October 11, 2022
Literature selections curated by Lewis Flint, MD, FACS, and reviewed by the ACS Brief editorial board.
Roth JS, Anthone GJ, Selzer DJ, et al. Long-Term, Prospective, Multicenter Study of Poly-4-Hyroxybutyrate Mesh (Phasix Mesh) for Hernia Repair in Cohort at Risk for Complications: 60-Month Follow-Up. J Am Coll Surg. 2022, in press.
A potential advantage of poly-4-hydroxybutyrate (Phasix) mesh as a means of reinforcing abdominal wall hernia repair is the longer resorption time for the mesh that provides additional strength during the healing and tissue remodeling phases of recovery. This article reported outcomes data from a long-term follow-up study (up to 60 months). The study cohort (N=121) comprised patients at increased risk of wound complications based on comorbid conditions including obesity, current smoking history, chronic obstructive pulmonary disease, diabetes mellitus, immunosuppression, coronary artery disease, corticosteroid use, hypoalbuminemia, age >75 years, or renal insufficiency.
The main outcomes of interest were hernia recurrence and surgical site infection (SSI). Hernia recurrence occurred in 22% of patients at 5 years of follow up; SSI was diagnosed in 10.1% of patients. The authors noted that these outcomes are comparable to published results of repairs with various types of mesh reinforcement. Pain and quality of life assessed with standard scores showed significant improvement over the follow up interval. The authors concluded that long-term outcomes of Phasix mesh repair showed that the mesh was safe and effective.
Holihan JL, Liang MK. Hernias and novel devices/implants: Raising the bar for patient safety. J Am Coll Surg. 2022, in press.
In the editorial that accompanied the article, Julie L. Holihan, MD, and Mike K. Liang, MD, FACS, stressed that more than half of the patients enrolled in the original cohort were lost to follow up. Because patients lost to follow up are more likely to have experienced complications, the conclusions of the authors of the study should be interpreted with caution. The editorialists recommended that resources be provided for the conduct of future high-quality randomized prospective trials.
Goolsby C, Jonson C-O, Goralnick E, et al. The Untrained Public’s Ability to Apply the Layperson Audiovisual Assist Tourniquet vs a Combat Application Tourniquet: A Randomized Controlled Trial. J Am Coll Surg. 2022, in press.
Available evidence has shown that training laypersons to apply tourniquets for hemorrhage control in injured extremities is possible, but that skill decay is rapid. The study reported in this article was a randomized prospective trial that assessed skills retention in groups of layperson students who were trained in the use of the Combat Application tourniquet (CAT) compared with the Layperson Audiovisual Assist Tourniquet (LAVA-TQ). The LAVA-TQ device consists of a tourniquet that has audiovisual assistance incorporated into each device to facilitate efficient and effective application of the tourniquet.
The data analysis showed that, after initial training, participants in the trial were able to apply the LAVA-TQ tourniquet in 93% of attempts compared with 22% for participants applying the CAT. Application times for the LAVA-TQ tourniquet were significantly shorter compared with the CAT device. The authors concluded that the LAVA-TQ tourniquet was likely to improve skill retention and bleeding control educational efforts.
Ho JW, Alam HB. Doing It Right. J Am Coll Surg. 2022, in press.
In the editorial accompanying the article, Jessie W. Ho, MD, and Hasan B. Alam, MD, FACS, noted that the educational environment is controlled and calm and results obtained in these circumstances may not be confirmed in actual bleeding control events. Another caution emphasized by the editorialists is that the cost of the LAVA-TQ tourniquet is currently unknown.
McCormick BJ, Keihani S, Hagedorn J, et al. A Multicenter Prospective Cohort Study of Endoscopic Urethral Realignment Versus Suprapubic Cystostomy after Complete Pelvic Fracture Urethral Injury: Comparison of EUR versus SPT after PFUI. J Trauma Acute Care Surg. 2022.
Pelvic fracture-associated urethral injury is observed in 10% of patients who sustain pelvic fractures. The multicenter prospective cohort study reported in this article compared outcomes in patients whose urethral injuries were managed with endoscopic urethral realignment (EUR) or suprapubic tube placement (SPT). The authors hypothesized that EUR would reduce the rate of urethral obstruction following urethral injury.
Data were gathered from 26 participating institutions; treatment methods were assigned to individual centers and the primary endpoint of interest was development of urethral obstruction. Urethral injury was diagnosed in 106 patients over the 5-year course of the study; complete urethral disruption occurred in 65% of the study cohort, and this condition was observed in similar proportions of the two comparison groups. The data analysis showed that urethral obstruction occurred in 97% of patients treated with EUR compared with 94% of patients treated with SPT. Surgical repair of the urethral injury was required in 87% of the EUR group and 91% of the SPT group.
The authors concluded that EUR was not superior to suprapubic tube placement for management of urethral injury in patients with pelvic fracture. They recommended that suprapubic tube placement be the preferred first-line treatment for these injuries.