Surgery Open Digestive Advance最新文献

Background

Herein we describe the anatomic consequences of maintaining splenic artery and removing the splenic vein in distal pancreatectomy with spleen preservation.

Patients and Methods

The records of 9 patients who were scheduled for splenic preservation distal pancreatectomy were analyzed.

Results

Three patients underwent vessels preservation, 4 had splenic vein ligation and artery preservation, Warshaw procedure was performed in 1 patient, and another patient required unintended splenectomy. In the long-term follow-up, one patient had submucosal gastric varices and gastrointestinal bleeding 12.7 years after distal pancreatectomy. One patient developed perisplenic varicesand hypertrophic perigastric veins, and 3 patients developed perigastric hypertrophic vessels. None of these patients manifest gastric bleeding.

Discussion

Spleen preservation in distal pancreatectomy can be performed by preserving splenic artery and vein, ligation of the vein, or ligation of vein and artery and preservation of short gastric vessels. It is not unusual the hypertrophic perigastric vessels development after distal pancreatectomy with spleen preservation. Submucosal varices may result in late gastric hemorrhage.

Background

During laparoscopic inguinal hernia repair (LIH) repair, it is common practice to insert a urinary catheter (UC) to mitigate the risk of bladder injury or acute postoperative urinary retention. However, this procedure often leads to potential complications or infections. This study aims to evaluate the implications of the UC placement during LIH repair.

Methods

This retrospective, monocentric study included patients who underwent LIH repair between 01/01/2018 to 31/12/2022. Patients were divided into two groups: UC and no-UC.

Results

212 patients were included: 119 (56 %) in the no-UC group and 93 (44 %) in the UC group. The UC group presented a higher prevalence of bilateral hernias (38.7 % vs. 52.7 %), (p = 0.01) and a greater frequency of intraperitoneal approach (TAPP) (83.9 % vs. 100 %), (p = 0.01). No intraoperative complications were attributable to the absence of the UC. Four patients in the UC group had postoperative acute urinary retention necessitating intermittent catheterization, allowing discharge (p = 0.13). Rates of readmission and reoperation rates were comparable between groups. One month post-surgery, 7.5 % of UC group patients (vs. 0.8 %) developed urinary tract infection (p = 0.01). Subgroup analysis confirmed a higher incidence of urinary tract infections in unilateral hernia and in TAPP procedure.

Conclusion

Routine UC insertion during LIH repair seems unnecessary; rather, it increases the risk of postoperative urinary tract infections and should thus be avoided.

Introduction

External rectal prolapse (ERP) is a complete protrusion of the rectal wall through the anal canal. The precise prevalence of recurrent (R)- ERP is still unknown although some studies have reported 20–30 % after primary surgery. The aim of this study was to assess the anatomic and functional outcomes of R-ERP surgical treatment proposing a decision-making algorithm for this rare and challenging disease.

Material and methods

This is a case series report. Of the 141 patients treated for external rectal prolapsed between January 2014 and December 2020, 19 (3M-16F) developed a recurrence. Anatomical recurrence was assessed and classified as complete or partial and mucosal or full-thickness. Functional outcomes were assessed using Wexner scores for constipation and incontinence. The global satisfaction rate was evaluated using a 5-point scale.

Results

The patients were stratified according to the first line surgery: 5(26 %) Delorme (Group A), 6(32 %) Altemeier (Group B), and 8(42 %) robotic ventral rectopexy (Group C). Five patients had a previous proctologic and pelvic floor surgery; Functional disorders were: 8 (42 %) fecal incontinence and 4(21 %) ODS. The overall recurrence rate was 21.4 %. The overall functional outcomes showed a significant improvement in the Wexner incontinence score (median value 8.7 vs 3.1) and constipation score (10.4 vs 4.6). 78.6 % patients declared to be satisfied.

Conclusion

The treatment of choice for R-ERP needs to be tailored according to personal surgical competence considering the first-line ERP surgery,prolapse characteristics, and patients’ comorbidities.

Background

Gastric cancer is an important cause of morbidity and mortality worldwide. Laparoscopic procedures have been adopted to perform oncologic resection but still required a mini-laparotomy incision for specimen extraction. Natural orifice specimen extraction has proven to be an effective method to minimize trauma, decrease complications, speed recovery, and improve cosmetic result.

Case presentation

This is the case of a 67-year-old obese lady presenting with asymptomatic microcytic anemia wherein investigations revealed her to have subcardial gastric adenocarcinoma stage IIA. She underwent neoadjuvant chemotherapy followed by laparoscopic total gastrectomy with D2 lymphadenectomy. The procedure was complemented by a roux-en-y gastrojejunal anastomosis complemented with transvaginal specimen extraction through a posterior colpotomy. The recovery period post-operatively went smoothly and the patient had no major complaints on follow up.

Conclusion

Extracting a gastric cancer specimen transvaginally after laparoscopic procedures is feasible in females, mostly postmenopausal, who are overweight, even obese, and might pose a way to lessen complications post-operatively.

