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Evidence for open groin hernia repair demonstrates less pain with bioglue mesh fixation compared with invasive methods. This study aimed to assess the short- and long-term effects of laparoscopic groin hernia repair with noninvasive and invasive mesh fixation. A systematic review of MEDLINE, CENTRAL, and OpenGrey was undertaken. Randomized trials assessing the outcome of laparoscopic groin hernia repair with invasive and noninvasive fixation methods were considered for data synthesis. Nine trials encompassing 1,454 patients subjected to laparoscopic hernia repair with mesh fixation using biologic or biosynthetic glue were identified. Short-term data were inadequate for data synthesis. Chronic pain was less frequently reported by patients subjected to repair with biologic glue fixation than with penetrating methods (odds ratio .46, 95% confidence interval .22 to .93). Duration of surgery, incidence of seroma/hematoma, morbidity, and recurrence were similar. Laparoscopic groin hernia repair with bioglue mesh fixation was associated with a reduced incidence of chronic pain compared with mechanical fixation, without increasing morbidity or recurrence. Longer term data on recurrence are necessary. •Bioglue has recently emerged as an alternative means of mesh fixation in open and laparoscopic groin hernia repair.•Synthesis of data suggests that this method reduces chronic postoperative pain, without increasing morbidity or recurrence.•Longer term data on recurrence are needed.

Background Increasing life expectancy requires specific attention on geriatric patients. Data support a potential reduction of surgical morbidity for patients undergoing laparoscopic surgery as compared to conventional surgery. The aim of this study was to investigate the comparative effect of laparoscopic and open colorectal surgery on geriatric patients. Methods A systematic review of electronic information sources was undertaken. Studies that provided outcome data on patients aged 65 years or older, subjected to laparoscopic or open colorectal surgery, were considered. Mortality, morbidity, cardiac and pulmonary complications were the outcome measures of treatment effect. The methodological quality of selected studies was independently appraised by two reviewers. Random effects model was applied to synthesize outcome data. Results Twenty-seven articles providing data for 66,592 patients were included in the analysis. Patients undergoing laparoscopic surgery had a decreased risk for mortality (2.2 vs. 5.4 %; OR 0.55, 95 % CI 0.44–0.67), overall morbidity (19.3 vs. 26.7 %; OR 0.54, 95 % CI 0.46–0.63), cardiac (4.7 vs. 7.7 %; OR 0.60, 95 % CI 0.39–0.92) and respiratory complications (3.9 vs. 6.3 %; OR 0.67, 95 % CI 0.47–0.95). Sensitivity analysis including reports with similar age, American Society of Anesthesiologists score and/or similar prevalence of cardiopulmonary morbidity between the laparoscopic and the open treatment arm validated the outcome estimates of the primary analysis. Conclusions This analysis supports a substantial benefit for elderly patients undergoing laparoscopic in comparison with open colorectal surgery. The comparative effect of either approach on geriatric patients with pulmonary and cardiac comorbidities is a subject of further investigation.

Measures have been taken to improve methodological quality of randomized controlled trials (RCTs). This review systematically assessed the trends in volume and methodological quality of RCTs on minimally invasive surgery within a 10-year period. RCTs on minimally invasive surgery were searched in the 10 most cited general surgical journals and the 5 most cited journals of laparoscopic interest for the years 2002 and 2012. Bibliometric and methodological quality components were abstracted using the Scottish Intercollegiate Guidelines Network. The pooled number of RCTs from low-contribution regions demonstrated an increasing proportion of the total published RCTs, compensating for a concomitant decrease of the respective contributions from Europe and North America. International collaborations were more frequent in 2012. Acceptable or high quality RCTs accounted for 37.9% and 54.4% of RCTs published in 2002 and 2012, respectively. Components of external validity were poorly reported. Both the volume and the reporting quality of laparoscopic RCTs have increased from 2002 to 2012, but there seems to be ample room for improvement of methodological quality. •Methodological quality of laparoscopic RCTs was assessed over a 10-year period.•Volume and reporting quality have increased from 2002 to 2012.•External validity items should be addressed in laparoscopic RCTs.•Researchers are urged to further improve methodological quality.

