Minimally invasive surgery for inguinal hernia repair is advantageous in terms of return to usual activities and lower rates of chronic pain; however, it requires general anesthesia. This study sought to analyze the benefits of ultrasound guided locoregional anesthesia of the quadratus lumborum muscle (QL block) as a single anesthetic technique for endoscopic totally extraperitoneal (TEP) inguinal hernia repair with regard to postoperative pain, length of hospital stay, and hospital cost. A total of 46 patients, aged 18 to 80 years, with unilateral inguinal hernia, one group that received general anesthesia and one that received sedation and QL block for TEP inguinal hernia repair. In the 46 patients the median pain score 6 hours after surgery was significantly lower (2 versus 4) among the QL block group than among the group receiving general anesthesia. Consequently, the former group showed a briefer median hospital stay (6 versus 24 hours, respectively). The anesthesia and hospital costs were also lower for the QL block group, with median reductions of 64.15% and 25%, respectively. QL block is a safe and effective option for patients undergoing TEP inguinal hernia repair, given the observed reduction in early postoperative pain, briefer hospital stay, and decreased anesthesia and hospital costs.

Objectives:The mechanism by which tumours escape the immune system has been becoming increasingly clear and is partly explained by the programmed death-1 (PD-1) and its ligand (PD-L1) pathway. This study aimed to investigate the prognostic significance of PD-L1 expression in patients with surgically resected pulmonary metastases from head and neck squamous cell carcinoma (HNSCC). Methods: A retrospective review was conducted of 28 patients who underwent surgical resection for pulmonary metastasis from HNSCC between January 2000 and December 2016. PD-L1 expression in the tumour cells was evaluated using immunohistochemistry (anti-PD-L1 antibody, clone SP263). High PD-L1 expression was defined as > _ 50% of tumour cells with positive staining for PD-L1. Survival was calculated using the Kaplan-Meier method. Univariate and multivariate analyses were performed to assess the prognostic value of relevant clinicopathological variables. Results: The median follow-up period was 41 months. The patients were 23 men and 5 women with a median age of 66 years. The site of the primary tumour was the hypopharynx (12 cases), larynx (10), oral cavity (4), and others (2). Incomplete resection occurred in 2 cases (7%). High PD-L1 expression was detected in 6 cases (21%), and in these cases, PD-L1 expression was low in the primary HNSCC. The 5-year overall survival (OS) rate after pulmonary metastasectomy was 53.0%. The 5-year OS rates were 65.3% and 16.7% in the low and high PD-L1 expression groups, respectively (P¼0.003). Univariate analysis showed that high PD-L1 expression, older age (> _65 years), and incomplete resection were significantly correlated with a shorter OS. Multivariate analysis demonstrated that high PD-L1 expression was independently correlated with a shorter OS (P<0.001). Conclusions: High PD-L1 expression in pulmonary metastases is an independent predictor of poor outcome in patients undergoing pulmonary metastasectomy of metastatic HNSCC. Disclosure: No significant relationships. P-133 DETAILED MEDICAL INTERVIEWS MIGHT IDENTIFY RISK FACTORS FOR ATRIAL FIBRILLATION FOLLOWING PULMONARY LOBECTOMYHironori Ishibashi, C. Takasaki, S. Kumazawa, A. Ui, M. Kobayashi, K. Okubo Thoracic Surgery, Tokyo Medical and Dental University, Tokyo, Japan Objectives: Atrial fibrillation (AF) after pulmonary lobectomy can be associated with increased morbidity and mortality as well as increased costs. The aim of this study is to identify risk factors for AF following lobectomy. Methods: A retrospective study of 883 patients who underwent lobectomy at our institution between April 2010 and November 2016 was performed. The following variables were considered in the analysis: age, sex, body mass index, comorbidities (interstitial pneumonia, emphysema, ischaemic heart disease, cerebral infarction, diabetes mellitus, renal dysfunction, presence of mental disorder), administration of steroid or anticoagulants, respiratory functions, arterial gas analysis, smoking index, ASA performance status, arrhythmia episodes, type of lobectomy, surgi...

