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The article discusses surgical techniques for repairing rectal prolapse, specifically focusing on robotic mesh rectopexy using the Geneva technique. The text explains that there are various approaches to rectal prolapse repair, ranging from perineal approaches to transabdominal approaches. The article highlights the diversity of methods for transabdominal rectopexy and the lack of strong evidence to compare these techniques. It also mentions that minimally invasive rectopexy using robotics may improve patient outcomes compared to laparoscopy. The article provides a step-by-step description of the robotic mesh rectopexy procedure, including patient positioning, port insertion, laparoscopic exploration, docking of the surgical robot, dissection, mesh preparation and stitching, and peritoneum closure. The authors of the article are listed, and a conflict of interest statement is included. [Extracted from the article]

Background: Prophylactic negative-pressure wound therapy (pNPWT) may prevent surgical site infection (SSI) after laparotomy, but existing meta-analyses pooling only high-quality evidence have failed to confirm this effect. Recently, several randomized controlled trials (RCTs) have been published. We performed an updated systematic review and meta-analysis to determine if pNPWT reduces the incidence of SSI after laparotomy. Methods: MEDLINE, Embase, CENTRAL and Web of Science were searched on the 25.08.2021 for RCTs reporting on the incidence of SSI in patients who underwent laparotomy with and without pNPWT. The systematic review was compliant with the AMSTAR2 recommendation and registered into PROSPERO. Risk ratios (RR) for SSI in patients with pNPWT, and risk difference (RD) between control and pNPWT patients, were obtained using random effects models. Heterogeneity was quantified using the I2 value, and investigated using subgroup analyses, funnel plots and bubble plots. Risk of bias of included RCTs was assessed using the RoB2 tool. Results: Eleven RCTs were included, representing 973 patients who received pNPWT and 970 patients who received standard wound dressing. Pooled RR and RD between patients with and without pNPWT were of, respectively, 0.665 (95% CI 0.49–0.91, I2: 38.7%, p = 0.0098) and −0.07 (95% CI −0.12 to −0.03, I2: 53.6%, p = 0.0018), therefore demonstrating that pNPWT decreases the incidence of SSI after laparotomy. Investigation of source of heterogeneity identified a potential small-study effect. Conclusion: The protective effect of pNPWT against SSI after laparotomy is confirmed by high-quality pooled evidence. [ABSTRACT FROM AUTHOR]

This article discusses the potential impact of electronic nicotine delivery systems (ENDS), commonly known as e-cigarettes, on the postoperative course in colorectal surgery. While traditional tobacco smoking has been shown to increase the incidence of surgical site infection and anastomotic leak, the effects of ENDS have not yet been explored. Some scientific societies urge caution and consider ENDS to be similar to traditional tobacco smoking, while others view them as a safe alternative. However, the article notes that there is a lack of literature on the impact of ENDS in colorectal surgery, despite their increasing use. The authors call for further studies to evaluate the effect of ENDS on surgical site infection and anastomotic leak in colorectal surgery. [Extracted from the article]

Objective: This study aimed to determine which bariatric procedure allows patients to obtain the best weight‐loss outcomes and a remission of type 2 diabetes. Methods: Databases were searched for randomized‐controlled trials comparing Roux‐en‐Y gastric bypass (RYGB) with sleeve gastrectomy (SG) or one‐anastomosis gastric bypass (OAGB). The mean difference (MD) or the relative risk was determined. Results: Twenty‐five randomized‐controlled trials were analyzed. Excess weight loss (EWL, percentage) was greater for RYGB patients at 3 years (MD: 11.93, p < 0.00001) and 5 years (MD: 13.11, p = 0.0004). Higher excess BMI loss (percentage) was found in RYGB at 1 year (MD: 11.66, p = 0.01). Total weight loss (percentage) was greater for RYGB patients after 3 months (MD: 2.41, p = 0.02), 6 months (MD: 3.83, p < 0.00001), 1 year (MD: 6.35, p < 0.00001), and 5 years (MD: 3.90, p = 0.005). No difference in terms of remission of type 2 diabetes was seen between RYGB and SG. EWL was significantly more important after OAGB than after RYGB after 1 year (MD: −10.82, p = 0.003). Conclusions: RYGB is more efficient than SG in the midterm. OAGB offers greater EWL than RYGB after 1 year, but further evidence is needed to confirm this result. [ABSTRACT FROM AUTHOR]

