SF-CORNER (splenic flexure colorectal cancer): an international survey of operative approaches and outcomes for cancers of the splenic flexure.

AIM: The optimum surgical approach to splenic flexure cancers (SFCs) remains uncertain. The aim of this survey was to explore the opinions of an international surgical community on the management and outcomes of SFC. METHOD: A questionnaire was constructed comprising five sections (information about respondents; definition and prognosis of SFC; operative approach; approach in specific scenarios; outcomes) and circulated through an international dissemination committee and social media. RESULTS: The survey received 576 responses over 4 weeks across 50 countries. There was no consensus regarding the definition of the splenic flexure, whilst the proportion of respondents who did and did not think that patients with SFC had a worse outcome was equal. The overall preferred operative approach was left hemicolectomy [203 (35.2%)], followed by segmental resection [167 (29%)], extended right hemicolectomy [126 (21.9%)] and subtotal colectomy [7 (12%)]. The stated pedicles for ligation varied between resection types and also within the same resection. One hundred and sixty-six (28.8%) respondents thought a segmental resection was associated with the worst survival and 190 (33%) thought it was associated with the best quality of life. CONCLUSION: This survey confirms a lack of consensus across all aspects SFC treatment. The differing approaches described are likely to represent different beliefs around the variable anatomy of this region and the associated lymphatic drainage. Future studies are required to address such inconsistencies and identify the optimum surgical strategy, whilst also incorporating quality-of-life metrics and patient-reported outcomes. A one-size-fits-all approach is probably not appropriate with SFC, and a more bespoke approach is required.

Splenic flexure mobilization in left-sided colonic and rectal resections: A meta-analysis and meta-regression of factors associated with anastomotic leak and complications.

AIM: Splenic flexure mobilization (SFM) is commonly performed during left-sided colon and rectal resections. The aim of the present systematic review was to assess the outcomes of SFM in left-sided colon and rectal resections and the risk factors for complications and anastomotic leak (AL). METHOD: This study was a PRISMA-compliant systematic review. PubMed, Scopus and Web of Science were searched for studies that assessed the outcomes of sigmoid and rectal resections with or without SFM. The primary outcomes were AL and total complications, and the secondary outcomes were individual complications, operating time, conversion to open surgery, length of hospital stay (LOS) and pathological and oncological outcomes. RESULTS: Nineteen studies including data on 81 116 patients (49.1% male) were reviewed. SFM was undertaken in 40.7% of patients. SFM was associated with a longer operating time (weighted mean difference 24.50, 95% CI 14.47-34.52, p < 0.0001) and higher odds of AL (OR 1.19, 95% CI 1.06-1.33, p = 0.002). Both groups had similar odds of total complications, splenic injury, anastomotic stricture, conversion to open surgery, (LOS), local recurrence, and overall survival. A secondary analysis of rectal cancer cases only showed similar outcomes for SFM and the control group. CONCLUSIONS: SFM was associated with a longer operating time and higher odds of AL, yet a similar likelihood of total complications, splenic injury, anastomotic stricture, conversion to open surgery, LOS, local recurrence, and overall survival. These conclusions must be cautiously interpreted considering the numerous study limitations. SFM may have only been selectively undertaken in cases in which anastomotic tension was suspected. Therefore, the suboptimal anastomoses may have been the reason for SFM rather than the SFM being causative of the anastomotic insufficiencies.

Innovative pancreas-guided technique for splenic flexure mobilization in laparoscopic left hemicolectomy.

