bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trocar site closure with a novel anchor-based (neoClose®) system versus standard suture closure: A prospective randomized controlled trial
Authors: Iranmanesh P , Bajwa K , Snyder B , Wilson T , Chandwani K , Shah S , Wilson E 
Published: May 2021

Abstract

Objective
Patients with obesity have a higher risk of trocar site hernia. The objective of the present study was to compare a standard suture passer versus the neoClose® device for port site fascial closure in patients with obesity undergoing laparoscopic bariatric surgery.

Methods
This is a randomized, controlled trial with two parallel arms. Thirty five patients with BMI ≥ 35 kg/m2 and undergoing laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass were randomized to each group. Port site fascial closure for trocars ≥ 10 mm was performed with the neoClose® device in the study group and the standard suture passer in the control group. Primary outcomes were time required to complete closure and intensity of postoperative pain at the fascial closure sites. Secondary outcomes were intraabdominal needle depth and incidence of trocar site hernia.

Results
The use of the neoClose® device resulted in shorter closure times (20.2 vs 30.0 s, p = 0.0002), less pain (0.3 vs 0.9, p = 0.002) at port closure sites, and decreased needle depth (3.3 cm vs 5.2 cm, p &lt; 0.0001) compared to the standard suture passer. There was no trocar site hernia at the one-year follow-up in either group.

Conclusion
Use of the neoClose® device resulted in faster fascial closure times, decreased intraoperative needle depth, and decreased postoperative abdominal pain at 1 week as compared to the standard suture passer. These data need to be confirmed on larger cohorts of patients with longer follow-up, especially in terms of long-term hernia recurrence rates.
Performing total extraperitoneal inguinal hernia repair in patients with previous abdominal surgery is safe: an analysis of 1591 patients
Authors: Merker H , Slieker J , Soppe S , Keerl A , Nocito A 
Published: May 2021

Abstract

Objective
The safety of endoscopic total extraperitoneal inguinal hernia repair (TEP) in patients who previously underwent open lower abdominal surgery has been discussed for many years, since operative difficulties can be expected due to adhesions and scarring. Some research has been done in this area, most of which ask for further studies to be conducted. The aim of this study was to assess the safety and feasibility of TEP in patients with previous lower abdominal surgery (PLAS).

Methods
We retrospectively analysed all patients who underwent a TEP inguinal hernia repair at our institution between July 2012 and May 2018. Previous lower abdominal surgery (PLAS) was defined as any previous open surgery with scarring below the umbilicus. In case of scars outside the midline, these were defined as PLAS when on the same side as the operated inguinal hernia. A univariate analysis as well as logistic regression were performed to identify outcomes of surgery between patients with- and without PLAS.

Results
In total 1591 patients were included in the study. 274 patients had PLAS, corresponding to 17.2%. Comparing to patients without PLAS, the group with PLAS had a significant higher risk of increased operation duration (odds ratio 1.07, p-value 0.004), but no increased risk of conversion, or intra- or postoperative complications. The highest significant risk of increasing operation duration was found after aortoiliac surgery (OR 2.08), bladder surgery (OR 1.71) or prostate surgery (odds ratio 1.22).

Conclusion
Performing TEP inguinal hernia repair after lower abdominal surgery slightly increases the operation duration, however there is no negative effect on the length of stay and the complication- or conversion rate. Therefore, we consider TEP to be a feasible and safe operation technique also for patients who previously underwent open lower abdominal surgery.
Does the non-absorbable suture closure of the jejunal mesenteric defect reduce the incidence and severity of internal hernias after laparoscopic Roux-en-Y gastric bypass?
Authors: Schneider R , Schulenburg M , Kraljević M , Klasen J M , Peters T , Wölnerhanssen B , Peterli R 
Published: May 2021

Abstract

Objective
Internal hernias (IH) are frequent complications after laparoscopic Roux-en-Y gastric bypass (LRYGB). Closure of the jejunal mesenteric and the Petersen defect reduces IH incidence in prospective and retrospective trials. This study investigates whether closing the jejunal mesenteric space alone by non-absorbable suture and splitting the omentum can be beneficial to prevent IH after LRYGB.

