Enhanced Recovery After Surgery: Is It Time to Change Our Strategy Regarding Laparoscopic Colectomy?

Port Site Consequences After Laparoscopic Cholecystectomy Using an Open Versus Closed Approach of Pneumoperitoneum

Introduction: Laparoscopic surgery is the standard method for cholecystectomy, and pneumoperitoneum is performed either in a closed or open technique. However, exposure to the consequences of the port site may increase the patient's morbidity. Therefore, this study was conducted to compare both approaches in terms of complications at the port site of each procedure and potential risk factors.

Methods: A prospective study was conducted in the department of surgery, in hospitals affiliated with Kirkuk and Diyala governorates in Iraq, from January 2019 to March 2022. The participating patients (200) were electively divided into two groups, each group comprising 100 patients. The pneumoperitoneum was established in the first group by an open technique (Hasson) while in the second group it was by using a closed technique (Veress needle). A comparison was made between the two techniques for intraoperative and postoperative complications that may have occurred due to port insertion up to 18 weeks.

Results: According to the results, the highest percentage was for the following: females (84.0%), ages between 50 and 59 years (43.5%), and body mass index (BMI) range 25-30 kg/m² (49.0%). No significant difference was observed between those variables for the two surgical techniques (p-value > 0.05). No death was recorded in the study. Consequences at the port site were observed in 10.5% of patients, the majority reported in the open approach (8.5%) as follows: bleeding (3.0%), hematoma (2.0%), wound infection (1.5%), hernia (1.5%), and vascular injury (0.5%).

Conclusions: Thus, we concluded that port site complications are lowest in closed laparoscopic surgery which was not shown to be statistically significant but values showed less complications. Furthermore, samples could be used to gain a good statistical significance.

GENETIC INFLUENCES ON PAIN MECHANISMS

OBJECTIVE

The aim: To review the available results for genetic influences on pain syndrome development.

PATIENTS AND METHODS

Materials and methods: In the period from 2009 to 2020, a total of 45 research papers describing the key points of genetic influences on pain mechanisms in both adults and children were published in Ukrainian and English and they are now included in the PubMed, EMBASE, Cochrane, and Google Scholar research databases.

CONCLUSION

Conclusions: Pain is a comprehensive characteristic of a person; therefore, it is inevitable that several genes with little individual effect interact with each other and environmental factors, influencing pain susceptibility and chronic pain syndrome manifestation. This requires searching for biomarkers for diagnosing and predicting the development of acute and chronic pain syndromes, especially in pediatric practice.

Present status and future directions - Minimal endodontic access cavities

In the last decades, the move of Medicine towards minimally invasive treatments is notorious and scientifically grounded. As Dentistry naturally follows its footsteps, minimal access preparation also became a trend topic in the endodontic field. This procedure aims to maximize preservation of dentine tissue, backed up by the idea that this is an effective way to reduce the incidence of post-treatment tooth fracture. However, with the assessment of the body of evidence on this topic, it is possible to observe some key-points (a) the demand for nomenclature standardization, (b) the requirement of specific tools such as ultra-flexible instruments, visual magnification, superior illumination, and three-dimensional imaging technology, (c) minimally invasive treatment does not seem to affect orifice location and mechanical preparation when using adequate armamentarium, but it (d) may impair adequate canal cleaning, disinfection, and filling procedures, and also (e) it displays contradictory results regarding the ability to increase the tooth strengthen compared to the traditional access cavity. In spite of that, it is undeniable that methodological flaws of some benchtop studies using extracted teeth may be responsible for the conflicting data, thus triggering the need for more sophisticated devices/facilities and specifically designed research in an attempt to make it clear the role of the access size/design on long-term teeth survival. Moreover, it is inevitable that a clinical approach like minimal endodontic access cavities that demands complex tools and skilled and experienced operators bring to the fore doubts on its educational impact mainly when confronted with the conflicting scientific output, ultimately provoking a cost-benefit analysis of its implementation as a routine technique. In addition, this review discusses the ongoing scientific and clinical status of minimally invasive access cavities aiming to input an in-depth and unbiased view over the rationale behind them, uncovering not only the related conceptual and scientific flaws, but also outlining future directions for research and clinical practices. The conclusions attempt to skip from passionate disputes highlighting the current body of evidence as weak and incomplete to guide decision making, demanding the development of a close-to-in-situ laboratory model or a large and well-controlled clinical trial to solve this matter.

