PROPHYlactic Implantation of BIOlogic Mesh in peritonitis (PROPHYBIOM): a prospective multicentric randomized controlled trial

BACKGROUND

Patients undergoing emergency surgery for peritonitis are at increased risk of abdominal wall-related complications. In patients with peritonitis, the risk of incisional hernia (IH) is extremely elevated. The evaluation of quality of life of patients with incisional hernia showed lower mean scores on physical components of health-related quality of life and body image. Furthermore, the arise of a post-operative abdominal wall complication (i.e., wound dehiscence, evisceration and IH) greatly increases morbidity and mortality rates and prolongs the hospitalization.

METHODS

The present study aims to evaluate the efficacy of the use of a swine dermal collagen prosthesis implanted preperitoneally as a prophylactic procedure in urgency/emergency setting against abdominal wall complications in patients operated with contaminated/infected field in peritonitis. The sample size was defined in 90 patients divided in two arms (prosthesis positioning versus normal wall abdominal closure). The follow-up will be performed at 3, 6, and 12 months after surgery. The percentage of incisional hernias, wound infections, and adverse events will be investigated by physical examination and ultrasound.

DISCUSSION

The objective is to evaluate the possibility to reduce the incisional hernia rate in patients undergoing urgent/emergent laparotomy in contaminated/infected field with peritonitis by using swine dermal collagen prosthesis preperitoneal positioning as a prophylactic procedure.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04681326. Registered (retrospectively after first patient recruited) on 23 December 2020.

Comparison of abdominal radiographs and sonography in prognostic prediction of infants with necrotizing enterocolitis

PURPOSE

The purpose of this study was to investigate the comparison of AR and AUS in predicting prognosis in infants with necrotizing enterocolitis.

METHODS

All patients were diagnosed as NEC at the department of general surgery and neonatal surgery, Qilu children's hospital between 1st, Jun, 2010 and 30th, Dec, 2016. The logistic regression analysis and the area under ROC curve (AUC)s were also used to compare the prognostic values of radiograph and sonograph for NEC.

RESULTS

Throughout the study period, 86 preterm neonates were hospitalized with diagnosis of definite NEC. Among these patients, 39 infants (45.3%) required surgical treatment. After adjusting for competing sonographic factors, we identified that thick bowel wall (more than 2.5 mm) (p = 0.001, HR: 1.849), intramural gas (pneumatosis intestinalis) (p = 0.017, HR: 1.265), portal venous gas (p = 0.002, HR: 1.824), and reduced peristalsis (p = 0.021, HR: 1.544) were independent prognostic factors associated with NEC. After adjusting for competing radiographic factors, we identified that free peritoneal gas (p = 0.007, HR: 1.472), portal venous gas (p = 0.012, HR: 1.649), and dilatation and elongation (p = 0.025, HR: 1.327). Moreover, we found that the AUROC for AR logistic model was 0.745 (95% CI 0.629-0.812), which was significant lower than the AUS logistic model (AUROC: 0.857, 95% CI 0.802-0.946) for predicting prognosis of NEC.

CONCLUSIONS

In conclusion, we found that several radiographic and sonographic parameters were associated with the prognosis of patients with NEC. The AUS model based on the logistic regression analysis was significant superior to the AR model in the prognostic prediction of NEC.

The benefit of abdominal sonography and chest X-ray for staging oral squamous cell carcinomas in stages UICC I and II

PURPOSE

The purpose of this study was to evaluate how often distant metastases occur in localized oral squamous cell carcinomas (OSCC). The investigators hypothesize that abdominal sonography and chest X-ray may not be necessary for initial staging of early oral squamous cell carcinoma in UICC stage I/II.

MATERIAL AND METHODS

The investigators implemented a retrospective study. The study collective was composed of 124 patients with OSCC, who were treated in the department of oral and maxillofacial surgery during the years 2011-2015 at the University Medical Center Hamburg Eppendorf, Germany. We focused on age, gender, date of diagnosis, tumour stage (clinical and pathological), HPV status, occurrence of metastases, recurrences, date and frequency of staging and restaging (abdominal sonography, chest X-ray, CT Abdomen/Thorax, PET CT), follow up time and date of death. Descriptive and bivariate statistics were computed (chi-square test) and the P value was set at .05.

RESULTS

19 distant metastases were found in 13 out of 124 patients (10.48%). Of those 20 metastases 5 were found in the liver (26.32%), 11 in the lung (57.89%) and 4 in the bone (15.79%). Hepatic metastases co-occurred in every case with pulmonary metastases. In one case bone metastases occurred without the presence of pulmonary metastases. There was no significant correlation of metastasis rate to T stage. But distant metastases were solely found in node positive patients. This was significant for pulmonary metastases, not for liver metastases. Only one out of 11 pulmonary metastases was diagnosed by chest X-ray.

CONCLUSION

Abdominal sonography and chest X-ray can be omitted as a standard procedure in staging of localized node negative oral squamous cell carcinoma. A thoracic CT including the liver should be performed in patients with suspected lymph nodes metastases in the neck on CT. A skeletal scintigraphy or alternatively a PET/PET-CT should be added if there are signs and symptoms suspicious for bone metastases.