Methods
Observational cohort study of 785 patients undergoing linear LRYGB including omental split at a single institution, 493 without jejunal mesenteric defect closure, 292 with closure by non-absorbable suture with a minimal follow-up of 2 years. Patients were assessed for appearance and severity of IH. Additionally, open mesenteric gaps without herniated bowel, as well as early obstructions due to kinking of the entero-enterostomy (EE) were explored.

Results
By primary mesenteric defect closure, the rate of manifest jejunal mesenteric and Petersen IH could be reduced from 6.5% to 3.8%, but without reaching statistical significance. The most common location for an IH was the jejunal mesenteric space, where defect closure during primary surgery could reduce the rate of IH from 5.3% to 2.4%. Higher weight loss seemed to increase the risk of developing an IH.

Conclusion
The closure of the jejunal mesenteric defect by non-absorbable suture can reduce the rate of IH at the jejunal mesenteric space after LRYGB. However, the beneficial effect in our collective is smaller than expected, especially in patients with excellent weight loss. Petersen IH rate remained low by consequent T-shape split of the omentum without suturing of the defect.
Roux-en-Y gastric bypass with a long compared to a short biliopancreatic limb leads to better weight loss and glycemic control in obese mice
Authors: Schneider R , Kraljević M , Peterson C J , Lazaridis I , Rohm T V , Bosch A J T , Low A J Y , Vonaesch P , Peterli R , Delko T , Cavelti-Weder C 
Published: May 2021

Abstract

Objective
Roux-en-Y gastric bypass (RYGB) shows durable long-term weight loss and control of comorbidities in randomized controlled trials. However, the impact of the proportions of the biliopancreatic limb (BPL) and the total alimentary limb (TALL) on weight loss or glucose metabolism is still unclear.

Methods
Six weeks old C57BL/6J mice were fed high fat diet (HFD) to induce obesity and glucose intolerance. Mice underwent RYGB surgery with a very-long BPL (35% of total bowel length [TBL]), long BPL (25% of TBL), short BPL (15 % of TBL), or sham surgery. The alimentary limb (AL) was adjusted in dependency on the BPL to achieve a fixed CC length. Glycemia was assessment by intraperitoneal glucose tolerance tests.

Results
Mice undergoing RYGB with a very-long BPL showed excessive weight loss and mortality and were therefore excluded for further analyses. Total weight loss (TWL%) was significantly higher in the long BPL- compared to short BPL-group. Mice with a long BPL showed significantly improved glucose tolerance 14 days postoperatively, while 35 days postoperatively, the improvement in glucose tolerance with a long BPL was much less distinctive.

Conclusion
RYGB with a longer BPL leads to improved results including weight loss and glucose tolerance. However, the metabolic improvements seem to decrease over time. These findings could potentially be translated to humans by adjusting the BPL according to body weight and comorbidities. To avoid possible negative effects of a longer BPL total bowel length measurement is mandatory.
Comparison of injury patterns between electric bicycle, bicycle and motorcycle accidents
Authors: Spörri E , Pape H -C , Rauer T 
Published: May 2021

Abstract

Objective
Electric bicycles (E-bikes) are an increasingly popular means of transport, especially in the current Covid-19 pandemic situation. Accident statistics show that E-bikes are growingly involved in traffic accidents. This study evaluates the injury pattern and severity of E-bike injuries in direct comparison to injuries in motorcycle and bicycle accidents.

Methods
In a retrospective cohort study, the data of 1796 patients who were treated at a Level I Trauma Center between 2009 and 2018 due to traffic accident, involving bicycles, E-bikes or motorcycles, were evaluated and compared with regard to injury patterns and injury severity. Accident victims treated as inpatients with at least 16 years of age were included in this study. Pillion passengers and outpatients were excluded.