Intervention of WeChat Group Guidance in Rapid Rehabilitation after Gynecological Laparoscopic Surgery

Gynecological laparoscopic surgery is the current routine treatment. Although the injury is relatively small, it is still a traumatic operation and also increases the recovery speed of patients. This paper mainly explores the intervention effect of rapid rehabilitation after gynecological laparoscopic surgery by means of WeChat group guidance based on the information adoption model and UTAUT model. Gynecological patients who underwent laparoscopic surgery and met the inclusion and exclusion conditions in a provincial maternal and child health hospital were selected as the research objects. The WeChat intervention group was compared with the nonintervention group, and the oral description score (VRS), comfort score (BCS), and 40-item recovery quality rating scale (QoR-40) were used as the scoring criteria. The results showed that the postoperative VRS and BCS scores in the WeChat intervention group were significantly lower than those in the nonintervention group. The total score of QoR-40 in both groups decreased compared with that before operation, reached the lowest on the first day after operation, and began to rise from the second day. This result is consistent with the patient's postoperative recovery process. After operation, the total score of the WeChat intervention group on days 1 and 2 was higher than that of the non-WeChat intervention group. By comparing the results of the patient's postoperative oral description score (VRS), comfort score (BCS), 40-item recovery quality score scale (QoR-40), etc., it can be shown that the overall recovery quality of the WeChat intervention group was better during these two days. In each section, the oral description score (VRS) and the 40-item recovery quality score scale (QoR-40) indicated that the pain sensation and emotional state scores of patients in the WeChat intervention group were higher than those in the nonintervention group, while the comfort score (BCS) was lower, indicating better comfort in the WeChat intervention group.

Visceral versus somatic pain: an educational review of anatomy and clinical implications

Somatic and visceral nociceptive signals travel via different pathways to reach the spinal cord. Additionally, signals regulating visceral blood flow and gastrointestinal tract (GIT) motility travel via efferent sympathetic nerves. To offer optimal pain relief and increase GIT motility and blood flow, we should interfere with all these pathways. These include the afferent nerves that travel with the sympathetic trunks, the somatic fibers that innervate the abdominal wall and part of the parietal peritoneum, and the sympathetic efferent fibers. All somatic and visceral afferent neural and sympathetic efferent pathways are effectively blocked by appropriately placed segmental thoracic epidural blocks (TEBs), whereas well-placed truncal fascial plane blocks evidently do not consistently block the afferent visceral neural pathways nor the sympathetic efferent nerves. It is generally accepted that it would be beneficial to counter the effects of the stress response on the GIT, therefore most enhanced recovery after surgery protocols involve TEB. The TEB failure rate, however, can be high, enticing practitioners to resort to truncal fascial plane blocks. In this educational article, we discuss the differences between visceral and somatic pain, their management and the clinical implications of these differences.

Minimally Invasive Surgery for Congenital Abdominal Cystic Lesions in Newborns and Infants

BACKGROUND/AIM

In the variety of congenital abdominal cystic lesions (CACL) of different origin, ovarian cyst is the most common intra-abdominal pathology in female neonates. The prognosis and timing of treatment varies depending on the nature of CACL. This study aimed to assess the results of diagnostics and treatment of CACL.

PATIENTS AND METHODS

A retrospective analysis was performed of 39 cases of CACL, with the spectrum including ovarian, enteric, mesenteric and pancreatic origin. Outcome of minimally invasive surgery, open surgery or conservative approach was analyzed.

RESULTS

Twenty-eight neonates underwent surgery, while 11 were treated conservatively. Twenty patients were treated with a laparoscopic technique and eight with laparotomy combined with laparoscopy. Final diagnosis included: Fifteen cases of ovarian pathology (ovarian torsion in 11 cases), 12 treated laparoscopically and three with laparotomy, six enteric duplications (four laparoscopic and two laparotomic), three mesenteric cysts (one laparoscopic and two laparotomic), two pancreatic cysts (both laparoscopic only), two duodenal stenoses, including duodenal septum (both laparotomies with Heineke-Mikulicz plasty). No blood transfusion apart from two cases requiring re-laparotomy and no early complications were observed in any case; no death occurred.

CONCLUSION

With the strategy of management based on ultrasound and laboratory data, a laparoscopically assisted minimal access approach resulted in minimal risk of complications and complete recovery in all patients, leading to exclusion of oncological risk.