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Background Laparoscopic incisional and ventral hernia repair (LIVHR) is an alternative approach to conventional open incisional and ventral hernia repair (OIVHR). A consensus on outcomes of LIVHR when compared with OIVHR has not been reached. Methods As the basis for the present study, we performed a systematic review and meta-analysis of all randomized controlled trials comparing LIVHR and OIVHR. Results Eleven studies involving 1,003 patients were enrolled. The incidences of wound infection were significantly lower in the laparoscopic group than that in the open group (laparoscopic group 2.8 %, open group 16.2 %; RR = 0.19, 95 % CI 0.11–0.32; P  < 0.00001). The rates of wound drainage were significantly lower in the laparoscopic group than that in the open group (laparoscopic group 2.6 %, open group 67.0 %; RR = 0.06, 95 % CI 0.03–0.09; P  < 0.00001). However, the rates of bowel injury were significantly higher in the laparoscopic group than in the open group (laparoscopic group 4.3 %, open group 0.81 %; RR = 3.68, 95 % CI 1.56–8.67; P  = 0.003). There were no significant differences between the two groups in the incidences of hernia recurrence, postoperative seroma, hematoma, bowel obstruction, bleeding, and reoperation. Descriptive analyses showed a shorter length of hospital stay in the laparoscopic group. Conclusions Laparoscopic incisional and ventral hernia repair is a feasible and effective alternative to the open technique. It is associated with lower incidences of wound infection and shorter length of hospital stay. However, caution is required because it is associated with an increased risk of bowel injury compared with the open technique. Given the relatively short follow-up duration of trials included in the systematic review, trials with long-term follow-up are needed to compare the durability of laparoscopic and open repair.

Background Minimally invasive pancreaticoduodenectomy (PD) remains one of the most challenging abdominal procedures, and its application is poorly reported in the literature so far. To date, few data are available comparing a minimally invasive approach to open PD. The aim of the present study is to compare the robotic and open approaches for PD at a single institution. Methods Data from 83 consecutive PD procedures performed between January 2002 and May 2010 at a single institution were retrospectively reviewed. Patients were stratified into two groups: the open group ( n  = 39; 47%) and the robotic group ( n  = 44; 53%). Results Patients in the robotic group were statistically older (63 years of age versus 56 years; p  = 0.04) and heavier (body mass index: 27.7 vs. 24.8; p  = 0.01); and had a higher American Society of Anesthesiologists (ASA) score (2.5 vs. 2.15; p  = 0.01) when compared to the open group. Indications for surgery were the same in both groups. The robotic group had a significantly shorter operative time (444 vs. 559 min; p  = 0.0001), reduced blood loss (387 vs. 827 ml; p  = 0.0001), and a higher number of lymph nodes harvested (16.8 vs. 11; p  = 0.02) compared to the open group. There was no significant difference between the two groups in terms of complication rates, mortality rates, and hospital stay. Conclusions The authors present one of the first studies comparing open and robotic PD. While it is too early to draw definitive conclusions concerning the long-term outcomes, short-term results show a positive trend in favor of the robotic approach without compromising the oncological principles associated with the open approach.

The chemical industry has sustained the development of global economies by providing an astonishing variety of products and services, while also consuming massive amounts of raw materials and energy. Chemical firms are currently under tremendous pressure to become lean enterprises capable of executing not only traditional lean manufacturing practices but also emerging competing strategies of digitalization and sustainability. All of these are core competencies required for chemical firms to compete and thrive in future markets. Unfortunately, reports of successful transformation are so rare among chemical firms that acquiring the details of these cases would seem an almost impossible mission. The severe lack of knowledge about these business transformations thus provided a strong motivation for this research. Using The Open Group Architecture Framework, we performed an in-depth study on a real business transformation occurring at a major international chemical corporation, extracting the architecture framework possibly adopted by this firm to become a lean enterprise. This comprehensive case study resulted in two major contributions to the field of sustainable business transformation: (1) a custom lean enterprise architecture framework applicable to common chemical firms making a similar transformation, and (2) a lean enterprise model developed to assist chemical firms in comprehending the intricate and complicated dynamics between lean manufacturing, digitalization, and sustainability.

