Early recognition of the risk of bowel resection of patients with incarcerated groin hernia will facilitate the clinical decision making of surgeons and improve the outcomes of patients. This study aimed to quantitatively analyse the risk factors of bowel resection in incarcerated groin hernia patients. A systematic literature search for studies on risk factors of bowel resection in incarcerated groin hernia patients was performed in the PubMed and Embase databases from inception until July 15, 2019. The Newcastle-Ottawa Scale was used to evaluate the quality of included study. Review Manager version 5.3 was used for data analysis. Seven articles with a total of 762 patients published between 2004 and 2017 were included. The total rate of bowel resection was 21.0% (160/762). Eight factors were significantly related to the risk of bowel resection in the pooled analysis: female sex, age, age (>65 years), femoral hernia, bowel obstruction, duration of incarceration (hours), white blood cell count, and neutrophilic leukocyte count. Patients who underwent bowel resection had a significantly increased hospitalization times and postoperative complications. The 8 risk factors mentioned above are significantly associated with bowel resection in incarcerated groin hernia patients. The results of this meta-analysis provide a strong reference for the decision making of surgeons in the treatment of incarcerated groin hernia, facilitating the timely surgery and improving the outcome of patients.

The decision of ligation at the origin of the inferior mesenteric artery (IMA) or below the origin of the left colic artery (LCA) has remained a dilemma for surgeons in colorectal cancer surgery. The available studies are controversial. The objective of this meta-analysis is to compare the predictive significance of high versus low ligation in colorectal cancer surgery. A literature search done using Medline, EMBASE, GoogleScholar, and references. A meta-analysis was performed to analyze the 5-year overall survival (OS) of the high and low ligation using hazard ratio (HR) and 95% confidence interval (CI). We further analyzed 2 subgroups considering the level of lymph nodes (LNs) extension. That is IMA positive (+ve) and negative (−ve) LNs. Survival differences were analyzed. A total of 3119 patients in 5 cohorts were included in this meta-analysis. The pooled HR results showed significant OS benefit of high ligation than low ligation (HR; 0.77, 95% CI: 0.66–0.89) in the “IMA +ve” group with 33% decreased risk, while there is no statistical significance in the “IMA −ve” (HR 0.66, 95% CI: 0.30–1.46) and the “all cases” group (HR 0.69, 95% CI: 0.41–1.15). The pooled data showed high ligation of IMA has a better survival benefit for the patients with IMA positive LNs. It signifies high ligation should be recommended for the advanced cases or with the suspected high risk of IMA lymphatic metastasis. The limited number of articles demands future high-powered, well-designed randomized controlled trials (RCTs) for the further reliable conclusion.

Background: Incarcerated groin hernia (IGH) is a common surgical emergency. However, there are few accurate and applicable predictors for differentiating patients with strangulated groin hernia from those with IGH. In this study, we aimed to identify the independent risk factors for bowel resection in patients with IGH. Methods: We retrospectively collected 323 patients who underwent emergency hernia repair surgery for IGH between January 2010 and October 2019. The patients were categorized into those who received bowel resection and those who did not require bowel resection. The receiver-operating characteristic curve was used to identify the best cutoff values for continuous variables. Following this, univariate and multivariate analyses were performed to identify potential risk factors for bowel resection in these patients. Results: Univariate analysis identified 6 variables that were significantly associated with bowel resection among patients with IGH. On multivariate analysis, neutrophil-to-lymphocyte ratio (NLR) (odds ratio [OR] = 3.362, 95% confidence interval [CI] 1.705–6.628, P = .000) and bowel obstruction (OR = 3.191, 95% CI 1.873–5.437, P = 0.000) were identified as independent risk factors for bowel resection among patients with IGH. Conclusion: In this study, an elevated NLR and those with bowel obstruction are associated with an increased risk of bowel resection among patients with IGH. Based on our findings, surgeons should prioritize prompt emergency surgical repair for patients who present with elevated NLR and bowel obstruction concurrent with IGH.

Background: The efficacy of intersphincteric resection (ISR) surgery for patients with lower rectal cancer remains unclear compared to abdominoperineal resection (APR). The aim of this study is to compare the oncologic outcomes for lower rectal cancer patients after ISR and APR through a systematic review and meta-analysis. Materials and Methods: A systematic electronic search of the Cochrane Library, PubMed, EMBASE, and MEDLINE was performed through January 12, 2022. The primary outcomes included 5-year disease-free survival (5y-DFS) and 5-year overall survival. Secondary outcomes included circumferential resection margin involvement, local recurrence, perioperative outcomes, and other long-term outcomes. The pooled odds ratios, mean difference, or hazard ratios (HRs) of each outcome measurement and their 95% CIs were calculated. Results: A total of 20 nonrandomized controlled studies were included in the qualitative analysis, with 1217 patients who underwent ISR and 1135 patients who underwent APR. There was no significant difference in 5y-DFS (HR: 0.84, 95% CI: 0.55–1.29; P=0.43) and 5-year overall survival (HR: 0.93, 95% CI: 0.60–1.46; P=0.76) between the two groups. Using the results of five studies that reported matched T stage and tumor distance, we performed another pooled analysis. Compared to APR, the ISR group had equal 5y-DFS (HR: 0.76, 95% CI: 0.45–1.30; P=0.31) and 5y-LRFS (local recurrence-free survival) (HR: 0.72, 95% CI: 0.29–1.78; P=0.48). Meanwhile, ISR had equivalent local control as well as perioperative outcomes while significantly reducing the operative time (mean difference: −24.89, 95% CI: −45.21 to −4.57; P=0.02) compared to APR. Conclusions: Our results show that the long-term survival and safety of patients is not affected by ISR surgery, although this result needs to be carefully considered and requires further study due to the risk of bias and limited data.