Restrictive Strategy vs Usual Care for Cholecystectomy in Patients With Abdominal Pain and Gallstones: 5-Year Follow-Up of the SECURE Randomized Clinical Trial.

Importance: The 1-year results of the SECURE trial, a randomized trial comparing a restrictive strategy vs usual care for select patients with symptomatic cholelithiasis for cholecystectomy, resulted in a significantly lower operation rate after restrictive strategy. However, a restrictive strategy did not result in more pain-free patients at 1 year.

Objective: To gauge pain level and determine the proportion of pain-free patients, operation rate, and biliary and surgical complications at the 5-year follow-up.

Concurrent validity of objective assessment by finger tracking for open surgical suturing training.

Background: The aim of this study is to evaluate whether the parameters 'time' and 'distance', measured by SurgTrac, correlate with the assessment of the same skills by blinded experts.

Methods: Basic open suturing tasks were executed by medical students. SurgTrac software measured objective parameters by tracking fingers.

Objective assessment for open surgical suturing training by finger tracking can discriminate novices from experts.

It is difficult, time consuming and expensive to assess manual skills in open surgery. The aim of this study is to investigate the construct validity of a low-cost, easily accessible tracking technique for basic open suturing tasks. Medical master students, surgical residents, and surgeons at the Radboud University Medical Center were recruited between September 2020 until September 2021.

Restrictive strategy versus usual care for cholecystectomy in patients with gallstones and abdominal pain (SECURE): a multicentre, randomised, parallel-arm, non-inferiority trial.

Background: International guidelines advise laparoscopic cholecystectomy to treat symptomatic, uncomplicated gallstones. Usual care regarding cholecystectomy is associated with practice variation and persistent post-cholecystectomy pain in 10-41% of patients. We aimed to compare the non-inferiority of a restrictive strategy with stepwise selection with usual care to assess (in)efficient use of cholecystectomy.

Antimicrobials: a global alliance for optimizing their rational use in intra-abdominal infections (AGORA).

Intra-abdominal infections (IAI) are an important cause of morbidity and are frequently associated with poor prognosis, particularly in high-risk patients. The cornerstones in the management of complicated IAIs are timely effective source control with appropriate antimicrobial therapy. Empiric antimicrobial therapy is important in the management of intra-abdominal infections and must be broad enough to cover all likely organisms because inappropriate initial antimicrobial therapy is associated with poor patient outcomes and the development of bacterial resistance.

Large Contaminated Ventral Hernia Repair Using Component Separation Technique with Synthetic Mesh.

Background: Large ventral hernia repair represents a major reconstructive surgical challenge, especially under contaminated conditions. Synthetic mesh is usually avoided in these circumstances because of fear of mesh infection, although evidence is outdated and does not regard new materials and techniques. The authors evaluated the safety of synthetic mesh in large contaminated ventral hernia repair.

Efficacy and Safety of Ultrapure Alginate-Based Anti-Adhesion Gel in Experimental Peritonitis.

Background: Intra-abdominal infection may lead to adhesion and abscess formation. An adhesion barrier can reduce these complications but also aggravate intra-peritoneal infection, causing the opposite effects. The fear of infection propagation has limited clinical adhesion barrier use in a contaminated or infected abdomen.

[Incarcerated Spigelian hernia: a rare cause of ileus].

Background: First described in 1764, the hernia of the semilunar line is called a Spigelian hernia. Spigelian hernias are rare: comprising only 1-2% of all abdominal hernias.

Case Description: A 73-year-old man presented at the emergency department complaining of not having defaecated and swelling of the right lower abdomen.

Surgical techniques for parastomal hernia repair: a systematic review of the literature.

Background: Parastomal hernias are a frequent complication of enterostomies that require surgical treatment in approximately half of patients. This systematic review aimed to evaluate and compare the safety and effectiveness of the surgical techniques available for parastomal hernia repair.

Methods: Systematic review was performed in accordance with PRISMA.

Repair of parastomal hernias with biologic grafts: a systematic review.

Background: Biologic grafts are increasingly used instead of synthetic mesh for parastomal hernia repair due to concerns of synthetic mesh-related complications. This systematic review was designed to evaluate the use of these collagen-based scaffolds for the repair of parastomal hernias.

Methods: Studies were retrieved after searching the electronic databases MEDLINE, EMBASE and Cochrane CENTRAL.

Peritoneal cytokines predict mortality after surgical treatment of secondary peritonitis in the rat.

Background: The study aimed to analyze if peritoneal cytokine levels can predict survival in an experimental model for peritonitis. Early identification of patients most at risk for adverse outcomes would facilitate the decision for aggressive therapy in order to maximally exploit their chance for survival.

Study Design: Peritonitis was induced by intraperitoneal injection of a feces/bacteria mixture in 175 rats.

Timing and dose of tissue plasminogen activator to prevent abscess formation after surgical treatment of secondary peritonitis in the rat.

Early administration of fibrinolytics after surgical treatment of peritonitis in the rat reduces abscess formation. The current study investigates the effect of various treatment protocols using intraperitoneal recombinant tissue plasminogen activator (rtPA). Peritonitis was induced in rats and surgical debridement was performed after 1 hour.

Tissue-type plasminogen activator prevents abscess formation but does not affect healing of bowel anastomoses and laparotomy wounds in rats with secondary peritonitis.

Background: Intra-abdominal application of recombinant tissue-type plasminogen activator (rtPA) can decrease the rate of abscess formation in a rat peritonitis model. Before using rtPA clinically, its effects on healing of bowel anastomoses and laparotomy wounds should be investigated.

Methods: Peritonitis was induced in 148 male Wistar rats via intra-abdominal injection of a feces/bacteria mixture.

Tissue-type plasminogen activator prevents formation of intra-abdominal abscesses after surgical treatment of secondary peritonitis in a rat model.

Background: Optimal therapy of secondary peritonitis frequently results in the formation of residual abscesses, which bear a substantial mortality and morbidity. This study aims to prove that fibrinolytic therapy with recombinant tissue plasminogen activator (rtPA) can reduce abscess formation after surgical treatment of secondary peritonitis in a rat model, without causing unwanted side effects.

Materials And Methods: Male Wistar rats received an intra-abdominal injection with a suspension of sterile feces, 10(5) cfu Escherichia coli and 10(4) cfu Bacteroides fragilis.

A peritonitis model with low mortality and persisting intra-abdominal abscesses.

Intra-abdominal abscesses are a potential source of recurrent or residual infection after surgical intervention for secondary peritonitis. The development of therapies requires a model which combines low mortality with the formation of persisting abscesses and which is also suitable to study the local inflammatory response. Male Wistar rats were injected intraperitoneally with a mixture of sterile rat faeces, increasing doses of E.