Background Laparoscopic surgery has become popular during the last decade, mainly because it is associated with fewer postoperative complications than the conventional open approach. It remains unclear, however, if this benefit is observed after laparoscopic correction of perforated peptic ulcer (PPU). The goal of the present study was to evaluate whether laparoscopic closure of a PPU is as safe as conventional open correction. Methods The study was based on a randomized controlled trial in which nine medical centers from the Netherlands participated. A total of 109 patients with symptoms of PPU and evidence of air under the diaphragm were scheduled to receive a PPU repair. After exclusion of 8 patients during the operation, outcomes were analyzed for laparotomy ( n  = 49) and for the laparoscopic procedure ( n  = 52). Results Operating time in the laparoscopy group was significantly longer than in the open group (75 min versus 50 min). Differences regarding postoperative dosage of opiates and the visual analog scale (VAS) for pain scoring system were in favor of the laparoscopic procedure. The VAS score on postoperative days 1, 3, and 7 was significant lower ( P  < 0.05) in the laparoscopic group. Complications were equally distributed. Hospital stay was also comparable: 6.5 days in the laparoscopic group versus 8.0 days in the open group ( P  = 0.235). Conclusions Laparoscopic repair of PPU is a safe procedure compared with open repair. The results considering postoperative pain favor the laparoscopic procedure.

Enterprise architecture (EA) plays a crucial role in organizations by providing a clear strategy for digital transformation and seamless information flow across boundaries. It is a tool for achieving current and future objectives effectively. By providing a comprehensive view, EA helps organizations build suitable and sustainable software solutions while avoiding complex challenges caused by unmanageable information flow blockages. Moreover, EA provides a standard framework for implementing enterprise resource planning (ERP) systems. Although EA and ERP systems have different concepts, they possess complementary characteristics that support decision-makers in the ERP selection process, which can be quite risky due to cost feasibility, time consumption, and team effort. This study proposes using the EA concept as a reference module for selecting the most suitable integrated solution for the higher education sector. The aim is to provide high-impact criteria for choosing the most appropriate ERP system as a core solution. Additionally, EA supports other related solutions integrated with the ERP system under the EA umbrella to run a fully automated smart entity. To determine the most suitable ERP solution for higher education entities in the study country, a set of critical criteria for ERP selection as a core solution in the education sector is generated through brainstorming, which is based on an EA reference module specifically designed for higher education entities that seek to operate smartly. A comparison technique is employed to evaluate the highlighted criteria, including a case study for ABC University. The study’s results reveal that fully integrated and sustainable solutions can be envisioned for higher education entities, which can support the digital transformation of the higher education sector based on a smart EA reference module along with a set of critical main ERP selection criteria. This can mitigate the risk associated with ERP selection as a core solution and support decision-makers in selecting the most suitable ERP package for educational entities.

Background Long-term results after laparoscopic repair of large incisional hernias remain to be determined. The aim of this prospective study was to compare early and late complications between laparoscopic repair and open repair in patients with large incisional hernias. Methods Only patients with a hernia diameter of ≥5 cm were included in this study and were prospectively followed. We compared 56 patients who underwent open incisional hernia repair with 69 patients who underwent laparoscopic repair. Median follow-up in the laparoscopic group was 32.5 months (range 1–62 months) and in the open group 65 months (range 1–80 months). Results The demographic parameters were not significantly different between the two groups. However, the median hospital stay (6.0 days, range 1–23 days vs. 7.0 days, range 1–67 days; p  = 0.014) and incidence of surgical site infections (SSIs) (5.8% vs. 26.8%; p  = 0.001) were significantly lower in the laparoscopic group than in the open surgery group. Bulging of the implanted mesh was observed in 17.4% in the laparoscopic group and in 7.1% in the open group ( p  = NS). The recurrence rate was 18% in the open group and 16% in the laparoscopic group ( p  = NS). Multivariate analysis revealed that width of the hernia ≥10 cm, SSI, and BMI ≥30 kg/m 2 were significant risk factors for hernia recurrence. Conclusions The incidence of SSIs was significantly lower after laparoscopic incisional hernia repair. At long-term follow-up, the recurrence rate was not different between the two techniques. Abdominal bulging is a specific problem associated with laparoscopic repair of large incisional hernias. Size of the hernia, BMI, and SSI are risk factors for hernia recurrence irrespective of the technique.

