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Famiglietti F, Wolthuis AM, De Coster J, Vanbrabant K, D'Hoore A, de Buck van Overstraeten A. Impact of single-incision laparoscopic surgery on postoperative analgesia requirements after total colectomy for ulcerative colitis: a propensity-matched comparison with multiport laparoscopy. Colorectal Dis 2019; 21:953-960. [PMID: 31058400 DOI: 10.1111/codi.14668] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 03/16/2019] [Indexed: 12/17/2022]
Abstract
AIM To compare the requirements for postoperative analgesia in patients with ulcerative colitis after single-incision versus multiport laparoscopic total colectomy. METHOD All patients undergoing single-incision or multiport laparoscopic total colectomy as a first stage in the surgical treatment of ulcerative colitis between 2010 and 2016 at the University Hospital of Leuven were included. The cumulative dose of postoperative patient-controlled analgesia was used as the primary end-point. A Z-transformation was performed combining values for patient-controlled epidural analgesia and patient-controlled intravenous analgesia, resulting in one hybrid outcome variable. The two groups were matched using propensity scores. Subgroup analysis was performed to analyse the impact of extraction site on postoperative pain. RESULTS A total of 81 patients underwent total colectomy for ulcerative colitis (median age 35 years). Thirty patients underwent single-incision laparoscopy, while 51 patients had a multiport approach. The mean normalized patient-controlled analgesia dose was significantly lower in patients undergoing single-incision laparoscopy (-0.33 vs 0.46, P < 0.001). This difference was no longer significant in subgroup analysis for patients with stoma site specimen extraction (P = 0.131). The odds of receiving tramadol postoperatively was 3.66 times lower after single-incision laparoscopy (P = 0.008). The overall morbidity rate was 32.1% (26/81). The mean Comprehensive Complication Index in single-incision and multiport laparoscopy group was 18.33 and 21.39, respectively (P = 0.506). Hospital stay was significantly shorter after single-incision laparoscopic surgery (6.3 days vs 7.6 days, P = 0.032). CONCLUSION Single-incision total colectomy was associated with lower postoperative analgesia requirements and shorter hospital stay, with comparable morbidity. However, the specimen extraction site played a significant role in postoperative pain control.
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Affiliation(s)
- F Famiglietti
- Department of Abdominal Surgery, University Hospital Leuven, KU Leuven, Leuven, Belgium
| | - A M Wolthuis
- Department of Abdominal Surgery, University Hospital Leuven, KU Leuven, Leuven, Belgium
| | - J De Coster
- Department of Anesthesiology, University Hospital Leuven, KU Leuven, Leuven, Belgium
| | - K Vanbrabant
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, KU Leuven and University of Hasselt, University Hospital Leuven, KU Leuven, Leuven, Belgium
| | - A D'Hoore
- Department of Abdominal Surgery, University Hospital Leuven, KU Leuven, Leuven, Belgium
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Köckerling F, Alam NN, Antoniou SA, Daniels IR, Famiglietti F, Fortelny RH, Heiss MM, Kallinowski F, Kyle-Leinhase I, Mayer F, Miserez M, Montgomery A, Morales-Conde S, Muysoms F, Narang SK, Petter-Puchner A, Reinpold W, Scheuerlein H, Smietanski M, Stechemesser B, Strey C, Woeste G, Smart NJ. What is the evidence for the use of biologic or biosynthetic meshes in abdominal wall reconstruction? Hernia 2018; 22:249-269. [PMID: 29388080 PMCID: PMC5978919 DOI: 10.1007/s10029-018-1735-y] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 01/11/2018] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Although many surgeons have adopted the use of biologic and biosynthetic meshes in complex abdominal wall hernia repair, others have questioned the use of these products. Criticism is addressed in several review articles on the poor standard of studies reporting on the use of biologic meshes for different abdominal wall repairs. The aim of this consensus review is to conduct an evidence-based analysis of the efficacy of biologic and biosynthetic meshes in predefined clinical situations. METHODS A European working group, "BioMesh Study Group", composed of invited surgeons with a special interest in surgical meshes, formulated key questions, and forwarded them for processing in subgroups. In January 2016, a workshop was held in Berlin where the findings were presented, discussed, and voted on for consensus. Findings were set out in writing by the subgroups followed by consensus being reached. For the review, 114 studies and background analyses were used. RESULTS The cumulative data regarding biologic mesh under contaminated conditions do not support the claim that it is better than synthetic mesh. Biologic mesh use should be avoided when bridging is needed. In inguinal hernia repair biologic and biosynthetic meshes do not have a clear advantage over the synthetic meshes. For prevention of incisional or parastomal hernias, there is no evidence to support the use of biologic/biosynthetic meshes. In complex abdominal wall hernia repairs (incarcerated hernia, parastomal hernia, infected mesh, open abdomen, enterocutaneous fistula, and component separation technique), biologic and biosynthetic meshes do not provide a superior alternative to synthetic meshes. CONCLUSION The routine use of biologic and biosynthetic meshes cannot be recommended.
