital stay, 30-day readmission, and reintervention.Results. A total of 228 patients were included in the study, 117 patients operated during the day (52%), and 111 at night (48%). Difficult cholecystectomy occurred in 26% vs. 34% of the cases operated on during the day and at night, respectively. The most frequent complication was seroma (14%). The mean hospital stay was 2.7 days in day surgeries and 2.5 in night surgeries; there were also 2% readmission at 30 days among patients operated during the day and 3% among those operated on at night. Conclusions. The frequency of difficult cholecystectomy and complications, postoperative hospital stay, 30-day readmission, and the need of reintervention, did not have significant differences with respect to the time of surgery.