62 Single- Versus Double-Layer Uterine Closure After Cesarean Section Delivery: A Systematic Review and Meta-Analysis

Aim

To compare single-layer (SL) with double-layer (DL) uterine closure techniques after caesarean section in terms of ultrasonographic findings and rate of CS complications.

Method

PubMed, Scopus, Web of Science, and Cochrane Library were searched for relevant randomized clinical trials (RCTs). Retrieved articles were screened, and relevant studies were included in a meta-analysis. Continuous data were pooled as mean difference (MD) with 95% confidence interval (CI), and dichotomous data were pooled as relative risk (RR) and 95% CI. Analysis was conducted using RevMan software (Version 5.4).

Results

Eighteen RCTs were included in our study. Pooled results favoured DL uterine closure in terms of residual myometrial thickness (MD = -1.15, 95% CI [-1.69, -0.60], P < 0.0001) and dysmenorrhea (RR = 1.36, 95% CI [1.02, 1.81], P = 0.04), while SL closure had shorter operation time than DL closure (MD = -2.25, 95% CI [-3.29, -1.21], P < 0.00001). Both techniques had similar results in terms of uterine dehiscence or rupture (RR = 1.88, 95% CI [0.63, 5.62], P = 0.26), healing ratio (MD = -5.00, 95% CI [-12.40, 2.39], P = 0.18), maternal infectious morbidity (RR = 0.94, 95% CI [0.66, 1.34], P = 0.72), hospital stay (MD = -0.12, 95% CI [-0.30, 0.06], P = 0.18), and readmission rate (RR = 0.95, 95% CI [0.64, 1.40], P = 0.78).

Conclusions

DL closure of caesarean uterine scar is associated with more residual myometrial thickness and less dysmenorrhea compared with SL uterine closure. But SL closure has the advantage of the shorter operation time.

63 Effects of Surgery, Chemotherapy, and Radiation on Hepatocellular Carcinoma Patients: A SEER-Based Cohort study

Aim

To assess the effect of surgery, chemotherapy, and radiation on the mortality risk in hepatocellular carcinoma (HCC) patients.

Method

A retrospective cohort study, obtaining HCC patients' data from the Surveillance, Epidemiology, and End Results (SEER) database. We used Pearson's chi-square test for evaluating the association between the different variables, the Kaplan–Meier, and the Cox regression tests in the univariate and multivariate analyses respectively.

Results

A total of 68270 HCC patients were analysed. In patients who performed surgery, the mortality risk was higher in patients aged ≥50 years, Black, single, and widowed, regional, and distant stages, and grades II, III, and IV (HR, 1.143), (HR, 1.057), (HR, 1.095), (HR, 1.284), (HR, 1.341), (HR, 2.291), (HR, 1.125), (HR, 1.711), and (HR, 1.894) respectively. In patients who received chemotherapy, the risk was lower in females (HR, 0.948), but higher in widowed (HR, 1.143), in regional and distant stages (HR, 1.479), and (HR, 2.439) respectively, and grades III, and IV (HR, 1.741), and (HR, 1.688) respectively. In patients who received beam radiation, the risk was higher in Black (HR, 1.195), widowed (HR, 1.181), regional (HR, 1.439), and distant stages (HR, 2.287), and in grades III (HR, 1.594), and IV (HR, 1.694).

Conclusions

In HCC patients, Black, widowed, regional, and distant stages, grades III and IV had higher mortality risks in several treatment options. In patients who underwent surgery, ≥50 years years and grade II also had a higher risk. We recommend future research to assess the radiation sequence with surgery.

Comparison between TAPP & Lichtenstein techniques for inguinal hernia repair: A retrospective cohort study

Background

Worldwide, inguinal hernia repair is one of the commonest surgeries. The best treatment option to primary hernia has been investigated, but there still remains lack of evidence about the ideal approach. Therefore, this study aimed to compare the outcomes of inguinal hernia repair using transabdominal preperitoneal procedure (TAPP) & Lichtenstein techniques.

Materials and methods

This was a retrospective cohort study, conducted at Department of General & Minimal Invasive Surgery, SKIMS Medical College, Bemina, Srinagar. For performing the analysis, we used SPSS. Continuous variables were expressed as mean and standard deviation, and the categorical ones were presented as frequencies and percentages.

Results

A total of 60 patients were included (30 in each group). The mean age of the patients in both groups was around 54 years, and all patients were males. In unilateral cases the operating time was greater in the TAPP group than the Lichtenstein group (p < 0.001); however, in the bilateral cases, the operating time was significantly greater in the Lichtenstein than the TAPP group (p = 0.003). The pain scores, in unilateral cases, were significantly lower in the TAPP group than the Lichtenstein group (p < 0.001). The overall complication rate in the TAPP group was 6.7% while in the Lichtenstein group it was at 23.3%. In unilateral and bilateral cases, the patients significantly returned to work earlier in the TAPP group than those in the Lichtenstein group (p < 0.001).

Conclusion

TAPP and Lichtenstein techniques are both safe and reliable techniques for inguinal hernia repair. However, TAPP repair showed lesser post-operative pain, earlier discharge from the hospital, earlier return to usual activities, better cosmetic outcomes, and less persisting pain. However, there was no significant difference in the complication rate and TAPP repair was more costly for the patient.

•

In unilateral inguinal hernia, operating time was significantly greater in TAPP group.

•

In bilateral hernia, operating time was significantly greater in Lichtenstein group.

•

In all cases, pain was significantly lower with TAPP than Lichtenstein groups.

•

The overall complication rate was not significant between the two groups.

•

Occult hernias on the opposite side could be identified in the TAPP group.