OBJECTIVE: Splenic flexure mobilization (SFM) is a major challenge in laparoscopic left hemicolectomy. This study aims to assess the safety and effectiveness of the pancreas-guided SFM technique during laparoscopic left hemicolectomy. METHODS: From January 2018 to December 2023, 352 patients with left-sided colon cancer underwent laparoscopic left hemicolectomy. Based on the SFM method used, the patients were divided into the pancreas-guided group (167 cases) or the "Three Approaches Roundabout"/classic group (185 cases). Clinicopathologic characteristics and intraoperative and postoperative variables were compared between the two groups. RESULTS: The two groups had no significant differences in baseline indicators (P > 0.05). All surgeries were successful without needing to convert to laparotomy, and there were no combined organ resections involving the spleen or pancreas in either group. The mean duration of surgery was significantly lower in the pancreas-guided group than in the classic group (P < 0.01). The median volume of intraoperative blood loss in the pancreas-guided group was lower than that in the classic group (P < 0.01). Through video playback, it was found that the retro-pancreatic space had been entered during operation in 8 cases (4.3%) in the classic group, while there were no such occurrences in the pancreas-guided group. This difference was statistically significant (P < 0.05). The difference in the number of lymph nodes cleared, postoperative hospital stays, and incidence of complications were not statistically significant (all P > 0.05) between the groups. CONCLUSION: The pancreas-guided SFM technique is a safe and feasible option for laparoscopic left hemicolectomy. Our study's findings suggest that this approach facilitates accurate access to the correct anatomic plane, potentially improving surgical efficiency.

The effect of landing zone toricity on scleral lens fitting characteristics and optics.

PURPOSE: The fit and optical performance of a scleral lens is affected by the alignment of the landing zone with the underlying ocular surface. The aim of this research was to quantify the effect of landing zone toricity upon scleral lens fitting characteristics (rotation and decentration) and optics (lens flexure) during short-term wear. METHODS: Scleral lenses with nominal landing zone toricities of 0, 100, 150 and 200 µm were worn in a randomised order by 10 young healthy participants (mean [SD] 24 [7] years) for 30 min, with other lens parameters held constant. Scleral toricity was quantified using a corneo-scleral profilometer, and lens flexure, rotation, and decentration were quantified using over-topography during lens wear. Repeated measures analyses were conducted as a function of landing zone toricity and residual scleral toricity (the difference between scleral and lens toricity) for eyes with 'low' magnitude scleral toricity (mean: 96 µm) and 'high' magnitude scleral toricity (mean: 319 µm). RESULTS: Toric landing zones significantly reduced lens flexure (by 0.37 [0.21] D, p < 0.05) and lens rotation (by 20 [24]°, p < 0.05) compared with a spherical landing zone. Horizontal and vertical lens decentration did not vary significantly with landing zone toricity. These trends for flexure, rotation, and decentration were also observed for eyes with 'low' and 'high' magnitude scleral toricity as a function of residual scleral toricity. CONCLUSION: Landing zones with 100-200 µm toricity significantly reduced lens flexure (by ~62%) and rotation (by ~77%) but not horizontal or vertical lens decentration, compared with a spherical landing zone, when controlling for other confounding variables. The incorporation of a toric landing zone, even for eyes with lower magnitude scleral toricity (~100 µm), may be beneficial, particularly for front surface optical designs.

Unveiling the hidden: identification and management of overlooked blood vessels in laparoscopic left hemicolectomy for splenic flexure cancer.

BACKGROUND: During laparoscopic left hemicolectomy procedures, a previously overlooked consistently thick blood vessel within the gastrocolic ligament near the splenic hilum may contribute to post-operative bleeding complications. The purpose of this study was to investigate the identification and management of the previously overlooked blood vessel. METHODS: This is a retrospective descriptive study of patients undergoing laparoscopic left colectomy for splenic fexure cancer conducted at a national gastrointestinal surgery centre in China. Consecutive patients with splenic fexure cancer who underwent laparoscopic left colectomy using our"five-step process"(n = 34) between January 2021 and July 2023 were included. RESULTS: The vessels can be effectively exposed using the aforementioned "five-step process." It was observed that the overlooked vessels consistently present in all patients were identified as the omental branch of the left gastroepiploic artery and vein. CONCLUSION: We have identified the origin of previously overlooked blood vessels and recommended a safe method for their management. This may offer advantages to colorectal surgeons performing laparoscopic left colectomy for splenic flexure cancer.

Effect of multiple firings on optical and mechanical properties of Virgilite-containing lithium disilicate glass-ceramic of varying thickness.

