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PURPOSE: Accidental ureteric injury during colorectal surgery is a rare but dreadful event. It is associated with a higher risk of urinary tract infection (UTI) and acute kidney injury (AKI). Prophylactic placement of double J stents could improve ureteral identification and decrease the chance of accidental ureteral injury. METHODS: We searched MEDLINE, Cochrane, Central Register of Clinical Trials, and Web of Science for studies published until March 2024. Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled with a random-effects model. Statistical significance was defined as p < 0.05. Heterogeneity was assessed using the Cochran Q test and I2 statistics, with p-values inferior to 0.10 and I2 > 25% considered significant. Statistical analysis was conducted in RStudio version 4.4.1. RESULTS: Eleven observational studies were included, comprising 71,784 patients. Among them, 11,723 (16.4%) were submitted to a prophylactic ureteral stent while 59,961 (83.6%) were not. There was no significant difference in ureteral injury between the groups (0.66% vs 0.8%; OR 1.45; 95% CI 0.43-4.87; p = 0.552; I2 = 56%). Prophylactic stent placement was associated with an increase in AKI (1.7% vs. 0.56%; OR 1.54; 95% CI 1.24-1.91; p < 0.001; I2 = 44%), operative time (MD 24.8 min; 95% CI 4.9-44.8; p = 0.01; I2 = 91%), and a decrease in mortality (OR 0.11; 95% CI 0.05-0.23; p < 0.001; I2 = 42%). No differences were observed in UTI, hematuria, length of hospital stays, and reoperation. CONCLUSION: In colorectal surgery, prophylactic ureteral stents were associated with increased AKI and operative time. No significant difference was observed in ureteral injury, UTI, hematuria, length of hospital stays, and reoperation.

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INTRODUCTION: Laparoscopic cholecystectomy is one of the most frequently performed procedures by general surgeons. Strategies for minimizing bile duct injuries including use of the critical view of safety method, as outlined by the SAGES Safe Cholecystectomy Program, are not always possible. Subtotal cholecystectomy has emerged as a safe "bail-out" maneuver to avoid iatrogenic bile duct injury in these difficult cases. Strasberg and colleagues defined two main types of subtotal cholecystectomies: reconstituting and fenestrating. As there is a paucity of studies comparing the two subtypes of laparoscopic subtotal cholecystectomy (LSC), we performed a systematic review and meta-analysis comparing the reconstituting and fenestrating techniques for managing the difficult gallbladder. METHODS: A search of PubMed, Embase, and Cochrane databases was conducted to identify prospective and retrospective studies comparing fenestrating and reconstituting LSC. The outcomes of interest were bile leak, reoperation, readmissions, completion cholecystectomy, postoperative ERCP, and retained CBD stones. RESULTS: We screened 2855 studies and included 13 studies with a total population of 985 patients. Among them, 330 patients (33.5%) underwent reconstituting LSC and 655 patients (55.5%) underwent fenestrating LSC. Twelve studies were retrospective, and one was prospective. Notably, reconstituting STC was associated with decreased incidence of bile leak (OR 0.29; CI 95% 0.16-0.55; p = 0.0002; I2 = 36%). We also noted increased rates of postoperative ERCP with fenestrating STC in sensitivity analysis (OR 0.32; CI 95% 0.16-0.64; p = 0.001; I2 = 31%). In addition, there was no difference between the two techniques regarding the rates of completion of cholecystectomy, reoperation, readmission, and retained CBD stones. CONCLUSIONS: Fenestrating LSC leads to a higher incidence of postoperative bile leakage. In addition, our sensitivity analysis revealed that the fenestrating technique is associated with a higher incidence of postoperative ERCP. Further randomized trials and studies with longer-term follow-up are still necessary to better understand these techniques in the difficult gallbladder cases.

