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Background: Groin hernia repair constitutes a very common procedure in general surgery. Minimal invasive closure of groin hernia has evolved to become the standard means of closure. However, there seems to be a gender-associated discrimination with regard to endoscopic groin hernia repair. We investigated the rate of endoscopic closure in female patients undergoing groin hernia closure., Materials and Methods: A retrospective analysis of the data of patients undergoing elective groin hernia repair within a four-year period from 2013 to 2016 was performed. The rate of endoscopic hernia repair was calculated for both genders., Results: Eight hundred and forty-six patients including 94 females and 752 males were included for analysis. The female group was significantly older compared to the male group (68.0 vs. 61.0 yrs, P=0.02). The rate of endoscopic groin hernia repair was significantly lower in the female group compared to in the male cohort (30% vs. 60%, P=0.001). The overall duration of surgery was 74.0min in the female cohort and 93.0min in the male group, P=0.001. However, there was no statistically significant difference amongst both groups with regard to the duration of surgery for endoscopic repair: 78.0min in the female group and 89.0min in the male group, P=0.67., Conclusion: Findings from this retrospective collective suggests that, there might be some degree of sex discrimination with regard to endoscopic groin hernia repair in favor of the male population., (Copyright © 2019. Published by Elsevier Masson SAS.)

Background: Anastomotic leakage (AL) following colorectal resection is a serious issue. AL in oncologic patients might negatively affect the overall survival. Recently, mechanical bowel preparation with additive oral antibiotics (MBP + AB) prior to surgery has been suggested as a means of reducing AL. However, it is unclear whether this positive effect is secondary to MBP alone or secondary to the additive oral antibiotic (MBP + AB). The aim of this study was to investigate the effect of mechanical bowel preparation with additive oral antibiotics (MBP + AB) and without additive oral antibiotics (MBP - AB) on the rate of AL following colorectal resection for cancer., Materials and Methods: Patients undergoing surgical management for colorectal cancer with anastomosis from January 2014 till September 2017 were included for analysis. Cases undergoing MBP + AB were included in the study group. Patients undergoing MBP - AB were included in the control group. Both groups were compared with regard to the rate of AL., Results: Four hundred and ninety-six patients: 125 undergoing MBP + AB and 371 undergoing MBP - AB were included for analysis. Significantly, more male patients were included in the MBP - AB group compared to the MBP + AB group: 60.1% vs. 45.6% respectively (p = 0.03). Both groups were similar with regard to age distribution and clinicopathological findings (p > 0.05). The rate of AL was significantly higher in the control group (MBP - AB) compared to study group (MBP + AB) (9.1% vs. 4.0%, p = 0.03)., Conclusion: Mechanical bowel preparation with additive oral antibiotics prior to elective colorectal resection with anastomosis significantly reduces the risk of AL. Therefore, mechanical bowel preparation with additive non-absorbable oral antibiotics should be recommended in all cases prior to elective colorectal surgery.

Background: Incisional hernia is a common problem following open abdominal surgery. Hernia repair in patients with relevant medical conditions is a topic of controversy due to the high risk of morbidity and recurrence. We investigated the risk of recurrence in patients with relevant medical conditions managed with a prosthesis in the retromuscular position., Methods: A retrospective review of the data of patients undergoing midline incisional hernia repair was performed. The outcomes of patients with relevant concomitant medical conditions defined as ASA scores >2 were compared with those of healthier patients with ASA scores ≤2., Results: 115 patients including 41 with ASA >2 and 74 with ASA ≤2 were included for analysis. There were no statistically significant differences amongst both groups with regard to the size of the hernia defect, the duration of surgery (123.0 ± 71 vs. 149.0 ± 92 min, p = 0.73), the incidence of postoperative seroma (14.6% vs. 29.7%, p = 0.07), postoperative hematoma (12.2% vs. 4.1%, p = 0.10) and surgical site infection (14.6% vs. 8.1%, p = 0.27). No statistically significant difference was seen amongst both groups with respect to the rate of long-term recurrence after a median follow-up of 63.0 ± 36 months (12.2% vs. 6.8%, p = 0.32)., Conclusion: Relevant medical condition alone cannot be seen as a contraindication for midline incisional hernia repair using the retromuscular technique. Rates of morbidity and long-term recurrence following mesh-associated closure are not difference from those of healthier patients., (Copyright © 2018. Published by Elsevier Taiwan LLC.)

Background: Acute perforated cholecystitis (APC) is probably the most severe benign gallbladder pathology with high rates of morbidity and mortality. The cause of APC has not been fully understood. We postulated that APC is a complication of advanced gallbladder inflammation. The aim of this study was to investigate the extent of gallbladder inflammation in patients with APC., Methods: Patients with intraoperative and histopathologic diagnosis of APC were compared with cases with acute cholecystitis without perforation with respect to the extent of inflammation on histopathology as well as surgical outcomes., Results: Fifty patients with APC were compared to 150 cases without perforation. Advanced age > 65 years and elevated CRP were confirmed on multivariate analysis as independent risk factors for APC. Advanced gallbladder inflammation was seen significantly more often in patients with APC (84.0 vs. 18.7%). Surgery lasted significantly longer 131.3 ± 55.2 min vs. 100.4 ± 47.9 min; the rates of conversion (22 vs. 4%), morbidity (24 vs. 7%), and mortality (8 vs. 1%) were significantly higher in patients with APC. ICU management following surgery was needed significantly more often in the APC group (56 vs. 15%), and the overall length of stay (11.2 ± 12.0 days vs. 5.8 ± 6.5 days) was significantly longer compared to the group without perforation., Conclusion: Acute gallbladder perforation in patients with acute cholecystitis represents the most severe complication of cholecystitis. Acute perforated cholecystitis is a sequela of advanced gallbladder inflammation like empyematous and gangrenous cholecystitis and is associated with poor outcome compared to non-perforated cases., Competing Interests: A written consent was received from all patients. Ethics approval was received from the Ethics Committee of the Witten–Herdecke University (Approval No.11/2016).A written consent was received from all patients or their legal representatives for the use of their data and specimens for research purposes.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The paper presents the efficient training program of multilayer feedforward neural networks. It is based on the best second order optimization algorithms including variable metric and conjugate gradient as well as application of directional minimization in each step. Its efficiency is proved on the standard tests, including parity, dichotomy, logistic and two-spiral problems. The application of the algorithm to the solution of higher dimensionality problems like deconvolution, separation of sources and identification of nonlinear dynamic plant are also given and discussed. It is shown that the appropriately trained neural network can be used for the nonconventional solution of these standard signal processing tasks with satisfactory accuracy. The results of numerical experiments are included and discussed in the paper. Copyright 1996 Elsevier Science Ltd.