Background: Pilonidal cysts are a painful condition that primarily affect young adult men. In the literature, numerous operative techniques for resolving pilonidal cysts are described, with variable outcomes. The objective of this study was to compare primarily closed midline incisions managed with or without the use of closed incision negative pressure therapy after pilonidal cyst excision. Methods: Twenty-one patients underwent excision and midline primary closure. Postoperative care composed of closed incisional negative pressure therapy (study group; n = 10) or gauze dressings (control group; n = 11). In both groups, the sutures were partially removed on day 14 and completely removed on day 21. Compared outcomes included the duration of hospitalization, pain on the day of surgical procedure, and on postoperative day 7, and time-to-healing. Results: The median hospital stay was about 9 hours and 23 hours in the study and control groups, respectively ( P < 0.05). The median pain scores on the day of operation were 1.20/10 in the study group and 3.36/10 in the control group ( P < 0.05). On day 7, study group showed median pain score 0.9/10 and control group showed 2.63/10 ( P < 0.05). The mean healing time was 23.8 and 57.9 days in the ciNPT group and gauze group, respectively ( P < 0.05). Conclusion: These outcomes supported the incorporation of closed incision negative pressure therapy into our surgical treatment protocol for pilonidal cysts.

Background: The search for less traumatic surgical procedures without compromising efficacy and safety, together with the technological advances and greater experience of the teams, led to the development of operative techniques with increasingly smaller incisions, the so-called “minimally invasive surgeries”. Aim: To evaluate the technical aspects and results of single port cholecystectomy. Method: Were analyzed 170 patients between 18-74 years submitted to videolaparoscopic cholecystectomies by single port, regardless of elective or urgent indication, without restriction of patient selection. Results: Among the 170 operations, 158 were exclusively performed by single port, and the conversion rate was 7% (inclusion of other accessory trocars or conversion to multiportal). Conversion to open surgery occurred in three cases (1.76%). The mean surgical time was 67.97 min, showing a marked decrease when was reached close to 50 cases and a stabilization after 100 surgeries. The overall complication rate was 10%, with minor complications such as: incisional pain, hematomas, granulomas, port access hernias (9.41%). Conclusion: Single port cholecystectomy can, after standardization and surgical team training, be a safe surgical procedure associated with a recognized aesthetic advantage.

RESUMO Objetivo: avaliar a acurácia da ultrassonografia no diagnóstico de hérnia inguinal no pré-operatório de pacientes submetidos à herniorrafia inguinal. Métodos: estudo retrospectivo descritivo, analítico, baseado em dados obtidos dos prontuários de pacientes submetidos à herniorrafia inguinal entre janeiro de 2016 e dezembro de 2017 e que realizaram ultrassonografia no período pré-operatório. A amostra foi composta por 232 pacientes e foram comparados os resultados da ultrassonografia com as queixas, exame físico e achados intraoperatórios desses pacientes. Resultados: a ultrassonografia apresentou concordância com a queixa de hérnia inguinal em 52% dos pacientes (p=0,019). Houve discordância entre a porcentagem de pacientes que apresentaram hérnia ao exame físico não confirmada pelo exame ultrassonográfico (28,57%) e a porcentagem de hérnias identificadas somente ao exame complementar (8,93%), com significância estatística (p=0,0291). Quando comparados os resultados ultrassonográficos com achados intraoperatórios, 32,70% dos pacientes que apresentavam hérnia tinham ultrassonografia normal com significância estatística para discordância (p=0,001). Conclusão: a ultrassonografia mostrou-se método não confiável para auxiliar no diagnóstico em casos duvidosos de hérnia inguinal e dispensável quando o diagnóstico era confirmado por queixas típicas e exame físico compatível.