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Affiliation(s)
- F Köckerling
- Department of Surgery and Center of Minimally Invasive Surgery, Vivantes Hospital, 13585, Berlin, Germany.
| | - N N Alam
- Department of General Surgery, Manchester Royal Infirmary, Manchester, UK
| | - S A Antoniou
- Department of General Surgery, University Hospital of Heraklion, Heraklion, Greece
| | - I R Daniels
- Exeter Surgical Health Services Research Unit, Royal Devon & Exeter Hospital, Exeter, UK
| | - F Famiglietti
- Department of Abdominal Surgery, University Hospital Gasthuisberg Campus, Louvain, Belgium
| | - R H Fortelny
- Department of General Surgery, Wilhelminenspital, Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - M M Heiss
- Department of Visceral-, Vascular and Transplantation Surgery, Cologne Merheim Medical Center, University Witten/Herdecke, Cologne, Germany
| | - F Kallinowski
- Department of General and Visceral Surgery, Regional Hospital Bergstrasse GmbH, Heppenheim, Germany
| | | | - F Mayer
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - M Miserez
- Department of Abdominal Surgery, University Hospital Gasthuisberg Campus, Louvain, Belgium
| | - A Montgomery
- Department of Surgery, Skåne University Hospital, Malmö, Sweden
| | - S Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, Department of General und Digestive Surgery, University Hospital "Virgen del Rocio", Seville, Spain
| | - F Muysoms
- Department of Surgery, AZ Maria Middelares, Ghent, Belgium
| | - S K Narang
- Exeter Surgical Health Services Research Unit, Royal Devon & Exeter Hospital, Exeter, UK
| | - A Petter-Puchner
- Austrian Cluster of Tissue Regeneration, Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
| | - W Reinpold
- Department of Surgery and Hernia Center, Wilhelmsburger Hospital "Gross Sand", Hamburg, Germany
| | - H Scheuerlein
- Department of General and Visceral Surgery, St. Vincenz Hospital, Paderborn, Germany
| | - M Smietanski
- Department of Surgery & Hernia Centre, District Hospital in Puck, Medical University of Gdansk, Gdansk, Poland
- Department of Radiology, Medical University of Gdansk, Gdansk, Poland
| | | | - C Strey
- Department of Surgery, Friederiken-Hospital, Hanover, Germany
| | - G Woeste
- Department of Surgery, University Hospital, Frankfurt/Main, Germany
| | - N J Smart
- Exeter Surgical Health Services Research Unit, Royal Devon & Exeter Hospital, Exeter, UK
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Famiglietti F, Leonard D, Bachmann R, Remue C, Abbes Orabi N, van Maanen A, van den Eynde M, Kartheuser A. Single-incision laparoscopic surgery for locally advanced colorectal cancer : feasibility, short-term and oncologic outcomes. Acta Gastroenterol Belg 2018; 81:23-28. [PMID: 29562374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND STUDY AIMS Data about single-incision laparoscopic surgery (SILS) in locally advanced colorectal cancers are scarce. This study aimed to evaluate perioperative and shortterm oncologic outcomes of SILS in pT3-T4 colorectal cancer. PATIENTS AND METHODS From 2011 to 2015 data from 249 SILS performed in our Colorectal Unit were entered into a prospective database. Data regarding patients with a pT3-T4 colorectal adenocarcinoma were compared to those with pTis-pT2. Factors influencing conversion were assessed by multivariate analysis. RESULTS There were 100 consecutive patients (T3-T4 = 70, Tis-T2 = 30). Demographics were similar. Tumor size was significantly larger in the T3-T4 group [3.9cm vs 2cm; p<0.001]. In T3-T4 patients we found a significant higher number of lymph nodes harvested [20 vs 13 ; p<0.001]. Early (<30 days) severe (Clavien-Dindo classification>2) postoperative complication rate was similar between groups (8.6% vs 10% ; p = 0.999), as well as conversion rate (18.6% vs 6.7% ; p = 0.220). Finally, there were no differences in terms of hospital stay and mortality rate. On multivariate analysis, age (OR = 1.06, 95%CI: 1.012-1.113 ; p = 0.015] and stage IV (OR = 5.372, 95%CI: 1.320-21.862, p = 0.019) were independently associated with conversion. CONCLUSIONS SILS for locally advanced colorectal cancer did not affect the short-term outcomes in this series and oncological clearance remained satisfactory. Age and stage IV disease are independent risk factors for conversion.
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Affiliation(s)
- F Famiglietti
- Colorectal Surgery Unit, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - D Leonard
- Colorectal Surgery Unit, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - R Bachmann
- Colorectal Surgery Unit, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - C Remue
- Colorectal Surgery Unit, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - N Abbes Orabi
- Colorectal Surgery Unit, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - A van Maanen
- Statistical Support Unit, Institut Roi Albert II, Brussels, Belgium
| | - M van den Eynde
- Departement of Oncology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
- Departement of Hepato-gatroenterology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - A Kartheuser
- Colorectal Surgery Unit, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
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Mistrangelo M, Conte ID, Cassoni P, Senetta R, Delmonte S, Rondoletti S, Famiglietti F, Perotto L, Codognotto E, Morino M. 334. Anal Malignancies Associated to Condyloma Acuminata - Differences Between HIV+ and HIV- Patients. Eur J Surg Oncol 2012. [DOI: 10.1016/j.ejso.2012.06.321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Abstract
Surgical techniques and technologies are rapidly evolving. In the field of colorectal surgery the transanal video-assisted approach was introduced by Buess, 30 years ago, with transanal endoscopic microsurgery (TEM). In more recent years different techniques and technologies have been proposed, including natural orifice specimen extraction (NOSE), natural orifice transluminal endoscopic surgery (NOTES) and single-access surgery. Furthermore, a better understanding of the prognostic and risk factors of rectal cancer has allowed TEM to expand its indications to local resection of selected tumours, and more recently there have been proposals for sentinel node biopsy in colon and rectal cancer.
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Affiliation(s)
- M Morino
- Digestive and Colorectal Surgery, University of Torino, Torino, Italy.
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