Results
The following distribution was found in the individual groups: 67 E-bike, 1141 bicycle and 588 motorcycle accidents. The injury pattern of E-bikers resembled that of bicyclists much more than that of motorcyclists. The patients with E-bike accidents were almost 14 years older and had a higher incidence of moderate traumatic brain injuries than patients with bicycle accidents. Considering the E-bike riders wore nearly twice as often a helmet as bicycle riders. In comparison, the motorcyclists involved in an accident had fewer facial injuries, but more frequent and more serious injuries to the spine, abdomen and lower extremities.

Conclusion
The overall E-bike injury pattern is similar to that of cyclists. The differences in the injury pattern to motorcycle accidents could be due to the higher speeds at the time of the accident, the different protection and vehicle architecture. What is striking, however, is the higher age and the increased craniocerebral trauma of the E-bikers involved in accidents compared to the cyclists. Older and untrained people who have a slower reaction time and less control over the E-bike could benefit from head protection or practical courses similar to motorcyclists.
Increased incidence of complicated acute appendicitis after the first COVID-19 pandemic peak: Have patients a different attitude towards COVID-hospitals?
Authors: Passoni S , Giuliani M , Arigoni M 
Published: May 2021

Abstract

Objective
The 11 March 2020 the World Health Organisation considered the COVID-19 Infection a pandemic disease. Between March and May 2020, the region of southern Switzerland was affected by the first pandemic peak, which was managed by dividing hospitals in Covid and non Covid facilities and by reducing elective surgery. At the end of the pandemic peak hospitals returned to their original structure but there was concern as to possible avoidance of former COVID facilities by patients because of fear of contracting of COVID-19 infection. For acute situations such as acute appendicitis, this could imply a delay of treatment. The aim of this retrospective study is to analyse the increment in incidence of complicated appendicitis in the post-pandemic period at our institution.

Methods
Clinical data of patients who underwent appendectomies in the period before and after the COVID-19 pandemic were analysed and compared. Diagnosis was based histopathological examination and/or on intra-operative or CT findings. Complicated appendicitis was defined as the presence of perforated or gangrenous appendicitis on histopathology or the presence of an abscess on CT scan. The incidence of complicated appendicitis, the time between onset of symptoms and patient admission (TOSA), the initial inflammatory blood tests and the complication rate was compared between the two periods.

Results
79 patients were included in the study, 31 in the post-COVID-19 peak group (A), April - October 2020, and 48 in the pre-pandemic group (B), April - October 2019. Incidence of complicated appendicitis was significantly higher in group A (55% vs 14% p = 0.02). These findings correlate with a greater TOSA (mean time 35 hours vs 17 hours, p = 0.01) and higher inflammatory values in the initial blood test, (mean WBC count 14.8 G/l vs 12.9 G/l, p = 0.08 and mean CRP value 73 mg/l vs 43 mg/l, p = 0.01) in group A.

Conclusion
Our data show a clear increase of incidence of complicated acute appendicitis after the pandemic peak in our hospital. Indeed patients tended to wait longer to visit our emergency department after the pandemic peak. One explanation is a possible fear by the patients of contracting COVID-19 infection in a former COVID hospital. Management of surgical emergencies during and after a pandemic peak phase should take into account the fact that patients may wait longer to visit a doctor thus aggravating the degree of their disease.
Comparison of two whole-body computer tomography protocols for polytrauma patients
Authors: van Veelen N , Studer S , van de Wall B , Babst R , Link B -C , Knobe M , Beeres F 
Published: May 2021

Abstract

Objective
The use of whole-body computed tomography (CT) is an established standard primary diagnostic method in the work up of polytrauma patients. The protocols used for such CTs however vary between trauma centers. In our Level 1 trauma Centre the protocol was changed from a three phase to a two phase protocol with different positioning of the patient. The primary aim of this study was to compare the estimated radiation dose and scan duration of the two protocols. The secondary aim was to evaluate whether the revision of the CT protocol led to a reduction of required additional imaging of the upper extremities.