Aim: Caecal diverticulitis (CD) is an uncommon condition which can be misdiagnosed as acute appendicitis due to similar clinical presentations. Further, its management varies among medical centres. The aim of this study was to review cases of patients with CD, to identify the factors differentiating CD from acute appendicitis and to provide a summary of existing diagnostic methods and therapeutic alternatives regarding its management. Methods: This systematic review was conducted in accordance with the PRISMA guidelines and the AMSTAR2 checklist. We searched MEDLINE and Embase from inception until 1 October 2018 for original publications reporting cases of CD. Results: Out of the 560 identified studies, 146 publications (988 patients) were included in the qualitative synthesis. Most frequent symptoms of CD were right iliac fossa pain (93.2%), nausea and/or vomiting (35.4%) and fever (26.9%). A total of 443 patients (44.8%) underwent radiological imaging, which reported CD in 225 patients (22.8%). For the other patients, the diagnosis was obtained by surgical exploration (73.9%). Among patients diagnosed with CD by imaging, 67 (29.8%) underwent surgery and 158 (70.2%) were treated conservatively. Among patients who underwent surgical exploration, treatment consisted most frequently of right hemi‐colectomy (33%), appendectomy (18.8%) and diverticulectomy with appendectomy (16.3%). Conclusion: CD can be misdiagnosed as acute appendicitis, therefore resulting in unnecessary surgical exploration. The review of the literature starting from 1930 highlights the critical role of medical imaging in supporting the clinician to diagnose this condition and administer adequate treatment. [ABSTRACT FROM AUTHOR]

Importance: Rectal cancers occupy the eighth position worldwide for new cases and deaths for both men and women. These cancers have a high tendency to form metastases in the mesorectum but also in the lateral lymph nodes. The therapeutic approach for the involved lateral lymph nodes remains controversial. Objective: We performed a systematic review and meta-analysis to assess the prevalence of metastatic lateral lymph nodes in patients with lateral lymph node dissection (LLND) for rectal cancer, which seems to be a fundamental and necessary criterion to discuss any possible indications for LLND. Methods: Data sources–study selection–data extraction and synthesis–main outcome and measures. We searched MEDLINE, EMBASE and COCHRANE from November 1, 2018, to November 19, 2018, for studies reporting the presence of metastatic lateral lymph nodes (iliac, obturator and middle sacral nodes) among patients undergoing rectal surgery with LLND. Pooled prevalence values were obtained by random effects models, and the robustness was tested by leave-one-out sensitivity analyses. Heterogeneity was assessed using the Q-test, quantified based on the I2 value and explored by subgroup analyses. Results: Our final analysis included 31 studies from Asian countries, comprising 7599 patients. The pooled prevalence of metastatic lateral lymph nodes was 17.3% (95% CI: 14.6–20.5). The inter-study variability (heterogeneity) was high (I2 = 89%). The pooled prevalence was, however, robust and varied between 16.6% and 17.9% according to leave-one-out sensitivity analysis. The pooled prevalence of metastatic lymph nodes was not significantly different when pooling only studies including patients who received neoadjuvant treatment or those without neoadjuvant treatment (p = 0.44). Meta-regression showed that the pooled prevalence was associated with the sample size of studies (p < 0.05), as the prevalence decreased when the sample size increased. Conclusion: The pooled prevalence of metastatic lateral lymph nodes was 17.3% among patients who underwent rectal surgery with LLND in Asian countries. Further studies are necessary to determine whether this finding could impact the therapeutic strategy (total mesorectal excision with LLND versus total mesorectal excision with neoadjuvant radiochemotherapy). [ABSTRACT FROM AUTHOR]

