Devender Mittapalli

Clinical outcomes of a percutaneous cholecystostomy for acute cholecystitis: a multicentre analysis

BACKGROUND The aim of this study was to review a series of consecutive percutaneous cholecystostomies (PC) to analyse the clinical outcomes. METHODS All patients who underwent a PC between 2000 and 2010 were reviewed retrospectively for indications, complications, and short- and long-term outcomes. RESULTS Fifty-three patients underwent a PC with a median age was 74 years (range 14-93). 92.4% (n = 49) of patients were American Society of Anesthesiologists (ASA) III and IV. 82% (43/53) had ultrasound-guided drainage whereas 18% (10/53) had computed tomography (CT)-guided drainage. 71.6% (n = 38) of PCs employed a transhepatic route and 28.4% (n = 15) transabdominal route. 13% (7/53) of patients developed complications including bile leaks (n = 5), haemorrhage (n = 1) and a duodenal fistula (n = 1). All bile leaks were noted with transabdominal access (5 versus 0, P = 0.001). 18/53 of patients underwent a cholecystectomy of 4/18 was done on the index admission. 6/18 cholecystectomies (33%) underwent a laparoscopic cholecystectomy and the remaining required conversion to an open cholecystectomy (67%). 13/53 (22%) patients were readmitted with recurrent cholecystitis during follow-up of which 7 (54%) had a repeated PC. 12/53 patients died on the index admission. The overall 1-year mortality was 37.7% (20/53). CONCLUSIONS Only a small fraction of patients undergoing a PC proceed to a cholecystectomy with a high risk of conversion to an open procedure. A quarter of patients presented with recurrent cholecystitis during follow-up. The mortality rate is high during the index admission from sepsis and within the 1 year of follow-up from other causes.

Meta-analysis of self-gripping mesh (Progrip) versus sutured mesh in open inguinal hernia repair.

BACKGROUND This metaanalysis was designed to systematically analyse all published randomized controlled trials comparing self-gripping mesh (ProGrip) and sutured mesh to analyse early and long term outcomes for open inguinal hernia repair. METHODS A literature search was performed using the Cochrane Colorectal Cancer Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials in the Cochrane Library, MEDLINE, Embase and Science Citation Index Expanded. Randomized trials comparing self-gripping mesh with sutured mesh were included. Statistical analysis was performed using Review Manager Version 5.2 software. The primary outcome measures were hernia recurrence and chronic pain after operation. Secondary outcome measures included surgical time, wound complications and perioperative complications. RESULTS Five randomized trials were identified as suitable, including 1170 patients. There was no significant difference between the two types of mesh repairs in perioperative complications, wound haematoma, chronic groin pain and hernia recurrence. Wound infection was lower in self gripping mesh group compared to sutured mesh but this was not statistically significant (risk ratio (RR) 0.57, 95% confidence interval 0.30-1.06, P = 0.08). The duration of operation was significantly shorter with self-gripping mesh compared to sutured mesh with a mean difference of -5.48 min [-9.31, -1.64] Z = 2.80 (P = 0.005). CONCLUSION Self-gripping mesh was associated with shorter operative time compared to sutured mesh. Both types of mesh repairs have comparable perioperative and long term outcomes.

Infrainguinal aneurysms in a tertiary setting: A study of outcomes

the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results: Twelve cohort studies involving 1512 patients were included. The majority of these were treated endovascularly (1168 patients).DR was associated with improved wound healing (Odds Ratio, OR 0.39, p<0.001) and limb salvage rates (OR 0.20, p<0.001) compared to IR, however this effect was lost on certain sensitivity analyses. DR had no effect on reintervention rates (OR 0.44, p1⁄40.27) or subsequent mortality (OR 0.83, p1⁄40.37). Overall study quality was low. Conclusions: DR appears superior in terms of wound healing and limb salvage. There was no evidence that the approach was less safe than IR. Vascular units performing infrapopliteal revascularisation should consider DR whenever feasible.