OBJECTIVES: To investigate the effect of multiple firings on color, translucency, and biaxial flexure strength of Virgilite-containing (Li0.5Al0.5Si2.5O6) lithium disilicate glass ceramics of varying thickness. MATERIALS AND METHODS: Sixty discs were prepared from Virgilite-containing lithium disilicate blocks. Discs were divided according to thickness (n = 30) into T0.5 (0.5 mm) and T1.0 (1.0 mm). Each thickness was divided according to the number of firing cycles (n = 10); F1 (Control group): 1 firing cycle; F3: 3 firing cycles, and F5: 5 firing cycles. The discs were tested for color change (ΔE00) and translucency (TP00) using a spectrophotometer. Then, all samples were subjected to biaxial flexure strength testing using a universal testing machine. Data were collected and statistically analyzed (α = 0.5). For chemical analysis, six additional T0.5 discs (2 for each firing cycle) were prepared; for each firing cycle one disc was subjected to X-ray diffraction analysis (XRD) and another disc was subjected to Energy dispersive X-ray spectroscopy (EDX) and Scanning electron microscope (SEM). RESULTS: Repeated firing significantly reduced the translucency of F3 and F5 compared to F1 in T0.5 (p < 0.001), while for T1.0 only F5 showed a significant decrease in TP00 (p < 0.001). For ΔE00, a significant increase was recorded with repeated firings (p < 0.05) while a significant decrease resulted in the biaxial flexure strength regardless of thickness. CONCLUSIONS: Repeated firings had a negative effect on both the optical and mechanical properties of the Virgilite-containing lithium disilicate glass ceramics. CLINICAL RELEVANCE: Repeated firings should be avoided with Virgilite-containing lithium disilicate ceramics to decrease fracture liability and preserve restoration esthetics.

A Low-Frequency Fiber Bragg Grating Acceleration Sensor Based on Spring Support and Symmetric Compensation Structure with Flexible Hinges.

To measure vibration signals, a low-frequency fiber Bragg grating (FBG) acceleration sensor featuring a flexible hinge with a spring support and symmetric compensation structure has been designed. Based on the mechanical model of the sensor's structure, the expressions for sensitivity and resonant frequency of the sensor are derived. The structural parameters of the sensor are optimized, and a simulation analysis is conducted using ANSYS 19.2 software. According to the results of simulation analysis and size optimization, the sensor prototype is constructed. Subsequently, its amplitude-frequency response, sensitivity, and temperature characteristics are investigated through vibration experiments. The experimental results show that the resonant frequency of the sensor is 73 Hz, the operating frequency range is 0~60 Hz, and the sensitivity measures 24.24 pm/g. This design meets the requirements for measuring vibration signals at low frequencies.

Dimensional and spatial computed tomographic abnormalities of the rectum and prostate are only partly reversible after surgical repair of perineal hernia in dogs.

Caudal protrusion of pelvic organs and dilatation and deviation of the rectum with perineal hernia (PH) have not previously been studied using CT, and it is not known how completely the changes normalize after PH repair. Objectives of this prospective experimental case series were to evaluate the dimensions and shape of the rectum and the volume, location, and other features (enhancement pattern, presence of cysts, and mineralizations) of the prostate of 66 dogs on CT before and 3 months after PH repair. The rectal cross-sectional areas were measured at intrapelvic and caudal locations, and the shape was categorized as straight, deviated, flexure, or caudal fold on dorsal images. According to paired samples t-tests, the caudal rectal dimensions were significantly larger (P < .001) than the intrapelvic dimensions both before and 3 months after PH repair, and according to linear mixed models, the intrapelvic dimensions increased significantly (P < .001) after repair. Before PH repair, the most common rectal shape was flexure (69.2%); after repair, the number of dogs having a straight rectum increased significantly (P < .001) according to the McNemar paired-samples proportion test. We were also able to show that rectal dimensions increased after PH repair despite straightening in most dogs. According to the linear mixed model, prostate ratio volume, and according to Wilcoxon signed ranks test, the number of prostates with intraprostatic cysts decreased significantly (both P < .001) after PH repair, but the proportion of prostates located in the caudal or perineal area did not. Small mineralizations remained in some dogs.

