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Toxic megacolon. 中毒性巨结肠
IF 8.6 1区 医学 Q1 SURGERY
British Journal of Surgery
Pub Date : 2024-08-02 DOI: 10.1093/bjs/znae200
Orestis Argyriou, Gita Lingam, Phil Tozer, Kapil Sahnan
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引用次数: 0
Severe acute pancreatitis. 重症急性胰腺炎
IF 8.6 1区 医学 Q1 SURGERY
British Journal of Surgery
Pub Date : 2024-08-02 DOI: 10.1093/bjs/znae170
Kjetil Søreide, S George Barreto, Sanjay Pandanaboyana
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引用次数: 0
Botulinum toxin injections for treatment of faecal incontinence after rectal resection. 肉毒杆菌毒素注射治疗直肠切除术后大便失禁。
IF 8.6 1区 医学 Q1 SURGERY
British Journal of Surgery
Pub Date : 2024-08-02 DOI: 10.1093/bjs/znae192
Charlotte Desprez, Virginie Vernon, Guillaume Gourcerol, Jean-Jacques Tuech, Valérie Bridoux, Anne-Marie Leroi
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引用次数: 0
Long-term cost-effectiveness of insertion of a biological mesh during stoma-site closure: 5-8-year follow-up of the ROCSS randomized controlled trial. 造口部位闭合时植入生物网片的长期成本效益：ROCSS 随机对照试验的 5-8 年随访。
IF 8.6 1区 医学 Q1 SURGERY
British Journal of Surgery
Pub Date : 2024-08-02 DOI: 10.1093/bjs/znae159

Background: The original ROCSS trial demonstrated a significant reduction in clinically detectable incisional hernias at 2 years in patients receiving prophylactic biological mesh during stoma closure. ROCSS-Ex was designed to investigate the 5-8-year cost-effectiveness of mesh in the surviving cohort using an abdominal wall-specific quality of life score.

Methods: Eligible participants from original UK centres were identified. The primary outcome (abdominal wall-specific quality of life) was measured using the HerQLes score and EQ-5D-5L. Assessors remained blind to patients' original allocation, even if the patient was aware of their treatment.

Results: Of the original 790 patients, 598 were available for long-term follow-up. HerQLes scores were available for 396 patients (no mesh: 191, mesh: 205). There was no difference in primary outcome between the two groups (mean difference of 1.48, 95% c.i. (-2.35, 5.32), P = 0.45) and no cost benefit of routine insertion of prophylactic biological mesh across the entire cohort in the long term. However, patients who received mesh experienced significantly fewer stoma site complications within the first 3 years after reversal and needed fewer surgical reinterventions (32 versus 54 for the no mesh group; incidence rate ratio of 0.55, 95% c.i. (0.31, 0.97), P = 0.04).

Conclusions: ROCSS-Ex has shown equivocal outcomes for prophylactic mesh insertion versus standard repair on abdominal wall-specific quality of life 5-8 years after surgery. As most reinterventions occurred within the first 3 years post-surgery, there may be a role for prophylactic mesh in a subset of patients who would be most adversely affected by repeated surgery early on.

Trial registration: ISRCTN25584182 (http://www.clinicaltrials.gov).

背景：最初的 ROCSS 试验表明，在造口关闭期间接受预防性生物网片治疗的患者在 2 年后临床上可发现的切口疝显著减少。ROCSS-Ex 的目的是使用腹壁特异性生活质量评分来调查网片在存活人群中 5-8 年的成本效益：方法：从英国最初的中心确定符合条件的参与者。主要结果（腹壁特异性生活质量）采用 HerQLes 评分和 EQ-5D-5L 进行测量。即使患者知道自己的治疗方法，评估人员对患者的原始分配仍然是盲人：在最初的 790 名患者中，有 598 人接受了长期随访。有 396 名患者获得了 HerQLes 评分（无网片：191 人，有网片：205 人）。两组患者的主要结果没有差异（平均差异为 1.48，95% 置信区间为 (-2.35, 5.32)，P = 0.45），而且从长期来看，在整个队列中常规植入预防性生物网片没有成本效益。不过，接受网片治疗的患者在逆转术后头 3 年内造口部位并发症明显减少，需要再次手术治疗的人数也更少（无网片组 32 人，无网片组 54 人；发病率比为 0.55，95% 置信区间为 (0.31，0.97)，P = 0.04）：ROCSS-Ex显示，在术后5-8年腹壁特异性生活质量方面，预防性网片植入与标准修复的结果并不一致。由于大多数再干预发生在术后的前 3 年，预防性网片可能会在一部分患者中发挥作用，这些患者在早期会受到重复手术的最大不利影响：ISRCTN25584182（http://www.clinicaltrials.gov）。
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引用次数: 0
Advancing surgical techniques: three-port robotic cholecystectomy. 先进的外科技术：三孔机器人胆囊切除术。
IF 8.6 1区 医学 Q1 SURGERY
British Journal of Surgery
Pub Date : 2024-08-02 DOI: 10.1093/bjs/znae205
Fanourios Georgiades, Kanapathi Rajaratnam
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引用次数: 0
Impact of small-bite (5 mm) fascial closure on the incidence of incisional hernia following open colorectal cancer surgery: randomized clinical trial. 小咬口（5 毫米）筋膜闭合对开放式结直肠癌手术后切口疝发生率的影响：随机临床试验。
IF 8.6 1区 医学 Q1 SURGERY
British Journal of Surgery
Pub Date : 2024-08-02 DOI: 10.1093/bjs/znae189
Cumhur Ozcan, Tahsin Colak, Ozgur Turkmenoglu, Mustafa Berkesoglu, Elif Ertas

