Langenbeck's Archives of Surgery最新文献

Aim: We aimed to evaluate the utility of procalcitonin (PCT) as a biomarker for clinical severity grading of intra-abdominal infections (IAI) in hospital-admitted patients presenting with acute abdomen.

Methods: In this retrospective study, median PCT values were compared with conventional inflammatory biomarkers, including leukocyte count (LC), neutrophil count (NC), and C-reactive protein (CRP), within the patient population.

Results: Among the 245 patients included in the study, 58 (23.7%) were diagnosed with appendicitis, 54 (22.0%) with diverticulitis, 34 (13.9%) with calculous cholecystitis, and 21 (8.6%) with pancreatitis. Additionally, 60 (24.5%) were diagnosed with non-specific abdominal pain (NSAP), and 18 (7.3%) with gallstones without cholecystitis. Median PCT levels were significantly higher in patients with calculous cholecystitis (p < 0.0001) and pancreatitis (p < 0.0001) compared to those with NSAP. The proportion of patients with a PCT cut-off ≥ 0.04 µg/L was significantly higher across all IAI subgroups compared to the NSAP group. However, 18 (10.8%) of IAI patients exhibited PCT levels ≥ 0.5 µg/L, indicating systemic infection. Spearman's rho analysis revealed a significant correlation between PCT and LC, NC, and CRP in patients with IAI (p < 0.0001). Moreover, median PCT levels were significantly higher in perforation/abscess vs. gangrenous appendicitis (p < 0.01), complicated vs. uncomplicated diverticulitis (p = 0.048), and severe vs. mild cholecystitis (p < 0.001).

Conclusion: PCT correlates strongly with conventional inflammatory biomarkers in patients with IAI. However, PCT appears to offer limited additional clinical value for guiding therapeutic decisions concerning the initial diagnosis and/or severity grading of IAI in patients admitted with acute abdomen. Further research is warranted to validate these findings.

Background: To compare the postoperative complications between temporary intravascular shunts (TIVS) and non-TIVS management in limb salvage surgery for severe limb trauma, and to provide reference for clinical decision making.

Methods: The literature on postoperative complications of limb salvage with and without TIVS was searched in PubMed, Cochrane Library, Embase and MEDLINE from January 2000 to December 2023. References were screened and extracted according to inclusion and exclusion criteria, and meta-analysis was performed using RevMan5.4 software.

Results: 8 studies were included, including 1375 cases, 329 of which used TIVS and 1046 of which did not. Compared with no TIVS group, TIVS group was associated with a lower rate of amputation (OR = 0.48, 95%CI: [0.29, 0.82], P = 0.007) and less limb ischemic time (SMD = -0.96, 95%CI: [-1.17, -0.74], P < 0.00001), the incidence of thrombosis (OR = 1.48, 95%CI: [0.46, 4.78], P = 0.51), fasciotomy (OR = 0.84, 95%CI: [0.30, 2.36], P = 0.75) and infection (OR = 0.88, 95%CI: [0.35, 2.19], P = 0.78) were not statistically significant.

Conclusion: Compared with no TIVS group, TIVS group may reduce amputation rate and limb ischemia time, prospective multi-centre studies are needed for further evaluation.

Purpose: Despite the high prevalence of ventral hernias worldwide, intraoperative drain placement remains a controversial topic. The benefit in reducing postoperative complications has not yet been clearly demonstrated. This study investigates whether a drain prevents postoperative complications after minimally invasive ventral hernia repair using the extended-totally-extraperitoneal-(eTEP)-technique.

Methods: This monocentric, retrospective cohort study included all patients who underwent eTEP between 2019 and 2024. Two comparison groups were formed (54 patients with drain,106 patients without) and analysed for potential differences.

Results: There were no significant sociodemographic or clinical differences between the study groups. The defect size was larger in the drain group (drain: 13 cm² (64,5) †, no-drain: 6,5 cm² (21) †, p = 0,025). There were no significant differences regarding frequency of postoperative complications (drain: 13%, no-drain: 8,5%, p = 0,373), surgical site infections (SSI) (drain: 0%, no-Drain: 1,9%, p = 0,550), and surgical site occurrences (SSO) (drain: 13%, no-Drain: 4,7%, p = 0,108). A subgroup analysis showed that robotically operated patients were more frequently provided with drains (rob: 30 (47,6%), lap: 24 (24,7%), p = 0,003), had larger defect sizes (rob: 28 cm² (72)†, lap: 6 cm² (9,87)†, p < 0,001), and received Transversus-abdominis-releases (TAR) more often (rob: 14 (22,2%), lap: 5 (5,2%), p = 0,001).

