Robotic-assisted versus laparoscopic incisional hernia repair: a systematic review and meta-analysis

PURPOSE

This study aimed to perform a systematic review and meta-analysis comparing the efficacy and safety outcomes of robotic-assisted and laparoscopic techniques for incisional hernia repair.

METHODS

PubMed, Embase, Scopus, Cochrane databases, and conference abstracts were systematically searched for studies that directly compared robot-assisted versus laparoscopy for incisional hernia repair and reported safety or efficacy outcomes in a follow-up of ≥ 1 month. The primary endpoints of interest were postoperative complications and the length of hospital stay.

RESULTS

The search strategy yielded 2104 results, of which four studies met the inclusion criteria. The studies included 1293 patients with incisional hernia repairs, 440 (34%) of whom underwent robot-assisted repair. Study follow-up ranged from 1 to 24 months. There was no significant difference between groups in the incidence of postoperative complications (OR 0.65; 95% CI 0.35-1.21; p = 0.17). The recurrence rate of incisional hernias (OR 0.34; 95% CI 0.05-2.29; p = 0.27) was also similar between robotic and laparoscopic surgeries. Hospital length of stay (MD - 1.05 days; 95% CI - 2.06, - 0.04; p = 0.04) was significantly reduced in the robotic-assisted repair. However, the robot-assisted repair had a significantly longer operative time (MD 69.6 min; 95% CI 59.0-80.1; p < 0.001).

CONCLUSION

The robotic approach for incisional hernia repair was associated with a significant difference between the two groups in complications and recurrence rates, a longer operative time than laparoscopic repair, but with a shorter length of stay.

Impact of natural control agents of the citrus leafminer Phyllocnistis citrella on lemon trees varies among seasons

Studies on insect natural enemies and their effects on host populations are of immense practical value in pest management. Predation and parasitism on a citrus pest, the leafminer Phyllocnistis citrella Stainton, were evaluated by sampling over 3 years in four locations within a world leading lemon producing area in Northwest Argentina. Both mortality factors showed seasonal trends consistent across locations, with predation exerting earlier and more sustained pressure than parasitism, which showed wider seasonal variations. The dominant parasitoids, native Cirrospilus neotropicus and introduced Ageniaspis citricola, showed different seasonal trends: C. neotropicus was dominant in spring whereas A. citricola superseded it in autumn and winter. Although parasitism rates were relatively low, the native C. neotropicus revealed favourable features as potential control agent, by showing density-dependence, parasitism rates comparable with those of the specific A. citricola during part of the cycle, and earlier synchronization with the host. The study provides highly relevant information for a sustainable management of this worldwide pest, for which biological control is considered the best long-term option.

Larvicide and oviposition deterrent effects of fruit and leaf extracts from Melia azedarach L. on Aedes aegypti (L.) (Diptera: Culicidae)

Aedes aegypti (L.) (Diptera: Culicidae), the main urban vector of dengue, has developed resistance to various insecticides, making its control increasingly difficult. We explored the effects of Argentine Melia azedarach L. (Meliaceae) fruit and senescent leaf extracts on Ae. aegypti larval development and survival, by rearing cohorts of first instar mosquitoes in water with different extract concentrations. We also analysed oviposition deterrent activity in choice tests with extract-treated ovitraps. The leaf extract showed a strong larvicide activity, with all larvae dying before pupation, and significantly delayed development time. It strongly inhibited oviposition by Ae. aegypti females. The fruit extract showed much weaker effects. This first report of highly effective larvicidal, growth regulating and oviposition deterrent activity of a senescent leaf extract of M. azedarach against Ae. aegypti, suggests that such extract could represent a promising tool in the management of this mosquito pest.

[Acute myocardial infarction complicating radiofrequency catheter ablation in a girl]

Paroxysmal supraventricular tachycardia is the most common tachyarrhythmia in childhood and adolescence. The current treatment of choice for managing and preventing frequent recurrences is radiofrequency catheter ablation, which provides a definitive solution in most cases. This technique is very effective but not devoid of potential complications, particularly in children and adolescents. We report the case of a 3-year-old girl who suffered acute myocardial infarction after occlusion of the right coronary artery during this procedure. We describe intraoperative and postoperative management. Progress was good and the patient was discharged 14 days after ablation.

Insecticide and antifeedant activity of different plant parts of Melia azedarach on Xanthogaleruca luteola

In laboratory choice and no-choice bioassays, treatment of elm leaves with extracts obtained from unripe fruits and green or senescent leaves of Melia azedarach at 1-10% concentration significantly deterred feeding by adults of the elm leaf beetle, Xanthogaleruca luteola. Also, in no-choice tests, adults fed on leaves treated with 2, 5 or 10% extract showed a dramatic increase in mortality rates. Extracts from the different plant structures were similarly active, and starvation as a consequence of their strong antifeedant activity could play a significant role in the high mortality values observed.

Differential susceptibility to DL-alpha-difluoromethylornithine in clinical isolates of Trypanosoma brucei rhodesiense

DL-alpha-Difluoromethylornithine is an enzyme-activated inhibitor of ornithine decarboxylase and an antagonist of polyamine metabolism that has been successful in clinical trials against West African sleeping sickness caused by Trypanosoma brucei gambiense. Its potential for use against the more virulent East African form of the disease, caused by T. brucei rhodesiense, is not certain. We examined 14 East African clinical isolates from the Kenya Trypanosomiasis Research Institute strain bank plus 2 established isolates for susceptibility to DL-alpha-difluoromethylornithine and to standard trypanocides. Seven of 16 strains were partially or totally refractory to DL-alpha-difluoromethylornithine in our test system. Four strains were also refractory to arsenical drugs, and five were refractory to diamidines. The results indicate that other novel agents or combinations of established agents may be needed for chemotherapy of East African disease.

[Hemoglobin, serum iron and transferrin saturation among users of intrauterine devices and oral contraceptive agents]

We studied 60 females using either intrauterine device or taking oral contraceptive pills. Hemoglobin, serum iron, total iron binding capacity and saturation of transferrin were determined before and 4 and 10 months after starting a responsible paternity program. Women with a basal hemoglobin level below 12 g/dl were excluded. Age, parity and hematologic parameters were similar for both groups. A significant decrease in hemoglobin level and saturation of transferrin was observed at 10 months in intrauterine device users (13.6 to 13.1 g/dl and 36.2 to 26.9%, respectively). Use of oral contraceptive pills was not associated to hemoglobin decrease but a significant rise in saturation of transferrin was observed (36.2 to 43.9%, p less than 0.05).