Methods
For this retrospective, cross-sectional study two groups of consecutive trauma patients, which were treated in a level 1 trauma center in Switzerland and received a whole-body CT were analyzed. Group A consisted of patients, who presented between January and August 2016. These patients received a three-phased CT in which a repositioning of the arms from the side of the torso to above the head between phases two and three was needed. Group B consisted of those, who presented between January and July 2017. These patients received a CT according to a revised protocol, which was performed in two phases with the arms positioned ventral on a pillow to the torso throughout the entire CT. Scan duration, estimated radiation dose, number of upper extremity injuries, number of addition imaging (xray and CT) of the upper extremities within 24 hours of initial CT.

Results
A total of 182 patients were included in group A and 218 in group B. Baseline characteristics didn't differ, except for there being more males in group B (p 0.006). The estimated radiation dose was lower (15.0 mSv vs 22.9 mSv, p &lt; 0.001) and the scan duration shorter (4 vs 7 minutes, p &lt; 0.001) in group B. No difference could be shown in the number of upper extremity injuries detected. Further, the number of additional images of the upper extremities needed within 24 hours of the initial CT did not differ between the groups.

Conclusion
Both the estimated radiation dose and the scan duration of a whole-body CT scan in trauma patients can be reduced when a two phase protocol in which the arms are positioned on a pillow ventral to the torso is used instead of a three phase protocol with repositioning of the arms. The amount of additional imaging of the upper limb could not be reduced by having the arms visible on the scan.
Stress related growth after severe trauma: Investigating long-term psychiatric outcomes and coping mechanisms 20+ years after injury
Authors: Kalbas Y , Halvachizadeh S , Luidl A T , Zelle B , Pfeifer R , Pape H -C 
Published: May 2021

Abstract

Objective
There is limited research on the long-term psychiatric outcomes of severely injured patients. Those studies existing, focus on the negativ effects like post-traumatic stress disorder, anxiety and depression. Yet, also psychiatric improvements can be noticed in patients after severe trauma, mainly focused on stress related growth. In our study we investigated coping mechanisms in multiply injured patients at least 20 years after trauma.

Methods
631 patients, who suffered a severe injury between 1971 and 1990 were contacted 20 or more years later. All patients were 3 to 60 years of age when injured and were attended to at the same institution. 36 questions inspired by the stress related growth scale (SRGS) and the post-traumatic growth inventory (PGI) were enquired via a questionnaire. Questions touched on 5 specific topics relating to growth: 1) relationships to others, 2) personal strengths, 3) appreciation of life, 4) new possibilities and 5) spiritual change. Each question quantified improvements in specific areas: Possible answers were „None at all“, „some“ and „a great deal“.

Results
A total of 338 patients returned the questionnaire and could be included in our study. Gender distribution was 114 females (33,8%) to 223 males (66,8%). 96,5% of patients reported improvements regarding at least one of the 36 questions. Approximately a third of patients noticed distinct improvements regarding their relationship to others (29,2%) and their appreciation of life (36,2%). Furthermore, 32,5% of patients registered overall positive attitudes towards new possibilities. Referring to spiritual changes, only 20,5% of patients reported positive changes, while 55,7% reported no changes at all. Regarding personal strengths, 23,4% indicated overall positive changes compared with 35% indicating no changes at all.
Statistical analysis showed women to adapt significantly better (p &lt; 0,01) in every aspect besides spiritual changes. Furthermore, we noticed weak positive correlations between positive changes and age at injury (r = 0.26) as well as injury severity (r = 0.152). We saw, however no correlation with general health.

Conclusion
20 years after severe trauma, patients report improvements in their relationship with others, appreciation of life and attitude towards new possibilities. Such coping mechanisms, as results of stress related growth, should be identified and fostered in clinical practice.
ORIF versus nailing for humeral shaft fractures: A meta-analysis and systematic review of randomised clinical trials and observational studies
Authors: van de Wall B , van Veelen N , Babst R , Link B , Knobe M , Beeres F 
Published: May 2021

Abstract

Objective
This meta-analysis aims to compare open reduction and internal fixation with a plate (ORIF) versus nailing for humeral shaft fractures in terms of healing, complications, general quality of life and shoulder/elbow function.