Conclusion: We found no significant differences between patients with and without drains after eTEP regarding the frequency of postoperative complications, SSOs and SSIs. Our findings do not suggest nor refute that wound drains prevent postoperative complications.

Introduction: Surgical process models (SPM) are simplified representations of operations and their visualization by surgical workflow management systems (SWMS), and offer a solution to enhance communication and workflow.

Methods: A 1:1 randomized controlled trial was conducted. A SPM consisting of six surgical steps was defined to represent the surgical procedure. The primary outcome, termed "deviation" measured the difference between actual and planned surgery duration. Secondary outcomes included stress levels of the operating team and complications. Analyses employed Welch t-tests and linear regression models.

Results: 18 procedures were performed with a SWMS and 18 without. The deviation showed no significant difference between the intervention and control group. Stress levels (TLX score) of the team remained largely unaffected. Duration of operation steps defined by SPM allows a classification of all liver procedures into three phases: The Start Phase (low IQR of operation time), the Main Phase (high IQR of operation time) and the End Phase (low IQR of operation time).

Conclusion: This study presents a novel SPM for open liver resections visualized by a SWMS. No significant reduction of deviations from planned operation time was observed with system use. Stress levels of the operation team were not influenced by the SWMS.

Purpose: Rapid weight loss that often occurs after laparoscopic sleeve gastrectomy (LSG) has been linked to an increased risk of gallstone formation. This study aimed to investigate whether ursodeoxycholic acid could be an effective alternative treatment for gallstone dissolution, potentially offering a nonsurgical option for patients requiring gallstone removal.

Methods: This retrospective study analyzed 88 patients who underwent LSG and subsequently developed gallstones between 2017 and 2023. Fifty-one patients who received UDCA treatment were compared to 37 patients who did not receive UDCA. Demographic and clinical characteristics and gallstone dissolution rates were analyzed using SPSS v25.0.

Results: Gallstones dissolved in 60% of patients who received UDCA treatment, and symptoms such as dyspepsia decreased. A stone diameter of less than 5 mm was associated with a higher treatment success rate. The number of hospitalizations and admissions due to gallstone symptoms has decreased. The side effects were mild and did not require treatment discontinuation.

Conclusions: UDCA treatment is an effective option for the resolution of gallstones after LSG. However, surgery may be more appropriate for treating larger stones. The results of this study suggest that UDCA is an effective intervention for reducing gallstone-related complications following LSG.

Background: Postoperative adjuvant transarterial chemoembolization (PA-TACE) is proposed as a potentially effective treatment for hepatocellular carcinoma (HCC), but its benefits may be limited according to recent evidence.

Methods: We analyzed clinicopathologic data from HCC patients who underwent hepatectomy between 2014 and 2019, categorizing them into two groups: surgery alone (non-PA-TACE) and PA-TACE. Propensity score matching (PSM) was used to adjust for selection bias. Cox proportional hazard models identified independent prognostic factors for overall survival (OS) and recurrence-free survival (RFS). Kaplan-Meier estimates were used to compare RFS and OS rates between groups.

Result: PA-TACE was not an independent prognostic factor for RFS (entire cohort: hazard ratio [HR] 1.17, 95% confidence interval [CI] 0.92-1.50, p = 0.206; matched cohort: HR 1.10, 95% CI 0.79-1.54, p = 0.560) or OS (entire cohort: HR 1.15, 95% CI 0.87-1.52, p = 0.317; matched cohort: HR 0.96, 95% CI 0.68-1.36, p = 0.823). In the matched cohort, independent Predictors of worse OS included tumor diameter ≥ 5 cm, positive microvascular invasion (MVI), Edmondson-Steiner grade III-IV, pathological cirrhosis, and Barcelona Clinic Liver Cancer (BCLC) B/C stage. Predictors of worse RFS included tumor diameter ≥ 5 cm and Edmondson-Steiner grade III-IV. Only in the BCLC B/C stage subgroup, PA-TACE may improve OS compared to non-PA-TACE (HR 0.47, 95% CI 0.26-0.85, p = 0.011).