Flexure wood formation via growth reprogramming in hybrid aspen involves jasmonates and polyamines and transcriptional changes resembling tension wood development.

Stem bending in trees induces flexure wood but its properties and development are poorly understood. Here, we investigated the effects of low-intensity multidirectional stem flexing on growth and wood properties of hybrid aspen, and on its transcriptomic and hormonal responses. Glasshouse-grown trees were either kept stationary or subjected to several daily shakes for 5 wk, after which the transcriptomes and hormones were analyzed in the cambial region and developing wood tissues, and the wood properties were analyzed by physical, chemical and microscopy techniques. Shaking increased primary and secondary growth and altered wood differentiation by stimulating gelatinous-fiber formation, reducing secondary wall thickness, changing matrix polysaccharides and increasing cellulose, G- and H-lignin contents, cell wall porosity and saccharification yields. Wood-forming tissues exhibited elevated jasmonate, polyamine, ethylene and brassinosteroids and reduced abscisic acid and gibberellin signaling. Transcriptional responses resembled those during tension wood formation but not opposite wood formation and revealed several thigmomorphogenesis-related genes as well as novel gene networks including FLA and XTH genes encoding plasma membrane-bound proteins. Low-intensity stem flexing stimulates growth and induces wood having improved biorefinery properties through molecular and hormonal pathways similar to thigmomorphogenesis in herbaceous plants and largely overlapping with the tension wood program of hardwoods.

Drainage pattern of the splenic flexure vein and its accompanying arteries using three-dimensional computed tomography angiography: a single-centre study of 600 patients.

AIM: The splenic flexure has variable vascular anatomy, and the details of the venous forms are not known. In this study, we report the flow pattern of the splenic flexure vein (SFV) and the positional relationship between the SFV and arteries such as the accessory middle colic artery (AMCA). METHODS: This was a single-centre study using preoperative enhanced CT colonography images of 600 colorectal surgery patients. CT images were reconstructed into 3D angiography. SFV was defined as a vein flowing centrally from the marginal vein of the splenic flexure visible on CT. AMCA was defined as the artery feeding the left side of the transverse colon, separate from the left branch of the middle colic artery. RESULTS: The SFV returned to the inferior mesenteric vein (IMV) in 494 cases (82.3%), the superior mesenteric vein in 51 cases (8.5%) and the splenic vein in seven cases (1.2%). The AMCA was present in 244 cases (40.7%). The AMCA branched from the superior mesenteric artery or its branches in 227 cases (93.0% of cases with existing AMCA). In the 552 cases in which the SFV returned to the IMV, superior mesenteric vein or splenic vein, the left colic artery was the most frequent artery accompanying the SFV (42.2%), followed by the AMCA (38.1%) and the left branch of the middle colic artery (14.3%). CONCLUSIONS: The most common flow pattern of the vein in the splenic flexure is from the SFV to IMV. The SFV is frequently accompanied by the left colic artery or AMCA.

Laparoscopic D3 oncological resection in splenic flexure cancer: Technical details and its impact on long-term survival.