Background: Incisional hernia is frequently observed after open colorectal cancer surgery, and should be considered a serious short- and long-term health issue. The present study evaluated the efficacy of small-bite abdominal closure in reducing the incidence of incisional hernia in this patient group.

Methods: An RCT was conducted between June 2019 and June 2022. A total of 173 patients who underwent open colorectal cancer surgery were assigned randomly to one of two groups to undergo fascial closure with either small bites (87) or conventional bites (86). The incisional hernia rate was accepted as the primary outcome, and surgical-site infection as the secondary outcome.

Results: The incisional hernia rates at 1 year were 7 and 27% in the small- and conventional-bite groups respectively (P < 0.001). This rate increased to 9 and 31% at the end of the second year (P < 0.001). Surgical-site infections occurred in 18% of the small-bite group and 31% of the conventional-bite group (P = 0.03). Compared with the conventional-bite group, the small-bite group had higher suture/wound length ratios (mean(s.d.) 5.18(0.84) versus 3.67(0.57); P < 0.001) and a longer fascial closure time 14.1(4.64) versus 12.9(2.39) min; P = 0.03).

Conclusion: Small-bite closure with 5-mm tissue bites placed 5 mm apart reduced the incidence of incisional hernia and surgical-site infection after open colorectal cancer surgery.

背景：开放性结直肠癌手术后经常会出现切口疝，这应该被视为一个严重的短期和长期健康问题。本研究评估了小口腹腔闭合术在降低该患者群体切口疝发生率方面的疗效：方法：在2019年6月至2022年6月期间进行了一项RCT研究。共有 173 名接受开腹结直肠癌手术的患者被随机分配到两组中的一组，分别接受小咬口（87 例）或传统咬口（86 例）的筋膜闭合术。切口疝发生率为主要结果，手术部位感染为次要结果：小型咬合组和传统咬合组一年后的切口疝发生率分别为 7% 和 27%（P < 0.001）。第二年末，这一比例分别增至 9% 和 31%（P < 0.001）。小型咬合组和传统咬合组分别有18%和31%的患者发生手术部位感染（P = 0.03）。与传统咬合组相比，小咬合组的缝合/伤口长度比更高（平均值（s.d.）为 5.18(0.84) 对 3.67(0.57); P < 0.001），筋膜闭合时间更长，为 14.1(4.64) 对 12.9(2.39) 分钟; P = 0.03）：结论：使用间隔 5 毫米的 5 毫米组织咬合进行小咬合闭合可降低开放式结直肠癌手术后切口疝和手术部位感染的发生率。
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引用次数: 0
Comment on: Total neoadjuvant therapy versus standard neoadjuvant treatment strategies for the management of locally advanced rectal cancer: network meta-analysis of randomized clinical trials. 评论：治疗局部晚期直肠癌的全面新辅助治疗与标准新辅助治疗策略：随机临床试验网络荟萃分析。
IF 8.6 1区 医学 Q1 SURGERY
British Journal of Surgery
Pub Date : 2024-08-02 DOI: 10.1093/bjs/znae209
Corrado Pedrazzani, Giulia Turri, Giovanni Ostuzzi, Corrado Barbui
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引用次数: 0
An 'idiopathic empty pelvis' is frequently observed when pelvic organ prolapses occur. 当盆腔器官脱垂时，经常会出现 "特发性空骨盆"。
IF 8.6 1区 医学 Q1 SURGERY
British Journal of Surgery
Pub Date : 2024-07-02 DOI: 10.1093/bjs/znae161
Carlo Ratto, Angelo A Marra
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引用次数: 0
Erratum to: Evaluation of laparoscopic peritoneal lavage for perforated diverticulitis: a national registry-based study. 勘误：腹腔镜腹膜灌洗治疗穿孔性憩室炎的评估：一项基于国家登记的研究。
IF 8.6 1区 医学 Q1 SURGERY
British Journal of Surgery
Pub Date : 2024-07-02 DOI: 10.1093/bjs/znae191
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引用次数: 0
Small bowel obstruction. 小肠梗阻。
IF 8.6 1区 医学 Q1 SURGERY
British Journal of Surgery
Pub Date : 2024-07-02 DOI: 10.1093/bjs/znae167
Josephine Walshaw, Henry G Smith, Matthew J Lee
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引用次数: 0
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