Neil J. Smart

Synthetic or biological mesh use in laparoscopic ventral mesh rectopexy--a systematic review.

Laparoscopic ventral mesh rectopexy (VMR) is a surgical option for internal and external rectal prolapse with low perioperative morbidity and low recurrence rates. Use of synthetic mesh in the pelvis may be associated with complications such as fistulation, erosion and dyspareunia. Biological meshes may avoid these complications, but the long‐term outcome is uncertain. Debate continues as to which type of mesh is optimal for laparoscopic VMR.

Deviation and failure of enhanced recovery after surgery following laparoscopic colorectal surgery: early prediction model

Aim  Enhanced recovery after surgery (ERAS) programmes are well established, but deviation from the postoperative elements may result in delayed discharge. Early identification of such patients may allow remedial action to be taken. The aims of this study were to investigate factors associated with delayed discharge and to produce a predictive scoring system for ERAS failure.

Meta-analysis of closure of the fascial defect during laparoscopic incisional and ventral hernia repair.

Laparoscopic incisional and ventral hernia repair (LIVHR) is being used increasingly, with reported outcomes equivalent to those of open hernia repair. Closure of the fascial defect (CFD) is a technique that may reduce seroma formation and bulging after LIVHR. Non‐closure of the fascial defect makes the repair of larger defects easier and reduces postoperative pain. The aim of this systematic review was to determine whether CFD affects the rate of adverse outcomes, such as recurrence, pseudo‐recurrence, mesh eventration or bulging, and the rate of seroma formation.

The use of porcine dermal collagen implants in assisting abdominal wall closure of pediatric renal transplant recipients with donor size discrepancy

Abstract:  Children may have kidneys transplanted from donors larger than themselves. Abdominal wall closure may be difficult, with risks of abdominal compartment syndrome and graft compromise. Meshes used to facilitate closure may cause dense intra‐abdominal adhesions, making further surgery or peritoneal dialysis difficult. We present five cases in which abdominal wall closure was facilitated by porcine dermal collagen implant. Five children (2–15 yr) received transplanted kidneys from adult donors of significantly greater weight. In four recipients, the kidney was transplanted onto the aorta and vena cava intra‐abdominally using a midline incision. In the fifth, the kidney was anastomosed onto the iliac vessels. The skin overlying the implant was closed normally. Maximum follow‐up was three yr. In all cases, primary closure was achieved. One child received a second intra‐abdominal transplant as an emergency, which later failed. The other kidneys are functioning well. One recipient developed a small incisional hernia three yr post‐transplant. Another developed a skin dehiscence over the implant 23 days post‐operatively. The implant was removed and skin closed. The other two recipients recovered well. Porcine dermal collagen implant is a helpful adjunct to abdominal wall closure following organ transplantation in children with donor size discrepancy.

Functional Outcome After Transperineal Rectocele Repair with Porcine Dermal Collagen Implant

PurposeSymptomatic rectocele results in obstructed defecation and constipation. Surgical repair may provide symptomatic relief. This study was designed to assess the safety and efficacy of transperineal rectocele repair with porcine dermal collagen (Permacol®).MethodsTen females with symptomatic rectocele had a transperineal repair using Permacol®. Median age was 51 (range, 33–71) years. Patients were followed with detailed interviews at a median time of 9 (range, 5–16) months. Objective preoperative and postoperative assessment was by outcomes for five symptoms: constipation, excessive straining, incomplete evacuation, vaginal bulging, and vaginal digitations (always, usually, occasionally, never), and Medical Outcomes Study Short Form 36 questionnaires. Subjective outcomes were assessed as excellent, good, moderate, and poor.ResultsAll patients had an improvement in two or more symptoms and 70 percent of patients in three or more symptoms. Postoperatively 80 percent reported an improvement in excessive straining (P = 0.0078) and in incomplete evacuation (P = 0.0078); 70 percent reported an improvement in vaginal bulging (P = 0.0156). Improvements in vaginal digitations and Medical Outcomes Study Short Form 36 scores were not statistically significant. Subjective outcomes were reported as excellent or good by 80 percent of patients. No patients had rectal perforation or infection, and no Permacol® has been removed.ConclusionsRectocele repair with Permacol® by the transperineal approach is a safe technique that avoids some of the complications associated with synthetic mesh use. Objective and subjective results are excellent in the majority of patients.

Prognostic significance of pre-operative C-reactive protein and the neutrophil–lymphocyte ratio in resectable pancreatic cancer: a systematic review

BACKGROUND Better pre-operative risk stratification may improve patient selection for pancreatic resection in pancreatic cancer. C-reactive protein (CRP) and the neutrophil-lymphocyte ratio (NLR) have demonstrated prognostic value in some cancers. The role of CRP and NLR in predicting outcome in pancreatic cancer after curative resection is not well established. METHODS An electronic search of MEDLINE, EMBASE and CINAHL was performed to identify studies assessing survival in patients after pancreatic cancer resection with high or low pre-operative CRP or NLR. Systematic review was undertaken using the PRISMA protocol. RESULTS In total, 327 studies were identified with 10 reporting on survival outcomes after a pancreatic resection in patients with high or low CRP, NLR or both. All but one paper showed a trend of lower inflammatory markers in patients with longer survival. Three studies from six showed low CRP to be independently associated with increased survival and two studies of eight showed the same for NLR. All studies were retrospective cohort studies of low to moderate quality. DISCUSSION Inflammatory markers might prove useful guides to the management of resectable pancreatic cancer but, given the poor quality of evidence, further longitudinal studies are required before incorporating pre-operative inflammatory markers into clinical decision making.

Experimental comparison of mesenteric vessel sealing and thermal damage between one bipolar and two ultrasonic shears devices

Several instruments are available for open and laparoscopic dissection, including electrothermal bipolar vessel sealers and ultrasonically coagulating shears. The vessel sealing ability of three devices in colorectal specimens was compared in an experimental study.

Systematic review of guidelines for the assessment and management of high-grade anal intraepithelial neoplasia (AIN II/III)

There is ambiguity with regard to the optimal management of anal intraepithelial neoplasia (AIN) III. The aim of this review was to assess and compare international/national society guidelines currently available in the literature on the management, treatment and surveillance of AIN III. We also aimed to assess the quality of the studies used to compile the guidelines and to clarify the terminology used in histological assessment.

Factors predicting 30-day readmission after laparoscopic colorectal cancer surgery within an enhanced recovery programme.

Hospital readmission within 30 days of surgery has become a marker of poor quality patient care. This study aimed to investigate factors predictive of 30‐day readmission after laparoscopic colorectal cancer surgery within an enhanced recovery after surgery (ERAS) programme.

A scientific evidence for the efficacy of biologic implants for soft tissue reconstruction

The challenges and complications arising from abdominal surgery frequently necessitate soft tissue reconstruction or augmentation. Soft tissue repair generally has been revolutionised by the introduction of synthetic meshes, but their use is contra‐indicated in contaminated or infected fields. Biologic materials derived from devitalised allo‐ or xenogeneic tissues have been proposed as a safer alternative to synthetics and provide an extracellular scaffold necessary for the in‐growth of new blood vessels and infiltration of native stromal cells. We review the scientific evidence behind commercially available biologic prostheses in relation to the impact of tissue source, manufacturing processes and supplemental cross‐linking on in vitro and in vivo (animal model and clinical) performance.