Background Single-incision laparoscopic surgery poses significant ergonomic limitations. Curved instruments have been developed in order to address the issue of lack of triangulation. Direct comparison between single-incision laparoscopic surgeries with conventional linear and curved instruments has not been performed to date. Methods MEDLINE, CENTRAL and OpenGrey were searched to identify relevant randomized trials. A network meta-analysis was applied to compare operative risks, conversion, duration of surgery and the need for placement of an adjunct trocar in single-incision laparoscopic cholecystectomy with linear and curved instruments. The random-effects model was applied for two sets of comparisons, with conventional laparoscopic cholecystectomy as the reference treatment. Odds ratios, mean differences and 95 % confidence intervals were calculated. Results Twenty-three randomized trials encompassing 1737 patients were included. The use of curved instruments was associated with increased operative time (mean difference 32.53 min, 95 % CI 24.23–40.83) and higher odds for the use of an adjunct trocar (odds ratio 22.81, 95 % CI 16.69–28.94) compared to the use of linear instruments. Perioperative risks could not be comparatively assessed due to the low number of events. Conclusion Single-incision laparoscopic cholecystectomy with curved instruments may be associated with an increased level of operative difficulty, as reflected by the need for auxiliary measures for exposure and increased operative time as compared to the use of linear instruments. Current instrumentation requires further improvement, tailored to the features of single-incision laparoscopic surgery (CRD42015015721).

The clinical effects of laparoscopy in the pulmonary function of obese patients have been poorly investigated in the past. A systematic review was undertaken, with the objective to identify published evidence on pulmonary complications in laparoscopic surgery in the obese. Outcome measures included pulmonary morbidity, pulmonary infection and mortality. The random effects model was used to calculate combined overall effect sizes of pooled data. Data are presented as the odds ratio (OR) with 95% confidence interval (CI). A total of 6 randomized and 14 observational studies were included, which reported data on 185,328 patients. Pulmonary complications occurred in 1.6% of laparoscopic and in 3.6% of open procedures (OR 0.45, 95% CI 0.34-0.60). Pneumonia was reported in 0.5% and in 1.1%, respectively (OR 0.45, 95% CI 0.40-0.51). Available evidence suggests lower pulmonary morbidity for laparoscopic surgery in obese patients; further quality studies are however necessary to consolidate these findings.

Summary Background Little is known about the effect of preoperative nutritional counseling on operative outcomes of bariatric surgery. Aim To identify and evaluate the effect of nutritional counseling on perioperative morbidity and postoperative weight loss. Methods The database of Medline was queried in May 2016. Randomized controlled trials comparing nutritional counseling of any form with standard care and providing data on perioperative morbidity or weight loss were considered. Pooled risk ratio (RR) or mean difference with 95% confidence intervals (CI) were computed. Results Three randomized controlled trials were identified. The RR for postoperative complications was 0.80 (95% CI 0.22–2.86) and the mean weight loss was −11.62 kg (95% CI 0.72 to −23.96). There was high evidence of heterogeneity among reports. No data on operative morbidity were available. Conclusion Current data are not adequately robust to support preoperative nutritional intervention as an effective modality to prevent perioperative morbidity and to achieve more optimal postoperative weight control. In the absence of opposing evidence, nutritional counseling prior to surgery may be conventionally recommended.

SummaryBackgroundLittle is known about the effect of preoperative nutritional counseling on operative outcomes of bariatric surgery.AimTo identify and evaluate the effect of nutritional counseling on perioperative morbidity and postoperative weight loss.MethodsThe database of Medline was queried in May 2016. Randomized controlled trials comparing nutritional counseling of any form with standard care and providing data on perioperative morbidity or weight loss were considered. Pooled risk ratio (RR) or mean difference with 95% confidence intervals (CI) were computed.ResultsThree randomized controlled trials were identified. The RR for postoperative complications was 0.80 (95% CI 0.22–2.86) and the mean weight loss was −11.62 kg (95% CI 0.72 to −23.96). There was high evidence of heterogeneity among reports. No data on operative morbidity were available.ConclusionCurrent data are not adequately robust to support preoperative nutritional intervention as an effective modality to prevent perioperative morbidity and to achieve more optimal postoperative weight control. In the absence of opposing evidence, nutritional counseling prior to surgery may be conventionally recommended.