AIM: The applicability of laparoscopic D3 oncological resection for splenic flexure cancer (SFC) surgery has not been fully explored due to technical difficulties and variations in surgical procedure. The aim of this work is to describe the feasibility of performing laparoscopic D3 resection in SFC and its impact on long-term survival. METHOD: A retrospective study on 47 out of 52 consecutive patients who underwent elective laparoscopic colectomy for SFC from December 2006 until December 2019 at Korea University Anam Hospital was performed. Data on patients' demographic and clinical features, surgical procedures, intraoperative and postoperative complications, pathological features and follow-up were collected. Categorical data are expressed as frequencies (n) and percentages (%). Continuous data are expressed as mean ± standard deviation and median (range). The Kaplan-Meier test was used to determine the overall survival (OS), progression-free survival (PFS) and disease-free survival (DFS). RESULTS: The median age of patients was 67.0 years (range 27-87 years) and 72.3% were men. Ten (21.3%) patients presented with an obstructing tumour and underwent an elective laparoscopic colectomy, while 68.1% of patients presented with Stage II and III disease. The conversion rate was 4.3% and the morbidity rate was 31.9%. There was one postoperative death secondary to splenic infarction and anastomotic leak leading to multi-organ failure. Four deaths occurred due to disease progression during a median follow-up of 63.8 months. The rate of recurrence was 20%, the 5-year OS was 89.6% and the 5-year PFS was 72.9%. After R0 resection, the 5-year OS was 91.5% and the 5-year DFS was 74.5%. CONCLUSION: Laparoscopic D3 colectomy for SFC is feasible, with an acceptable morbidity and long-term oncological outcome when performed by highly skilled laparoscopic colorectal surgeons with knowledge of the complex anatomy around the splenic flexure. Further randomized trials should be performed to determine the advantage of laparoscopic D3 colectomy over conventional colectomy for SFC.

Minimally invasive vs. open segmental resection of the splenic flexure for cancer: a nationwide study of the Italian Society of Surgical Oncology-Colorectal Cancer Network (SICO-CNN).

BACKGROUND: Evidence on the efficacy of minimally invasive (MI) segmental resection of splenic flexure cancer (SFC) is not available, mostly due to the rarity of this tumor. This study aimed to determine the survival outcomes of MI and open treatment, and to investigate whether MI is noninferior to open procedure regarding short-term outcomes. METHODS: This nationwide retrospective cohort study included all consecutive SFC segmental resections performed in 30 referral centers between 2006 and 2016. The primary endpoint assessing efficacy was the overall survival (OS). The secondary endpoints included cancer-specific mortality (CSM), recurrence rate (RR), short-term clinical outcomes (a composite of Clavien-Dindo > 2 complications and 30-day mortality), and pathological outcomes (a composite of lymph nodes removed ≧12, and proximal and distal free resection margins length ≧ 5 cm). For these composites, a 6% noninferiority margin was chosen based on clinical relevance estimate. RESULTS: A total of 606 patients underwent either an open (208, 34.3%) or a MI (398, 65.7%) SFC segmental resection. At univariable analysis, OS and CSM were improved in the MI group (log-rank test p = 0.004 and Gray's tests p = 0.004, respectively), while recurrences were comparable (Gray's tests p = 0.434). Cox multivariable analysis did not support that OS and CSM were better in the MI group (p = 0.109 and p = 0.163, respectively). Successful pathological outcome, observed in 53.2% of open and 58.3% of MI resections, supported noninferiority (difference 5.1%; 1-sided 95%CI - 4.7% to ∞). Successful short-term clinical outcome was documented in 93.3% of Open and 93.0% of MI procedures, and supported noninferiority as well (difference - 0.3%; 1-sided 95%CI - 5.0% to ∞). CONCLUSIONS: Among patients with SFC, the minimally invasive approach met the criterion for noninferiority for postoperative complications and pathological outcomes, and was found to provide results of OS, CSM, and RR comparable to those of open resection.

SAGES masters program: the top 10 seminal articles for the laparoscopic left and sigmoid colectomy pathway for complex disease.