Conclusion: PA-TACE may not extend OS or RFS in HCC patients with BCLC 0/A stage, tumor diameter ≥ 5 cm, or MVI. PA-TACE should be administered with caution, even in HCC patients with BCLC B/C stage.

Background: Our study aimed to combine the morphological behavior (tumor burden score, TBS) and the biological behavior (AFP and PIVKA-II) to predict the prognosis of HCC patients after radical liver resection.

Methods: A total of 1766 HCC patients were divided into the training cohort (n = 1079) and the validation cohort (n = 687) with a ratio of 6:4. The Kaplan-Meier method was used to analyze the recurrence-free (RFS) and overall survival (OS). The multivariable Cox regression model was established based on the variables screened by the least absolute shrinkage and selection operator (LASSO) regression to identify variables independently associated with recurrence-free survival (RFS) and overall survival (OS). Constructing our prognostic score (TBS-LN(AFP + PIVKA-II) score, TAP score) based on regression coefficients and the predictive ability of the TAP score was compared with Barcelona Clinic Liver Cancer (BCLC) stage.

Results: The TAP score had good performance in stratifying RFS (p < 0.001) and OS (p < 0.001) in the training cohort and the validation cohort. There still existed significant differences in the intergroup comparisons among three TAP score groups for RFS and OS in the training cohort and the validation cohort. In our LASSO-Cox regression model, the TAP score was independently associated with RFS and OS. The TAP score also outperformed the BCLC stage in predicting RFS (1, 2 and 3 years) and OS (1, 3 and 5 years).

Conclusions: The TAP score had good performance in predicting the prognosis of HCC patients after radical liver resection and was superior to the BCLC stage.

Purpose: Small intestinal neuroendocrine tumours (SI-NETs) are the most common malignancy of the small bowel. Curative treatment is surgical, with exploratory laparotomy considered the standard approach. This study aimed to assess the outcomes of minimally invasive surgery compared to open approach for SI-NETs at the Endocrine surgical unit at Uppsala University Hospital.

Methods: This retrospective cohort study included patients who underwent surgery for SI-NET between 2013 and 2023 at Uppsala University Hospital. Variables such as operative time, length of hospital stay, use of analgesia and radicality were compared between groups of patients operated on before and after 2019, when hand-port assisted laparoscopic surgery (HALS) for SI-NETs was introduced at our unit. Outcomes were further compared between open and hand-port assisted laparoscopic approaches. The primary outcome was the rate of radicality achieved for stage II-III patients. Secondary outcomes included operative time, the length of hospital stay and the use of epidural and patient-controlled analgesia.

Results: Of 97 patients, 58 (59.8%) underwent open surgery and 39 (40.2%) underwent hand-port assisted laparoscopic surgery. There was no significant difference in operative time (121 min [91.3-150.3] vs 108 min [83-141]), length of hospital stay, 6 days [4-7] vs 5 days [4-8]), and surgical radicality in patients with stage II-III, 85.2% vs 100%, (p = 0.079). 86.2% of patients with explorative laparotomy required epidural analgesia compared to only 23.1% with HALS (p < 0.001).

Conclusion: Hand-port assisted laparoscopic surgery of SI-NETs is a feasible approach that preserves radical resection while enhancing postoperative recovery, with a lower requirement of epidural analgesia.

Background: This study explores the association between the need for open necrosectomy (ON) during infected necrotizing pancreatitis (INP) treatment and the development of postoperative pancreatic fistula (POPF) following definitive surgery (DS) for transverse colonic fistulas.

Materials and methods: This study was conducted at two tertiary hospitals and included patients who underwent DS for colonic fistula secondary to INP from January 2009 to December 2023. Patients were followed until hospital discharge. The primary outcome was the incidence of POPF.

Results: A total of 135 patients were included. The median age was 38 years (interquartile range [IQR]: 32-44 years), with 85 (62.9%) being male. ON was required in 52 patients (38.5%), with 24 patients developing POPF post-DS. The need for ON (odds ratio [OR] = 2.78, 95% confidence interval [CI]: 1.03-7.58, p = 0.040) and the interval from INP resolution to DS (OR = 0.82, 95% CI: 0.68-0.92, p = 0.011) were associated with POPF.

Conclusion: The need for ON during INP treatment is significantly associated with an increased risk of POPF following DS for transverse colonic fistulas.