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BACKGROUND: Ventral hernia repair (VHR) is often performed in patients with obesity. While panniculectomy improves cosmetic outcomes, it may increase complications, particularly wound-related adverse events. Despite its widespread use, the impact of concurrent panniculectomy on postoperative complications in VHR remains unclear. This study aimed to assess whether concurrent panniculectomy increases postoperative complications in VHR. METHODS: We searched PubMed, Scopus, Web of Science, and Cochrane databases for studies published up to April 2024 comparing surgical outcomes in patients undergoing VHR with and without concurrent panniculectomy. We assessed recurrence, seroma, hematoma, surgical site infections (SSI), wound dehiscence, skin necrosis, chronic wound, length of stay (LOS), readmissions, duration of surgery, and deep venous thromboembolism (DVT). Risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were pooled for dichotomous and continuous endpoints, respectively. We used RStudio for statistics and heterogeneity was assessed with I2 statistics. RESULTS: We screened 890 studies, fully reviewed 40, and included 11 observational studies and 2 randomized controlled trials, comprising 23,354 patients. Of these, 2,972 (13%) patients underwent VHR with concurrent panniculectomy (VHR-PAN). The mean age ranged from 37 to 59 years, and 73% of the sample were women. The mean BMI varied from 29 to 45 kg/m2, and 75% of the patients underwent mesh repair. The mean defect area ranged from 36 to 389 cm2. Most repairs were performed using mesh (75%) in an underlay position (68%) and 24% underwent component separation. VHR-PAN was associated with a decrease in recurrence rates (RR 0.74; 95% CI 0.62 to 0.89; p < 0.001; I2 = 1%) with a follow-up ranging from 1 to 36 months. Furthermore, subgroup analysis of recurrence in studies with a mean follow-up of at least one year also showed a reduction in recurrence (RR 0.72; 95% CI 0.60 to 0.88; p < 0.001; I2 = 12%), with a follow-up ranging from 12 to 36 months. Moreover, concurrent panniculectomy was associated with increased SSI (RR 1.31; 95% CI 1.13 to 1.51; p < 0.001; I2 = 0%), SSO (RR 1.49; 95% CI 1.26 to 1.77; p < 0.001; I2 = 11%), skin necrosis (RR 2.94; 95% CI 1.26 to 6.85; p = 0.012; I2 = 0%) and reoperation (RR 1.73; 95% CI 1.32 to 2.28; p < 0.001; I2 = 0%), and longer LOS (MD 0.90 day; 95%CI 0.40 to 1.40; p < 0.001; I2 = 56%). There was no significant difference in ocurrence of DVT, enterocutaneous fistula, hematoma, seroma, or wound dehiscence, neither on operative time or readmission rates. CONCLUSION: VHR-PAN is associated with lower recurrence rates. However, it increases the risk of wound morbidity and reoperation and prolongs hospital stay. Surgeons should carefully weigh the risks and benefits of performing VHR-PAN. STUDY REGISTRATION: A review protocol for this systematic review and meta-analysis was registered at PROSPERO (CRD42024542721).

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Laparoscopic cholecystectomy (LC) is the established gold standard treatment for benign gallbladder diseases. However, robotic cholecystectomy is still controversial. Therefore, we aimed to compare intraoperative and postoperative outcomes in LC and robotic-assisted cholecystectomy (RAC) in patients with nonmalignant gallbladder conditions. PubMed, Scopus, Cochrane Library, and Web of Science were systematically searched for studies comparing RAC to LC in patients with benign gallbladder disease. Only randomized trials and non-randomized studies with propensity score matching were included. Mean differences (MDs) were computed for continuous outcomes and odds ratios (ORs) for binary endpoints, with 95% confidence intervals (CIs). Heterogeneity was assessed with I2 statistics. Statistical analysis was performed using Software R, version 4.2.3. A total of 13 studies comprising 22,440 patients were included, of whom 10,758 patients (47.94%) underwent RAC. The mean age was 48.5 years and 65.2% were female. Compared with LC, RAC significantly increased operative time (MD 12.59 min; 95% CI 5.62-19.55; p < 0.01; I2 = 79%). However, there were no significant differences between the groups in hospitalization time (MD -0.18 days; 95% CI - 0.43-0.07; p = 0.07; I2 = 89%), occurrence of intraoperative complications (OR 0.66; 95% CI 0.38-1.15; p = 0.14; I2 = 35%) and bile duct injury (OR 0.99; 95% CI 0.64, 1.55; p = 0.97; I2 = 0%). RAC was associated with an increase in operative time compared with LC without increasing hospitalization time or the incidence of intraoperative complications. These findings suggest that RAC is a safe approach to benign gallbladder disease.

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PURPOSE: Coloanal anastomosis with loop diverting ileostomy (CAA) is an option for low anterior resection of the rectum, and Turnbull-Cutait coloanal anastomosis (TCA) regained popularity in the effort to offer patients a reconstructive option. In this context, we aimed to compare both techniques. METHODS: PubMed, Cochrane, and Scopus were searched for studies published until January 2024. Odds ratios (RRs) with 95% confidence intervals (CIs) were pooled with a random-effects model. Statistical significance was defined as p < 0.05. Heterogeneity was assessed using the Cochran Q test and I2 statistics, with p-values inferior to 0.10 and I2 >25% considered significant. Statistical analysis was conducted in RStudio version 4.1.2 (R Foundation for Statistical Computing). Registered number CRD42024509963. RESULTS: One randomized controlled trial and nine observational studies were included, comprising 1,743 patients, of whom 899 (51.5%) were submitted to TCA and 844 (48.5%) to CAA. Most patients had rectal cancer (52.2%), followed by megacolon secondary to Chagas disease (32.5%). TCA was associated with increased colon ischemia (OR 3.54; 95% CI 1.13 to 11.14; p < 0.031; I2 = 0%). There were no differences in postoperative complications classified as Clavien-Dindo ≥ IIIb, anastomotic leak, pelvic abscess, intestinal obstruction, bleeding, permanent stoma, or anastomotic stricture. In subgroup analysis of patients with cancer, TCA was associated with a reduction in anastomotic leak (OR 0.55; 95% CI 0.31 to 0.97 p = 0.04; I2 = 34%). CONCLUSION: TCA was associated with a decrease in anastomotic leak rate in subgroups analysis of patients with cancer.

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