BACKGROUND: The SAGES University Colorectal Masters Program is a structured educational curriculum that is designed to aid practicing surgeons develop and maintain knowledge and technical skills for laparoscopic colorectal surgery. The Colorectal Pathway is based on three anchoring procedures (laparoscopic right colectomy, laparoscopic left and sigmoid colectomy for uncomplicated and complex disease, and intracorporeal anastomosis for minimally invasive right colectomy) corresponding to three levels of performance (competency, proficiency and mastery). This manuscript presents focused summaries of the top 10 seminal articles selected for laparoscopic left and sigmoid colectomy for complex benign and malignant disease. METHODS: A systematic literature search of Web of Science for the most cited articles on the topic of laparoscopic complex left/sigmoid colectomy yielded 30 citations. These articles were reviewed and ranked by the SAGES Colorectal Task Force and invited subject experts according to their citation index. The top 10 ranked articles were then reviewed and summarized, with emphasis on relevance and impact in the field, study findings, strength and limitations and conclusions. RESULTS: The top 10 seminal articles selected for the laparoscopic left/sigmoid colectomy for complex disease anchoring procedure include advanced procedures such as minimally invasive splenic flexure mobilization techniques, laparoscopic surgery for complicated and/or diverticulitis, splenic flexure tumors, complete mesocolic excision, and other techniques (e.g., Deloyers or colonic transposition in cases with limited colonic reach after extended left-sided resection). CONCLUSIONS: The SAGES Colorectal Masters Program top 10 seminal articles selected for laparoscopic left and sigmoid colectomy for complex benign and malignant disease anchoring procedure are presented. These procedures were the most essential in the armamentarium of practicing surgeons that perform minimally invasive surgery for complex left and sigmoid colon pathology.

Splenic flexure cancer: is right extended hemicolectomy better than left hemicolectomy?

INTRODUCTION: There is no consensus on the optimal surgery for splenic flexure cancers. METHODS: Review of a prospectively maintained database of patients with splenic flexure cancer undergoing either a right extended hemicolectomy or left hemicolectomy at a tertiary care cancer hospital from 14.5.2010 to 16.9.2021. The primary outcome measures were postoperative morbidity and hospital stay with secondary outcomes being overall survival, disease-free survival, and long-term patient reported functional and quality of life outcomes. RESULTS: The demographic variables were evenly distributed between groups, and median follow-up was 44 months. The groups were comparable in terms of postoperative morbidity (Clavien-Dindo complication ≥ 3a 10.6% vs 10%, p = 0.322) and hospital stay (8 days vs 7 days, p = 0.316). Oncological outcomes were similar in both groups (3-year disease-free survival 71.8% vs 67.8%, p = 0.877, and 3-year overall survival 83.9% vs 75.8%, p = 0.787), and long-term patient-reported functional outcomes were excellent in both groups. CONCLUSION: Oncological outcomes, post operative morbidity, and long-term patient reported functional outcomes are comparable in patients undergoing either a right extended or left hemicolectomy for splenic flexure cancer.

Segmental and extended resections provide comparable survival for clinically node-negative splenic flexure cancer: a propensity score-matched analysis of the National Cancer Database.

PURPOSE: There is an ongoing debate regarding the extent of resection for splenic flexure tumors (SFT). The purpose of this study was to compare segmental and extended resections in terms of overall survival (OS) and pathologic outcomes. METHODS: Retrospective analysis of all patients surgically treated for SFT in the National Cancer Database (NCDB) for the period 2010-2019. Outcomes of segmental and extended resections were compared and a 1:1 propensity score matching was used to match for confounders. Primary outcome was OS. RESULTS: In total 3498/668,852 (0.5%) patients with clinical stage I-III splenic flexure adenocarcinoma in the NCDB were included. Of these, 1533 (43.8%) underwent segmental resection while 1965 (56.1%) underwent extended resection. After matching, mean OS was similar between the groups (92 vs 91 months; p = 0.94). When survival was stratified by clinical N stage, an 8-month survival benefit was shown in the extended resection group for clinical N-positive status (86 vs 78); however, this difference did not achieve statistical significance (p = 0.078). Median number of harvested lymph nodes was significantly lower in the segmental resection group (16 vs 17; p < 0.001) and the percentage of patients with fewer than 12 harvested nodes was significantly higher (18.4% vs 11.6%; p < 0.001). Length of stay was significantly shorter in the segmental resection group (5 vs 6 days; p = 0.027). There were no significant differences between the groups in terms of 30-day readmission or 30- or 90-day mortality. CONCLUSIONS: While segmental and extended resections were associated with similar OS for clinically node-negative SFT, there might be a survival benefit for extended resection in patients with clinical evidence of lymph node involvement.