Indications and Complications of Hepatic Resection Patients at Sher-I-Kashmir Institute of Medical Sciences: An Observational Study

Aim: This study aimed to determine the indications and demographic profile of hepatic resection at Sher-I-Kashmir Institute of Medical Sciences (SKIMS), the performed types of hepatic resection, as well as assess the details of the operation and perioperative complications of hepatic resection.

Methods: This is a prospective, retrospective observational study. The retrospective study period was from January 2005 to August 2015 and the prospective study period was from 2015 till 2017. Prospective patients were clinically evaluated by medical history and clinical examination and also underwent various investigations. The patients were scored on Child-Pugh and American Society of Anesthesiology (ASA) scores for risk stratification and prepared for surgery, which included segmentectomy to major liver resection. The retrospective data were obtained from the Medical Records Department (MRD). Statistical analysis was done on SPSS software 25.0 version (Armonk, NY: IBM Corp.).

Results: This study included 122 patients with a male to female ratio of 1:1.59. The patients' age was between 1 and 73 years. The patients' most common complaint was right upper quadrant abdominal pain. The main established clinical diagnosis was oriental cholangiohepatitis (OCH) (36.9%) followed by carcinoma of gallbladder (CaGB) which accounted for 37 cases (30.4%). Liver metastases including solitary masses and multiple lesions were 10 cases (8.2%). Fifty-five patients underwent left lateral segmentectomy (45.1%) and mostly for OCH. Standard wedge resection was done in 30.7% of cases and for all cases of CaGB. The mean blood loss was 146.5 ml. A total of 37 patients had complications. Wound infection was the most common complication, occurring in 10 patients (8.2%).

Conclusion: Patients with hepatobiliary pathology, necessitating liver resection are now routinely admitted to the Department of Surgical Gastroenterology in SKIMS, Srinagar. Patients are carefully evaluated and operated with a confirmed definitive diagnosis. The overall surgical outcome does not differ from India's best centers.

Single- Versus Double-Layer Uterine Closure After Cesarean Section Delivery: A Systematic Review and Meta-Analysis

Cesarean section (CS) delivery is a common procedure, and its incidence is increasing globally. To compare single-layer (SL) with double-layer (DL) uterine closure techniques after cesarean section in terms of ultrasonographic findings and rate of CS complications. PubMed, Scopus, Web of Science, and Cochrane Library were searched for relevant randomized clinical trials (RCTs). Retrieved articles were screened, and relevant studies were included in a meta-analysis. Continuous data were pooled as mean difference (MD) with 95% confidence interval (CI), and dichotomous data were pooled as relative risk (RR) and 95% CI. Analysis was conducted using RevMan software (Version 5.4). Eighteen RCTs were included in our study. Pooled results favored DL uterine closure in terms of residual myometrial thickness (MD = -1.15; 95% CI -1.69, -0.60; P < 0.0001) and dysmenorrhea (RR = 1.36; 95% CI 1.02, 1.81; P = 0.04), while SL closure had shorter operation time than DL closure (MD = -2.25; 95% CI -3.29, -1.21; P < 0.00001). Both techniques had similar results in terms of uterine dehiscence or rupture (RR = 1.88; 95% CI 0.63, 5.62; P = 0.26), healing ratio (MD = -5.00; 95% CI -12.40, 2.39; P = 0.18), maternal infectious morbidity (RR = 0.94; 95% CI 0.66, 1.34; P = 0.72), hospital stay (MD = -0.12; 95% CI -0.30, 0.06; P = 0.18), and readmission rate (RR = 0.95; 95% CI 0.64, 1.40; P = 0.78). Double-layer uterine closure shows more residual myometrial thickness and lower incidence of dysmenorrhea than single-layer uterine closure of cesarean section scar. But single-layer closure has the advantage of the shorter operation time. Both methods have comparable blood loss amount, healing ratio, hospital stay duration, maternal infection risk, readmission rate, and uterine dehiscence or rupture risk.

Effects of surgery, chemotherapy, and radiation on hepatocellular carcinoma patients: A SEER-based study

Background

Hepatocellular carcinoma (HCC) is a major global health issue, accounting for 75%-85% of primary liver cancer cases. HCC has huge molecular heterogeneity, and the treatment varies among the patients. The aim of this study is assess the effect of surgery, chemotherapy, and radiation on the mortality risk in hepatocellular carcinoma (HCC) patients.

Methods

A retrospective cohort study, obtaining HCC patients' data from the Surveillance, Epidemiology, and End Results (SEER) database. The analyses were conducted using the SPSS software. We investigated the effect of surgery, chemotherapy, and radiation on the mortality risk factors using the Kaplan-Meier and the Cox regression tests in the univariate and multivariate analyses.

Results

A total of 68270 HCC patients, of whom 56347 patients died, were analyzed. In patients who performed surgery, the mortality risk was higher in patients aged ≥50 years, Black, single and widowed, regional and distant stages, and grades II, III, and IV (HR, 1.143), (HR, 1.057), (HR, 1.095), (HR, 1.284), (HR, 1.341), (HR, 2.291), (HR, 1.125), (HR, 1.711), and (HR, 1.894) respectively. In patients who received chemotherapy, the risk was lower in females (HR, 0.948), but higher in widowed (HR, 1.143), in regional and distant stages (HR, 1.479), and (HR, 2.439) respectively, and grades III, and IV (HR, 1.741), and (HR, 1.688) respectively. In patients who received beam radiation, the risk was higher in Black (HR, 1.195), widowed (HR, 1.181), regional (HR, 1.439), and distant stages (HR, 2.287), and in grades III (HR, 1.594), and IV (HR, 1.694).

Conclusion

In HCC patients, Black, widowed, regional, and distant stages, grades III and IV had higher mortality risks in several treatment options. In patients who underwent surgery, ≥50 years and grade II also had a higher risk. We recommend future research to assess the radiation sequence with surgery.