Safety and effectiveness of hemorrhoidal artery ligation using the HAL-RAR technique for hemorrhoidal disease.

Purpose: A wide variety of methods has been proposed for treating hemorrhoidal disease. The aim of the study is to assess the safety and effectiveness of hemorrhoidal artery ligation with rectoanal repair (HAL-RAR).

Methods: Retrospective study from January 2010 to November 2019 of patients who underwent HAL-RAR for grade II, resistant to conservative treatment, and grades III and IV hemorrhoidal disease.

Efficacy of Bilateral Transcutaneous Posterior Tibial Nerve Stimulation for Fecal Incontinence.

Context: Posterior tibial nerve stimulation is a new second-line treatment for refractory fecal incontinence.

Objective: To assess the efficacy of bilateral transcutaneous posterior tibial nerve stimulation (BTPTNS) for treatment of fecal incontinence in Japanese patients and its impact on quality of life.

Design: A prospective observational-interventional study was conducted from May 2015 to June 2017 in patients with fecal incontinence in whom conservative treatment had failed.

Generalized Pustular Psoriasis (Von Zumbusch Type) Following Renal Transplant: A Case Report.

Generalized pustular psoriasis appears as an uncommon variant form of psoriasis consisting of widespread pustules on an erythematous background (von Zumbusch). A 39-year-old male patient with a history of plaque psoriasis since the age of 9 who had an acute relapse of generalized pustular psoriasis 12 days following a successful renal transplantation is presented. Despite administered immunosuppression for transplantation, the addition of cyclosporine and methotrexate did not reverse the ongoing process of disease and the patient died on the 57th posttransplant day due to multiorgan failure subsequent to severe bone marrow suppression.

Management of patients after recovering from acute severe biliary pancreatitis.

Cholelithiasis is the most common cause of acute pancreatitis, accounting 35%-60% of cases. Around 15%-20% of patients suffer a severe attack with high morbidity and mortality rates. As far as treatment is concerned, the optimum method of late management of patients with severe acute biliary pancreatitis is still contentious and the main question is over the correct timing of every intervention.

Corticosteroid-free immunosuppression in liver transplantation: an evidence-based review.

Thirty-six randomized controlled trials and two meta-analyses were reviewed. With respect to adult patients undergoing first orthotopic liver transplantation (OLT), steroid replacement resulted in fewer cases of overall acute rejection in the corticosteroid free-immunosuppression arm. Initial steroid administration for two weeks and early tacrolimus monotherapy is a feasible immunosuppression regimen without steroid replacement, although further investigations are needed in view of chronic rejections.

Recurrent inguinal hernia repair: what is the evidence of case series? A meta-analysis and metaregression analysis.

To examine, if case series considered together with observational studies tend to produce similar results as randomized-controlled trials (RCTs), on recurrent hernia repair. A systematic literature review and meta-analysis between 1990 and 2013 revealed 46 nonrandomized studies (NRCTs) and 5 RCTs including 25,730 patients. A direct comparison of the summary estimates between RCTs and NRCTs is presented.

The combined use of serum neurotensin and IL-8 as screening markers for colorectal cancer.

This pilot study aimed to determine the feasibility of serum neurotensin/IL-8 values being used as a screening tool for colorectal cancer. Fifty-six patients and 15 healthy controls were assigned to seven groups according to their disease entity based on theater records and histology report. Blood samples for neurotensin and IL-8 were measured using an enzyme-linked immunosorbent assay.

Laparoscopic totally extraperitoneal versus open preperitoneal mesh repair for inguinal hernia recurrence: a decision analysis based on net health benefits.

Background: The aim of this study is to evaluate the most cost-effective treatment strategy using preperitoneal mesh for patients with recurrent inguinal hernia. Currently, the issue of cost-effectiveness is entirely unresolved.

Methods: A decision analysis was carried out based on the results of a systematic literature review of articles concerning recurrent inguinal hernia repair that were published between 1979 and 2011.

Complete response after neoadjuvant therapy in rectal cancer: to operate or not to operate?

Background/aims: Evidence exists to support both surgical and nonoperative observational approaches to the management of patients with distal rectal cancer who achieve a complete response following neoadjuvant chemoradiotherapy (CRT). This article summarizes findings from key studies on management strategies for complete pathologic and clinical responders after neoadjuvant CRT for rectal cancer.

Methods: A comprehensive literature review was undertaken comparing complete responders to neoadjuvant CRT who underwent surgical procedures or nonoperative observation.

Incidental findings in focused assessment with sonography for trauma in hemodynamically stable blunt trauma patients: speaking about cost to benefit.

Background: The purpose of this study was to identify which age-related groups of hemodynamically stable blunt trauma patients will present a positive cost-to-benefit ratio, in regard to the screening of incidental findings on Focused Assessment with Sonography for Trauma (FAST).