Load-Bearing Performance of Non-Prismatic RC Beams Wrapped with Carbon FRP Composites.

This study investigated the influence of CFRP composite wrapping techniques on the load-deflection and strain relationships of non-prismatic RC beams. A total of twelve non-prismatic beams with and without openings were tested in the present study. The length of the non-prismatic section was also varied to assess the effect on the behavior and load capacity of non-prismatic beams. The strengthening of beams was performed by using carbon fiber-reinforced polymer (CFRP) composites in the form of individual strips or full wraps. The linear variable differential transducers and strain gauges were installed at the steel bars to observe the load-deflection and strain responses of non-prismatic RC beams, respectively. The cracking behavior of unstrengthened beams was accompanied by excessive flexural and shear cracks. The influence of CFRP strips and full wraps was primarily observed in solid section beams without shear cracks, resulting in enhanced performance. In contrast, hollow section strengthened beams exhibited minor shear cracks alongside the primary flexural cracks within the constant moment region. The absence of shear cracks was reflected in the load-deflection curves of strengthened beams, which demonstrated a ductile behavior. The strengthened beams demonstrated 40% to 70% higher peak loads than control beams, whereas the ultimate deflection was increased up to 524.87% compared to that of the control beams. The improvement in the peak load was more prominent as the length of the non-prismatic section increased. A better improvement in ductility was achieved for the case of CFRP strips in the case of short non-prismatic lengths, whereas the efficiency of CFRP strips was reduced as the length of the non-prismatic section increased. Moreover, the load-strain capacity of CFRP-strengthened non-prismatic RC beams was higher than the control beams.

Cranial Base Angle in Patients With Cleft Lip and Palate-A Systematic Review and Meta-Analysis.

Background: Diverse findings have been reported for the cranial base angle (CBA) in patients with CLP (cleft lip and palate) and non-CLP controls. Objective: The aim of this study is to assess and evaluate the CBA in patients with CLP and non-CLP controls. Methods: Data from PubMed, OVID Technologies, Inc., Cochrane, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Scopus, Web of Science, and EMBASE for Excerpta Medica dataBASE (EMBASE) with relevant terms was extracted until December 31, 2020. Inclusion criteria were data of patients with non-syndromic unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP). In the case of UCLP and BCLP, patients with craniofacial syndromes were excluded. The study proposal was registered with PROSPERO (Registration number: CRD42021228632). Results: Fifteen studies with a total of 2032 participants were included for the systematic review and 14 studies with a total of 1972 participants were included for the meta-analysis. The risk of bias was assessed using the Modified Newcastle Ottawa scale under seven domains by two authors. Thirteen studies were graded as "good" and two as "satisfactory." The CBA in patients with CLP were greater than the non CLP Class I controls in six of the 15 studies. CBA was greater in patients with CLP than non-CLP controls by 1.21° (95% CI of 0.19-2.22). Meta-analysis reported considerable heterogeneity (I2 = 86%). Anterior (ACB) and posterior cranial base (PCB) lengths were shorter in patients with CLP than in the non-cleft Class I controls by 2.14 mm (95% CI of 0.99-3.30) and 2.06 mm (95% CI of 1.52-2.60), respectively. Conclusion: Most studies were graded as good. Patients with CLP had greater CBA and shorter ACB and PCB lengths when compared to non-CLP controls.

Comparative Evaluation of Cranial Base Length and Flexure on Facial Parameters in Hypodivergent, Normodivergent and Hyperdivergent Patients: A Retrospective Cephalometric Study.

