In addition, the median follow-up of 5 months in most patients is short,

and with longer follow-up, more recurrent hernias may develop because there is known to be a steady increase in recurrence with length of follow-up, particularly after PEH repair.14 In addition, in this study there was no comparison group in which we didn’t use mesh reinforcement or adjunct techniques to reduce tension because we strongly believe that all of these are critical components to long-term successful repair of a hiatal hernia. Lastly, there was no comparison to other Selleck Pictilisib types of mesh in this series. Mesh has been useful to reduce hernia recurrence rates at most sites in the body, and logically, it should be useful at the hiatus as well. However, the hiatus is unique in that there are 2 forms of tension that are applied against a hiatal hernia

repair, and failure to address tension likely contributes to the documented high objective hernia recurrence rate, particularly after PEH repair. In this study we used crural relaxing incisions and a Collis gastroplasty when necessary to reduce tension, Raf inhibitor and AlloMax graft reinforcement of the primary crural closure in all patients. Our early results confirm the efficacy of this approach, with no erosions, few complications, and objective evidence of an intact repair in 96% of patients. Further follow-up will define the role of these techniques and of AlloMax graft for reinforcement of the primary crural closure during antireflux surgery or PEH repair. Study conception and design: DeMeester Acquisition of data: Alicuben, Worrell Analysis and interpretation of data: Alicuben, Worrell, DeMeester Drafting of manuscript: Alicuben, Worrell, DeMeester Critical revision: Alicuben, Worrell, DeMeester “
“Multiple studies and meta-analyses have suggested some benefit to immunonutrition (IN) supplements. These studies have often included pre- and post-operative regimens and have utilized inconsistent controls ranging from standard non-supplemented oral diets to high-quality isonitrogenous controls. This study aims to compare outcomes after

preoperative nutritional supplementation with IN vs. standard oral nutritional supplements (ONS) or a regular diet without supplements. We performed a systematic literature review. 8 randomized Leukotriene-A4 hydrolase controlled trials (RCTs) of preoperative IN vs. ONS were identified and 9 RCTs of IN vs. no supplements were also identified. Meta-analysis was performed for reported outcomes including wound infection, infectious and non-infectious complications, and length of stay (LOS). The meta-analysis was prepared in accordance with Preferred Reporting of Systematic Reviews and Meta-Analyses (PRISMA) recommendations. We identified 561 patients in 8 RCTs of preoperative IN vs. ONS. 895 patients were identified in 9 RCTs of IN vs. no supplements. When compared to ONS, preoperative IN was not associated with reduced wound infection (OR 0.