Surgery Open Digestive Advance最新文献

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.

Duodenal diverticula are most often asymptomatic. However, inflammatory and infectious complications, such as uncomplicated or perforated diverticulitis, covered or free in the peritoneum, as well as compressive complications, such as acute pancreatitis or dilation of the bile ducts, can occur. In cases of complicated perforation with covered peritonitis, initial medical management is indicated, with surgery considered if the condition worsens.

Our case concerns a 55-year-old woman with a covered perforated duodenal diverticulum with poor clinical, biological, and radiological evolution after nine days of medical treatment. Treating a perforated duodenum is complex. Various surgical management approaches have been described in the literature. In our case, surgery was performed with a duodenojejunal anastomosis on a Y-loop at the duodenal orifice (Gregoire's intervention).

We will discuss the management, post-operative care, and complications following surgery.

Background

Through the past decades, various surgical methods have been introduced as new modalities for the management of grade III and IV hemorrhoidal disease HD, to provide an effective and less invasive operation in comparison with conventional haemorrhoidectomy which is the gold standard surgical treatment.

Methods

This study was conducted at Alexandria Main University Hospital. Ninety three patients with grade III and IV HD were enrolled in our study, thirty-one patients treated with diathermy hemorrhoidectomy DH (group A), thirty-one patients with LigaSure™ hemorrhoidectomy LH (group B),and thirty-one patients with Laser hemorrhoidoplasty LHP (group C). Assessment of postoperative pain, intra and postoperative bleeding, operative time, time to return to work, quality of life using Hemorrhoidal Disease Symptom Score HDSS, and Short Health Scale for hemorrhoidal disease SHS_HD and patient satisfaction were recorded and analyzed.

Results

The postoperative pain according to Visual analogue scale VAS scores from the evening of the procedure till the fourth week postoperatively were significantly higher in group A patients compared to group B and C patients, however, no significant statistical difference was found between group B and C patients. There was significant statistical difference between each group for intra-operative bleeding, operative time, and time to return to work with advantage for LHP. LH led to significant improvement in both HDSS, SHS_HD when compared with LHP (p = 0.015*and p = p3<0.001*respectively) and when compared with DH, however, only SHS_HD was statistical significance (p = 0.001*). The median score for patient satisfaction was 6 in the 3 groups (range: 3–7 group A, 3–7 group B and 2–6 group C) with no statistical significance.

Conclusion

LH and LHP are associated with significantly less postoperative pain and give superior results than DH in terms of less operative time, intraoperative blood loss, postoperative complications, and faster recovery time, with significantlys better health-related quality of life after LH.

Cholecystectomy is the most common routinely performed procedure for benign gallbladder disease worldwide and incidental gall bladder cancer is mostly detected in post-cholecystectomy specimens.

This retrospective study emphasizes on the need for routine surveillance of post-cholecystectomy specimens by evaluating the incidence of incidental findings of carcinoma in cholecystectomy specimens done for benign gallbladder disease.

A total of 2443 patients were evaluated over a period of 7 years, out of which, 18 patients were diagnosed with incidental gall bladder carcinoma with an incidence of 0.73 %. The mean age of affected patients was 59 years. Among the 18 patients, 8 patients (44 %) had an intra-operative suspicion of malignancy. Once incidental cancer is detected the treatment decision should be decided according to tumor spread and depth as well as the patient's age, additional health problems, and life expectancy.

Introduction

Radical re-resection is the recommended treatment in case of incidental gallbladder cancer (iGBC) stages ≥ pT1b [1], with similar disease-free survival rates in case of extended cholecystectomy versus segment IVb-V segmentectomy [2]. Given the increased risk of lymph node metastasis, a regional lymphadenectomy of the hepatoduodenal ligament should be associated to the re-resection [3,4,5]. The laparoscopic approach increasingly challenges traditional laparotomy, despite some concerns over the quality of lymphadenectomy [6]. Robotic platforms offer an increased degree of instrument freedom, which could overcome the limitations of laparoscopy.

Methods

A 68 years old man was referred for iGBC pT2a four weeks after laparoscopic cholecystectomy for cholelithiasis. Three weeks later was realized a radical reresection with regional lymphadenectomy (stations 5–8-9–12–13) by a robot-assisted minimally invasive approach, with the DaVinci Si surgical system console (Intuitive Surgical, Sunnyvale, CA, USA).

Results

The procedure lasted 360 minutes, with selective intermittent pedicle occlusion and minimal blood loss. The specimen included 6 nodes and was free from tumor lesion. The length of stay was seven days, and no complications were observed at 90 days. After surgery 6 cycles of adjuvant chemotherapy (Gemcitabine-Oxaliplatin) was administered, with no recurrence after six months of follow-up.

Conclusions

Robotic assisted radical surgery (segments IVb-V and regional lymphadenectomy) for iGBC is feasible, reproductible and safe [4].