Methods
PubMed/Medline/Embase/CENTRAL/CINAHL was searched for both randomised clinical trials (RCT) and observational studies comparing ORIF with nailing for humeral shaft fractures. Effect estimates were pooled across studies using random effects models and presented as weighted odds ratio (OR) or risk difference (RD) with corresponding 95% confidence interval (95%CI). Subgroup analysis was performed stratified by study design (RCTs and observational studies).

Results
A total of ten RCT's (525 patients) and eighteen observational studies (4906 patients) were included. The effect estimates obtained from observational studies and RCT's were similar in direction and magnitude. More patients treated with nailing required re-intervention (RD: 2%; OR 2.0, 95%CI 1.0 – 3.8) with shoulder impingement being the most predominant indication (17%). Temporary radial nerve palsy secondary to operation occurred less frequently in the nailing group (RD: 2%; OR 0.4, 95% CI 0.3 – 0.6). Notably, all but one of the radial nerve palsies resolved sponta-neously in each groups. Nailing leads to a faster time to union (mean difference: -1.9 weeks, 95%CI -2.9 – -0.9), lower infection rate (RD: 2%; OR: 0.5, 95%CI 0.3 – 0.7) and shorter operation duration (mean difference: -26 minutes, 95%CI -37 – -14). No differences were found regarding non-union, general quality of life, functional shoulder scores, and total upper extremity scores.

Conclusion
Nailing carries a lower risk of infection, postoperative radial nerve palsy, shorter operation duration, and time to union. Absolute differences, however, are small and almost all patients with radial nerve palsy recovered spontaneously. Satisfactory results can be achieved with both treatment modalities and both techniques have their inherent pros and cons.
MIPO vs. nail for extra-articular distal tibia fractures and the effect of intra-operative alignment control
Authors: Bleeker N J , van Veelen N , van de Wall B , Link B -C , Babst R , Knobe M , Beeres F 
Published: May 2021

Abstract

Objective
Definitive treatment of distal extra-articular fractures of the tibia is challenging and both minimal invasive plate osteosynthesis (MIPO) and intramedullary nailing (IMN) are considered feasible surgical modalities with their own implant-specific merits and demerits. This retrospective study was designed to compare MIPO versus IMN in terms of fracture healing, complications, functional and radiological outcomes and to assess the efficacy of intra-operative alignment control in order to reduce the rate of malalignment after definitive fixation of distal extra-articular fractures of the tibia.

Methods
All consecutive adult patients with extra-articular distal meta- or diaphyseal tibia fractures that were treated in a level 1 trauma center in Switzerland between January 2012 and September 2019 either with plating or IMN were included. Outcome measures included fracture healing, complications (infection, malalignment, subsequent sur-geries), functional and radiological outcomes. Intra-operative alignment control encompassed bilateral draping of the lower extremities.

Results
A total of 135 patients were included out of which seventy-two patients (53%) were treated with MIPO and 63 patients (47%) underwent IMN. There was a significantly higher incidence of non-union for fractures treated with an IMN (13 (22%) vs. 4 (6%), p = 0.037). There was no significant difference between both groups in terms of rotational malalignment (4% vs. 9%) and angular malalignment (4% vs. 5%). The incidence of malalignment in both groups was lower than reported in literature. A significantly higher rate of infection was found after MIPO (13% vs. 6%, p = 0.028). No differences were found in subsequent surgeries or functional outcomes.

Conclusion
Both MIPO and IMN are reliable surgical techniques. IMN is associated with higher rates of non-union whereas MIPO results in a higher risk for infection. The incidence of malalignment was surprisingly low endorsing the utility of the intra-operative alignment control.