BACKGROUND: The optimal reconstruction method after proximal gastrectomy remains unclear. This systematic review and meta-analysis aimed to compare the short-term outcomes and long-term quality of life of various reconstruction methods.
METHODS: PubMed, Embase, Web of Science and Cochrane Library were searched to identify comparative studies concerning the reconstruction methods after proximal gastrectomy. The reconstruction methods were classified into six groups: double tract reconstruction (DTR), esophagogastrostomy (EG), gastric tube reconstruction (GT), jejunal interposition (JI), jejunal pouch interposition (JPI) and double flap technique (DFT). Esophagogastric anastomosis group (EG group) included EG, GT and DFT, while esophagojejunal anastomosis group (EJ group) included DTR, JI and JPI.
RESULTS: A total of 27 studies with 2410 patients were included in this meta-analysis. The pooled results indicated that the incidences of reflux esophagitis of DTR, EG, GT, JI, JPI and DFT were 7.6%, 27.3%, 4.5%, 7.1%, 14.0%, and 9.1%, respectively. The EG group had more reflux esophagitis (OR = 3.68, 95%CI 2.44-5.57, P < 0.00001) and anastomotic stricture (OR = 1.58, 95%CI 1.02-2.45, P = 0.04) than the EJ group. But the EG group showed shorter operation time (MD=-56.34, 95%CI -76.75- -35.94, P < 0.00001), lesser intraoperative blood loss (MD=-126.52, 95%CI -187.91- -65.12, P < 0.0001) and shorter postoperative hospital stay (MD=-2.07, 95%CI -3.66- -0.48, P = 0.01). Meanwhile, the EG group had fewer postoperative complications (OR = 0.68, 95%CI 0.51-0.90, P = 0.006) and lesser weight loss (MD=-1.25, 95%CI -2.11- -0.39, P = 0.004). For specific reconstruction methods, there were lesser reflux esophagitis (OR = 0.10, 95%CI 0.06-0.18, P < 0.00001) and anastomotic stricture (OR = 0.14, 95%CI 0.06-0.33, P < 0.00001) in DTR than the esophagogastrostomy. DTR and esophagogastrostomy showed no significant difference in anastomotic leakage (OR = 1.01, 95%CI 0.34-3.01, P = 0.98).
CONCLUSIONS: Esophagojejunal anastomosis after proximal gastrectomy can reduce the incidences of reflux esophagitis and anastomotic stricture, while esophagogastric anastomosis has advantages in technical simplicity and long-term weight status. Double tract reconstruction is a safe technique with excellent anti-reflux effectiveness and favorable quality of life.
BACKGROUND: This meta-analysis was registered on the PROSPERO (CRD42022381357).

Several factors associated with prolonged hospital stay have been described. A recent study demonstrated that hospital length of stay (LOS) is directly associated with an increased cost for liver transplantation (LT) and may be associated with greater mortality; however, the factors associated with post-LT mortality are also related to a prolonged hospital stay, that is, those factors are confounders. Thus, the actual impact of the length of post-LT hospital stay on both short-term and long-term patient and graft survival remains uncertain.
To identify the optimal time to discharge patients after LT with respect to short-term outcomes; readmission rate, 30-90-mortality and morbidity.
Systematic review following PRISMA guidelines and recommendations using the GRADE approach derived from an international expert panel. Initial search keywords for screening were as follows; ((discharge AND (time OR \"time point\" OR \"time-point\")) OR \"length of hospital stay\" OR \"length of stay\") AND ((liver OR hepatic) AND (transplant OR transplantation)).
CRD42021245598 RESULTS: The strength of recommendation was rated as Weak, and we did not identify the direction of recommendations regarding the optimal timing after LT concerning short-term outcomes, including \"Readmission rate,\" six studies on 30- and/or 90-day mortality, and five studies on \"30- and/or 90-day morbidity rate.\"
Evidence is scarce to judge the optimal timing to discharge patients after LT with respect to short-term outcomes. In centers with robust outpatient follow-up, discharge can occur safely as early as post-transplant 6-8 days (Quality of Evidence [QOE]; Low | Grade of Recommendation; Weak).

Objectives Although inguinal hernia (IH) repair is low-risk surgery, older patients are occasionally offered watchful waiting because of their functional status and comorbidities. This study reviewed the surgical outcomes of IH repair in older patients in comparison with outcomes in younger patients. Methods This retrospective study included all patients who had IH repair from 2010 to 2020. The primary outcomes of interest were postoperative complications and recurrence. Results A total of 262 patients underwent IH repair during the study period; 40% were ≥60 years old. One patient had a recurrence. Among the 8% of patients who had postoperative complications, groin pain was the most common one (1.9%). Female patients had a significantly higher rate of complications than male patients did (38.5% female versus 6.4% male, p<0.001). The rate of complications was also higher for emergency surgery than for elective surgery (22.6% emergency versus 6.1% elective, p<0.001), as well for patients who needed concomitant bowel resection compared with those who did not. Patients who had emergency surgery or postoperative complications had a prolonged hospital stay.  Conclusions IH repair in older patients is low-risk surgery, comparable to that in younger patients. In this study, emergency surgery was more common in older than in younger patients and posed a higher risk of complications. We recommend offering elective hernia repair to older patients to avoid the higher complication rate associated with emergency repair.