Background Laparoscopic resection for gastric gastrointestinal stromal tumors (GISTs) is technically feasible, but the long-term effect remains uncertain. This study aims to compare the long-term oncologic outcomes of laparoscopic versus open resection of GISTs by larger cases based on tumor size–location-matched study. Methods Between 2006 and 2015, 63 consecutive patients with a primary gastric GIST undergoing laparoscopic resection were enrolled in and matched (1:1) to patients undergoing open resection by tumor size and location. Clinical and pathologic parameters and surgical outcomes associated with each surgical type were collected and compared. Results The operation time, intraoperative blood loss, return of bowel function and oral intake, nasogastric tube retention time and postoperative stay were all shorter/faster in laparoscopic group than those in open group ( P  < 0.001). Postoperative complications were comparable except for the higher incidence of abdominal/incision pain in open group (9.52 vs 27%, P  = 0.01). There was no statistical difference in recurrence rate (9.52 vs 15.87%, P  = 0.29) and long-term recurrence-free survival between the two groups ( P  = 0.39). Conclusions The long-term oncologic outcome of laparoscopic resection of primary gastric GISTs is comparable to that of open procedure, but laparoscopic procedure has the advantage of minimal invasion and is superior in postoperative recovery.

Background The aim of this study was to compare short-term and long-term sensory disturbance and discomfort after robotic thyroidectomy versus conventional open thyroidectomy. Methods We compared 118 patients who underwent robotic thyroidectomy by a gasless unilateral axillobreast (GUAB) or axillary (GUA) approach with 176 patients who underwent conventional open thyroidectomy from April 2009 to June 2011. Postoperative hypesthesia/paresthesia and discomfort of the neck and anterior chest were evaluated regularly for 1.5 years using a questionnaire with a scale from 0 to 4. Results There were no differences in neck discomfort or hypesthesia/paresthesia between the two groups. Neck discomfort and hypesthesia/paresthesia returned to preoperative levels by postoperative years 1.0 and 1.5, respectively, in both groups. Anterior chest discomfort and paresthesia/hypesthesia were higher in the robotic group than the open group. They returned to preoperative levels by postoperative year 1 in the robotic group and within 3 months in the open group. Conclusions Long-term sensory disturbance and discomfort of the neck does not differ between robotic thyroidectomy and conventional open thyroidectomy. However, anterior chest discomfort and sensory disturbance are greater and require longer times to recover after robotic thyroidectomy. Minimizing dissection of the anterior chest should be considered to reduce discomfort and sensory disturbance after robotic thyroidectomy by a GUAB/GUA approach.

Purpose The objective of the study was to evaluate peri- and postoperative outcomes, especially severe complications in adult incisional ventral hernia repair performed by open or laparoscopic surgery. Methods Adult patients who were operated for incisional ventral hernias in two tertiary hospitals in Finland during 2006–2012 were included in the study. Clinical data were collected from patient registers. Peri- and postoperative parameters were gathered and compared between open and laparoscopic groups. Postoperative complications were analyzed, and the focus was on major complications. Results The results of 818 hernioplasties were evaluated: 291 (36.3 %) open and 527 (63.7 %) laparoscopic operations. In the laparoscopic group, the number of patients with postoperative complications was slightly lower (18.4 vs. 23.4 %, p  = 0.090), and there were significantly fewer surgical site infections (3.2 vs. 8.6 %, p  = 0.001). Twelve major complications occurred. In the laparoscopic group, four of the five major complications were consequences of undetected enterotomies, leading to reoperations, longer hospital stays, and death of one patient. Major complications in the open group consisted of four cardiac infarctions and three septic surgical site infections. Complex adhesions had a significant influence on major complications, enterotomies, and surgical site infections. Laparoscopic operations had a lower mean blood loss (13 vs. 31.5 ml, p  = 0.028), and hospital stay (4 vs. 6 days, p  = 0.001) compared to open operations. Conclusions Laparoscopic incisional ventral hernia repair has a low rate of postoperative complications but it is associated with an increased risk of undetected enterotomies, in particular during cases involving adhesiolysis.