Neonatal and juvenile porcine islet cell clusters (ICC) present an unlimited source for islet xenotransplantation to treat type 1 diabetes patients. We isolated ICC from pancreata of 14 days old juvenile piglets and characterized their maturation by immunofluorescence and insulin secretion assays. Multipotent mesenchymal stromal cells derived from exocrine tissue of same pancreata (pMSC) were characterized for their differentiation potential and ability to sustain ICC insulin secretion in vitro and in vivo. Isolation of ICC resulted in 142 ± 50 × 103 IEQ per pancreas. Immunofluorescence staining revealed increasing presence of insulin‐positive beta cells between day 9 and 21 in culture and insulin content per 500IEC of ICC increased progressively over time from 1178.4 ± 450 µg/L to 4479.7 ± 1954.2 µg/L from day 7 to 14, P <.001. Highest glucose‐induced insulin secretion by ICC was obtained at day 7 of culture and reached a fold increase of 2.9 ± 0.4 compared to basal. Expansion of adherent cells from the pig exocrine tissue resulted in a homogenous CD90+, CD34−, and CD45− fibroblast‐like cell population and differentiation into adipocytes and chondrocytes demonstrated their multipotency. Insulin release from ICC was increased in the presence of pMSC and dependent on cell‐cell contact (glucose‐induced fold increase: ICC alone: 1.6 ± 0.2; ICC + pMSC + contact: 3.2 ± 0.5, P =.0057; ICC + pMSC no‐contact: 1.9 ± 0.3; theophylline stimulation: alone: 5.4 ± 0.7; pMSC + contact: 8.4 ± 0.9, P =.013; pMSC no‐contact: 5.2 ± 0.7). After transplantation of encapsulated ICC using Ca2+‐alginate (alg) microcapsules into streptozotocin‐induced diabetic and immunocompetent mice, transient normalization of glycemia was obtained up to day 7 post‐transplant, whereas ICC co‐encapsulated with pMSC did not improve glycemia and showed increased pericapsular fibrosis. We conclude that pMSC derived from juvenile porcine exocrine pancreas improves insulin secretion of ICC by direct cell‐cell contact. For transplantation purposes, the use of pMSC to support beta‐cell function will depend on the development of new anti‐fibrotic polymers and/or on genetically modified pigs with lower immunogenicity. [ABSTRACT FROM AUTHOR]

Moreover, patients who undergo robotic right hemicolectomy (robRHC) have better peri- and postoperative outcomes, as well as quicker recovery when compared to lapRHC [[7], [9]]. However, intracorporeal anastomosis (ICA) and off-midline specimen extraction were shown to, respectively, improve postoperative recovery [[4]] and decrease the incidence of subsequent incisional hernia [[5]]. Laparoscopic right hemicolectomy (lapRHC) with extra-corporeal anastomosis, and sometimes extra-corporeal vessel division, remains the standard of care for minimally invasive right hemicolectomy [[1], [3]]. [Extracted from the article]

Extracellular vesicles are membrane fragments that can be produced by all cell types. Interactions between extracellular vesicles and various liver cells constitute an emerging field in hepatology and recent evidences have established a role for extracellular vesicles in various liver diseases and physiological processes. Extracellular vesicles originating from liver cells are implicated in intercellular communication and fluctuations of specific circulating extracellular vesicles could constitute new diagnostic tools. In contrast, extracellular vesicles derived from progenitor cells interact with hepatocytes or non‐parenchymal cells, thereby protecting the liver from various injuries and promoting liver regeneration. Our review focuses on recent developments investigating the role of various types of extracellular vesicles in acute and chronic liver diseases as well as their potential use as biomarkers and therapeutic tools. [ABSTRACT FROM AUTHOR]