Background: The aim of this article is to explore the risk of incisional hernia (IH) occurrence at the site of specimen extraction following laparoscopic colorectal resection (LCR), highlighting the comparison between transverse incision versus midline vertical abdominal incision.Methods: Analysis was conducted according to PRISMA guidelines. Systematic search of medical databases, EMBASE, MEDLINE, PubMed and Cochrane Library were performed to find all types of comparative studies reporting the incidence of IH at the specimen extraction site of transverse or vertical midline incision following LCR. The analysis of the pooled data was done using the RevMan statistical software.Results: Twenty-five comparative studies (including 2 randomised controlled trials) on 10,362 patients fulfilled the inclusion criteria. There were 4,944 patients in the transverse incision group and 5,418 patients in the vertical midline incision group. In the random effects model analysis, the use of transverse incision for specimen extraction following LCR reduced the risk of IH development (odds ratio =0.30, 95% CI: 0.19-0.49, Z=4.88, P=0.00001). However, there was significant heterogeneity (Tau 2 =0.97; Chi 2 =109.98, df=24, P=0.00004; I 2 =78%) among included studies. The limitation of the study is due to lack of RCTs, this study includes both prospective and retrospective studies along with 2 RCTs which makes the meta-analysis potentially biased in source of evidence.Conclusions: Transverse incision used for specimen extraction following LCR seems to reduce the risk of postoperative IH incidence compared to vertical midline abdominal incisions.
Primary breast lymphoma (PBL) is an unusual clinical entity accounting for 0.4–0.5% of all breast neoplasms. The usual presentation includes a painless palpable mass similar to that of breast carcinoma. Diffuse large B-cell lymphoma (DLBCL) is the most common identifiable type of PBL based on the histopathological examination.
We report an unusual case of 22 years old Bangladeshi woman presented with a 6-month history of a lump on left breast. Although the lump was initially small, it began a rapid growth after 4 months. The swelling was localized and did not show any skin involvement or discharge and as she didn’t have any positive familial history of breast carcinoma her primary attending physician diagnosed it as a case of breast abscess. When local incision and drainage proved ineffective, she was referred to us. After doing an immunohistochemistry from incisional biopsy the diagnosis was confirmed as Diffuse Large B-cell Lymphoma. The patient was treated initially by chemotherapy with CHOP therapy followed by wide local excision.
Early and accurate diagnosis of PBL is crucial for selecting the appropriate MDT treatment strategies to avert potentially harmful surgical interventions.
Objective
The objective of this article is to explore whether the use of single or double ringed wound protectors (WP) in patients undergoing colorectal resection (CRR) is associated with reduced risk of surgical site infections (SSI).
Method
Analysis was conducted according to PRISMA guidelines. With the help of expert local librarian, systematic search of medical databases like MEBASE, MEDLINE and pubmed was conducted to find appropriate randomized controlled trials (RCT) according to predefined inclusion criteria. The analysis of the pooled data was done using the principles of meta-analysis on statistical software RevMan.
Result
Eighteen RCT on 3744 patients fulfilled the inclusion criteria. There were 1885 patients in the WP group and 1889 patients in the no-WP group. In the random effects model analysis, the use of WP during CRR was associated with the reduced risk of SSI [odds ratio 0.63, 95% CI (0.47–0.86), z= 2.94, p=0.003]. However, there was significant heterogeneity (Tau2 = 0.18; Chi2= 34.77, df = 17; (p=0.007; I2 = 51%) among included studies.
Conclusion
Use of WP seems to reduce the risk of SSI and therefore, may routinely be used during both open and laparoscopic CRR.
Objective
The objective of this article is to evaluate the prevention of internal hernia by mesenteric defect closure (MDC) versus non-closure of the mesenteric defect (MDNC) in patients undergoing Roux-en-Y gastric bypass.
Method
Standard medical electronic databases were searched, and relevant published randomized controlled trials (RCT) were shortlisted according to the inclusion criteria. Summated outcome of post-operative surgical variables including the incidence of internal hernia were analyzed using principles of meta-analysis on RevMan 5 statistical software.
Result
Five RCTs on 3285 patients undergoing Roux-en-Y gastric bypass operation for any indication or approach were found suitable for meta-analysis. There were 1635 patients in the MDC group and 1650 patients in the MDNC group. The duration of the operation was statistically longer in MDC [random effects model, standardized mean difference (SMD) 0.73, 95% CI (0.22–1.25), z=2.78, p=0.005]. There was no statistical difference related to length of hospital stay [random effects model, standardized mean difference (SMD) 0.15, 95% CI (-0.41, 0.44), z= 1.01; P= 0.31] between the two groups. The incidence of internal hernia was significantly reduced in MDC group. This difference was statistically significant [random effects model, odds ratio 0.36, 95% CI (0.19–0.66), z=3.27, p=0.001]. However, there was significant statistical heterogeneity (Chi2= 31.99, df = 4 (P < 0.00001) among included RCTs.
Conclusion
The routine closure of mesenteric defect in patients undergoing Roux-en-y bypass may be an effective approach to reduce the risk of internal hernia. However, more RCTs of robust quality recruiting higher number of patients are required to validate these findings.
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