Gastrointestinal Tract

Clinical study of "double diabolo" vs. continuous suture for laparotomy closure

2024-04-16T14:51:12+08:00

Background and Objectives: Incisional hernia is a common complication after abdominal surgery and presents a significant challenge for digestive surgeons. In 2000, we proposed a new suture design, termed “double diabolo”, which has optimum physical characteristics to ensure that both the thread and the holes are subjected to the least possible tension. We have since tested its effectiveness in theoretical and experimental studies. In the present paper, we demonstrate the effectiveness of this suture at the clinical level. Methods: A study was conducted on 100 patients all requiring a laparotomy. The operation was performed by the same surgeon for every case. Two study groups were compared: group A with 50 patients for whom the laparotomy closure was achieved by continuous suture; and group B with 50 patients for whom the laparotomy closure was achieved by double diabolo suture. The following parameters were assessed: age, sex, American Society of Anesthesiologists classification, laparotomy size, postoperative (PO) evisceration, PO wound infection, PO hernia, urgent/scheduled surgery, PO hernia duration, PO complications, and follow-up time. Results: The double diabolo suture group showed a statistically significant reduction in postoperative infections (16% vs. 38%, P = 0.002) and a non-statistically significant trend toward reducing postoperative hernias (14% vs. 28%, P = 0.14). However, the conclusion regarding “reducing the number of hernias” is unsupported by the results, as statistical significance was not achieved for this outcome.
Conclusion: The double diabolo suture reduces the rate of infection in surgical wounds following laparotomy closure and possibly reduces the number of postoperative hernias, although a statistically significant demonstration of the latter outcome requires further study, with a larger number of patients.

Retrospective surveillance of intussusception in pediatric hospitals in Havana: a necessary step before the introduction of rotavirus vaccine

2024-09-10T14:14:29+08:00

Background and Objectives: Intussusception (IS) is a common cause of bowel obstruction in children and has attracted increased attention since it was linked with the first rotavirus vaccine, Rotashield®, although many cases of intussusception self-resolve and could be fatal if not treated promptly. This study aims to provide information on clinical and epidemiology characteristics of IS among children aged < 24 months before rotavirus vaccine introduction. Methods: This is a hospital-based, retrospective review of hospital records from January 2011 to December 2020, at two largest pediatric hospitals in Havana, Cuba. Results: A total of 147 children aged less than 24 months diagnosed with intussusception were included. Most cases occurred under 1 year of age and the male was predominant. The predominant symptoms were vomiting (47.2%), irritability (31.7%), “currant jelly” bloody stool (42.5%) and abdominal pain (27.02%). A total of 69 patients were treated surgically using major manual reduction of intussusception. The postoperative complications were 8.8% and surgical site infection was the most frequent complication. None deaths were reported from both hospitals. Conclusion: Efforts should be made to complete a large-scale baseline surveillance of intussusception around the country before the introduction of rotavirus vaccine.

Influence of human milk oligosaccharides vs. lactulose on the gut microbiome in patients with hepatic encephalopathy

2025-02-21T10:23:11+08:00

Hepatic encephalopathy (HE) is a neuropsychiatric disorder associated with liver dysfunction. This literature review explores
the therapeutic potential of nutritional and microbiome-based interventions in managing HE, particularly minimal hepatic encephalopathy. Nutritional therapy, along with probiotics, prebiotics, and fecal microbiota transplants, has shown efficacy in reducing ammonia levels, improving cognitive function, and enhancing health-related quality of life. Additionally, the safety of 6'-sialyllactose, a human milk component, has been confirmed in clinical trials, supporting its potential use in HE treatment. Emerging evidence also suggests that bacteriophages within the gut microbiome are linked to cognitive impairment in cirrhotic patients, indicating that microbiome modulation could provide new therapeutic avenues. These findings highlight the promise of nutritional and microbiome-based strategies in managing HE and emphasize the need for further research to fully integrate these approaches into clinical practice.

Immune checkpoint inhibitors colitis: Current aspects on diagnosis and treatment in the era of biological agents

2025-02-20T22:44:42+08:00