Methods: We conducted a prospective study using retrospective data taken from the trauma registry of 6,041 consecutive hemodynamically stable blunt trauma patients who underwent FAST at our Level I urban trauma hospital during the year 2009. A receiver operating characteristic curve was used to determine whether age level is useful in detecting organ-/system-specific incidental findings in trauma patients undergoing FAST and to establish the required diagnostic cutoff value of this selected test.

Laparoscopic versus open mesh repair for recurrent inguinal hernia: a meta-analysis of outcomes.

Background: The objective of this study was to examine the outcomes of comparisons between laparoscopic and open mesh repairs in the setting of recurrent inguinal hernia.

Methods: The electronic databases MEDLINE, Embase, Pubmed, and the Cochrane Library were used to search for articles from 1990 to 2008. The present meta-analysis pooled the effects of outcomes of a total of 1,542 patients enrolled into 5 randomized controlled trials and 7 comparative studies, using classic and modern meta-analytic methods.

The use of self-expanding stents in esophageal and gastroesophageal junction cancer palliation: a meta-analysis and meta-regression analysis of outcomes.

Background: The objective of this study was to examine the impact of self-expanding stents versus locoregional treatment modalities in the setting of esophageal cancer palliation.

Methods: The present meta-analysis pooled the effects of outcomes of 1,027 patients enrolled in 16 randomized controlled trials.

Results: The meta-analysis revealed an advantage to the use of stents compared to locoregional modality treatments with respect to the number of patients requiring reinterventions, although the latter treatment arm had a higher 1-year survival.

Extragastrointestinal stromal tumors of the omentum: review apropos of a case with a novel gain-of-function KIT mutation.

Introduction: We describe a case of extragastrointestinal stromal tumor (EGIST) of the omentum harboring a novel KIT mutation and review the literature on omental EGISTs, emphasizing on molecular genetic data.

Case Presentation: A large EGIST arising from the lesser omentum was incidentally diagnosed in a 68-year-old man during emergency laparotomy for intra-abdominal hemorrhage following a car accident. The tumor was composed of CD117+/CD34+ spindle-shaped cells with low mitotic activity.

Assessment of strangulated content of the spontaneously reduced inguinal hernia via hernia sac laparoscopy: preliminary results of a prospective randomized study.

This prospective randomized study aimed to evaluate the impact of hernia sac laparoscopy on the morbidity and mortality in cases with a spontaneous reduction of the strangulated hernia content before the assessment of its viability. Ninety-five patients underwent operation owing to incarcerated hernia. Forty-one patients, whose strangulated indirect inguinal hernia spontaneously reduced before the viability of the content was assessed, were included in this study.

Stapled versus Ferguson hemorrhoidectomy: is there any evidence-based information?

Aims: The objective of this study was to compare the perioperative, short-term, and long-term outcomes of stapled hemorrhoidectomy with Ferguson hemorrhoidectomy.

Materials And Methods: The present meta-analysis pooled the effects of outcomes of a total 926 patients treated with stapled or Ferguson hemorrhoidectomy in five out of 122 screened for retrieval randomized controlled trials using the fixed-effects or a random-effects model.

Results: Stapled hemorroidectomy was equivalent to the Ferguson procedure in comparisons pertaining to the following outcomes: hospital stay, postoperative hemorrhage requiring intervention, early postoperative bleeding <4 weeks, late postoperative bleeding <8 weeks, and the presence of anal pathology at 1 year follow-up.

Endoloop application as an alternative method for gastrotomy closure in experimental transgastric surgery.

Background: Experimental studies investigating transgastric endoscopic surgery report closure of the gastric wall incision with clips. The author of this report describes endoloop placement as an alternative, equally efficient, faster method for gastrotomy closure.

Methods: Eight female pigs with a mean weight of 30 kg were used.

Predictors of common bile duct lithiasis in laparoscopic era.

Aim: To analyze retrospectively the records of 294 consecutive patients operated upon for gallbladder stones, to determine the predictive factors of synchronous common bile duct (CBD) stones and validate prospectively the generated model.

Methods: The prognostic estimation of a biochemical test and ultrasonography alone to differentiate between the absence and presence of choledocholithiasis was assessed using receiver operating characteristics curve analysis. Multivariate analysis was employed using discriminant analysis for establishment of a best model.

Regional targeting chemoimmunotherapy in patients undergoing pancreatic resection in an advanced stage of their disease: a prospective randomized study.

Purpose: To evaluate in a prospective randomized study the long-term results of adjuvant locoregional chemoimmunotherapy in a number of patients with stage III pancreatic duct cancer who underwent pancreatic resection between November 1993 and October 2000.

Methods: One hundred twenty-eight patients were divided into three groups. Group A (n = 40) patients had surgical resection alone.