Background

Obesity management presents a persistent challenge. Bariatric surgery, recognized for its transformative impact on weight loss and comorbidities, demands a thorough examination of its long-term implications.

Objectives

Our goal is to investigate different aspects of bariatric surgery, such as complications, comorbidities, infection rates, the long-term sustainability of weight loss, and factors predicting weight loss over an extended period following the procedure.

Setting

This study involves 100 patients who underwent primary bariatric surgery.

Methods

a sophisticated Longitudinal Observational Study design. With a Retrospective Component and a Follow-Up Component spanning eight years.

Results

The study included participants with a mean age of 36.4 years (±12.1) and a pre-surgery BMI of 44.5 kg/m² (±7.5). Excess Weight Loss (%EWL) peaked at 75.09 % by the third year, while Total Weight Loss (%TWL) sustained at 33.41 % after two years. Among individuals with type 2 diabetes, medication discontinuation rates reached 26.3 % at 5 years. Zero leaks, a low incidence of major complications and no incidence of mortality have been noted. In an extended 7-year follow-up, 40 % of patients experienced weight regain. Multivariate analyses identified age and preoperative BMI as negatively associated significant predictors impacting %EWL at three years, with standardized beta coefficients of −0.488 (p = 0.001) and −0.450 (p < 0.001), respectively. Conversely, smoking and Type 2 Diabetes Mellitus exhibited positive associations, with standardized beta coefficients of 0.336 (p = 0.004) and 0.286 (p = 0.063), respectively.

Conclusions

Bariatric surgery is acknowledged as a safe and efficacy procedure for reducing weight and comorbidities, with a relatively low incidence of major complications.

Background

Perioperative inflammation is a predictor of surgical complications and cancer prognosis in surgical oncology. Multimodal protocols are ongoing in order to find ways to control inflammation. A preoperative flash high-dose of corticosteroids has been suggested as a way to control perioperative inflammation, but its safety in colorectal surgery needs to be established prior to a phase 3 trial. The physiologic effects of such a dose should also be explored.

Methods

Prospective bicentric phase 2 single-arm study with a biological ancillary study. Patients were administered 20 mg/kg of methyl-prednisone before colorectal surgery. Primary outcome was major post-operative complications defined as a grade >II according to the Dindo-Clavien classification. Ancillary outcome was plasma endotoxin concentration and activity.

Results

Sixty-seven patients were included. Twelve (17.9 % [90 %CI:10.9 %-29.6 %]) patients developed major post-operative complications. No homeostatic disturbances troubles were observed. Severe postoperative hyperglycemia concerned 3 (4 %) patients which were all non-diabetic. The concentrations of endotoxin (mass) and its activity lowered between the pre-operative time point and the day after surgery.

Conclusion

Pre-operative single flash of high dose methylprednisolone (20 mg/kg) before elective colorectal surgery seemed safe. Our results suggest that corticosteroids could promote gut barrier integrity, reducing endotoxemia in patients with colorectal surgery. Further studies (in particular a large randomized controlled trial) are needed to confirm our findings and explore a potential benefit of corticosteroid in this population.

ClinicalTrials.gov

03437746

Background

The surgical trend nowadays is in favor of minimally invasive procedures, particularly for complicated surgeries such as colectomies that require large incisions. Even laparoscopic colectomies still need mini-laparotomy for specimen extraction. Natural orifice specimen extraction (NOSE) has emerged as a way to avoid such incisions and decrease postoperative complications.

Case Presentation

We present two cases of middle-aged ladies that underwent laparoscopic colectomies with NOSE. The first patient presented for recurrent flare-ups of Crohn's refractory to medical treatment with a history of ileocecectomy ending up in anastomotic stenosis at the level of the terminal ileum. Laparoscopic right hemicolectomy was performed with transvaginal specimen extraction through a posterior colpotomy. The second patient underwent a laparoscopic subtotal colectomy for two stenotic lesions of the transverse and left colon. however, in this case, the specimen was extracted transvaginally through an anterior colpotomy. The postoperative hospital stay for both patients was uneventful and neither patient developed any complications related to the site of extraction.

Conclusion

Laparoscopic colectomies with NOSE have a better outcome than traditional ones still requiring abdominal incisions. Following laparoscopic colectomies with transvaginal extraction can be accomplished when patient criteria and surgeon skills allow it. More studies are needed to evaluate the criteria making patients candidates for such procedures and to predict possible postoperative complications.

Incidental splenic lesions are common in daily practice and managing them presents challenges. There are no typical imaging features for splenic lesions and the non-invasive diagnosis includes clinical, radiological, and biological evaluation. Most studies published to date propose non-invasive diagnosis algorithms based on imaging features, but often with insufficient specificity. The aim of the present article is to propose an algorithm adapted to the management of all splenic incidentalomas, leading to a final and accurate diagnosis.

The management of splenic incidentaloma should be based on a multimodal approach including benign imaging features, nuclear medicine, follow-up, and biopsy.