AIM: The aim of the study was to assess the influence of cranial base length (CBL) and Flexure on facial parameters in Hypodivergent, Normodivergent, and Hyperdivergent patients. MATERIALS AND METHODS: Around 60 standardized cephalograms were divided into Hypodivergent, Normodivergent, and Hyperdivergent groups (20 each) based on the FMA angle. The CBL, cranial flexure (CF), and various facial parameters were measured for each case. The results were analyzed for the correlation between Cranial and facial parameters in each of the three study groups. RESULTS: Comparison and Pairwise Comparison of variables between study groups were done using ANOVA and Tukey's post hoc Test. Cranial base length, mandibular body length, LAFH, N-Me-Go angle (p-value <0.001), and Jarabak's ratio were found to be significantly different between the groups. Pearson's Correlation showed that most of the facial parameters had a significant correlation with CBL in Hypodivergent groups. CONCLUSION: The CBL is more closely related to facial parameters in vertical dysplasia individuals than CF. The CBL is positively correlated to facial variables, especially in Hypodivergent individuals. The N-Me-Go Angle introduced in the study was significantly different in all three vertical facial types studied; hence, it cannot be used as a valuable diagnostic tool. CLINICAL SIGNIFICANCE: Changes in the length and flexure of the cranial base influence the anteroposterior position of jaw bases. The influence of the cranial base on the development of vertical dysplasias is not studied much, hence the present study aims at resolving this lacuna in literature.

Comparison of laparoscopic and open colectomy for splenic flexure colon cancer: a systematic review and meta-analysis.

PURPOSE: This study examined the short- and long-term outcomes of laparoscopic and open splenic flexure colon cancer (SFCC) surgery. METHOD: Systematic literature searches were performed in PubMed and Ovid to compare laparoscopic and open colectomy for SFCC. The last search was conducted on November 7, 2021. Surgical and survival outcomes were collected and analyzed. This meta-analysis was performed using Review Manager Software (v 5.3). RESULTS: This study included seven publications with 2397 patients published between 2011 and 2021. A significant difference in operative time was seen in the laparoscopic group (P = 0.01, WMD = 50.13, 95%CI [10.32, 89.94], I2 = 97%); loss of blood estimated (P < 0.001, WMD = -101.88, 95%CI [-161.65, -42.11], I2 = 82%) and the incidence of overall complications (P < 0.001, OR = 0.53, 95%CI [0.38, 0.75], I2 = 0%) of laparoscopic procedure were greatly decreased. There were similar results as compared in the two groups in terms of lymph node harvesting (P = 0.71, WMD = 0.49, 95%CI [-2.13, 3.12], I2 = 93%) and the distance of proximal (P = 0.50, WMD = -1.09, 95%CI [-4.26, 2.08], I2 = 96%) or distal (P = 0.18, WMD = 2.44, 95%CI [-1.13, 6.01], I2 = 97%) resection margin. In addition, no significant differences were observed on overall/disease-free survival over 3/5 years between the two procedures. An analysis of subgroups that used propensity matching scores produced similar results. CONCLUSION: The laparoscopic procedure is clinically safe and feasible for SFCC. It shows the advantages in decreasing intraoperative blood loss and overall complications, and the long-term survival outcomes would not be affected. Randomized clinical trials with a larger sample size are warranted in the future for further investigation.

Pancreatic injuries following laparoscopic splenic flexure mobilization.

PURPOSE: To call awareness to pancreatic injury occurring following laparoscopic splenic flexure mobilization (LSFM) and to discuss the mechanisms which led to such an injury. METHODS: Retrospective review of patients who underwent LSFM as part of their colectomy procedure and sustained pancreatic injuries at a colorectal surgery referral center during 2014-2021. RESULTS: Of 1022 (0.6%) LSFM performed during the study period, six (0.6%) patients were identified in which clinically significant injuries to the pancreas occurred. Two patients had partial transection of the tail of the pancreas and underwent laparoscopic distal pancreatectomy during the index operation. Three patients developed a post-operative pancreatic fistula after their pancreatic injury went undiagnosed during surgery and required percutaneous drainage, one of whom eventually required a distal pancreatectomy for a persistent pancreatic fistula. Another patient developed a peripancreatic fluid collection which resolved with conservative treatment. CONCLUSIONS: Pancreatic injury is rare and a potentially major complication of LSFM. Anatomical misperception, retroperitoneal bleeding, a large bulky splenic flexure tumor, and a "difficult flexure" were recognized as possible mechanisms of such injury.