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.
Background: Radiological localization imaging aids in the identification of abnormal parathyroid glands resulting in primary hyperparathyroidism (PHPT), thereby facilitating minimally invasive parathyroid surgery. Sometimes initial imaging may fail to identify the abnormal gland and imaging may therefore be repeated. This study explored patient outcomes of repeated parathyroid localization imaging, after initial negative gland localization, at a United Kingdom institution.Methodology: Data was retrospectively collected and analyzed for patients with PHPT undergoing repeated imaging during a five-year period (2015)(2016)(2017)(2018)(2019)(2020). The total number of episodes of scanning, types of scans performed, the time interval between scans and the imaging success of gland localization were recorded. We explored the reasons for repeated imaging and attempted to identify any factors that might predict subsequent positive radiological localization.Results: A total of 45 patients were identified who underwent repeated localizing imaging after first localizing imaging was negative. Of these, 39 did not undergo surgery despite repeat imaging being undertaken; 11 out of these 39 patients (28%) had subsequent positive localization scans. Again, a large proportion of patients were managed conservatively, despite the repeated sets of imaging being done. Patients undergoing three or four sets of repetitive imaging did not have imaging or surgical success. Conclusion:A streamlined parathyroid pathway should be followed whereby patients should be triaged for suitability for surgery prior to repeated imaging. A second set of scans should be offered when patients are unsuitable for conservative management and are willing and fit to undergo surgery. There is no merit to repeating imaging more than twice.
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