Langenbeck's Archives of Surgery最新文献

Purpose: A German transplant center recently published a prognostic model predicting graft function one year after deceased donor kidney transplantation (KTx) relying on pre-transplant variables. The aim of this study is to externally validate this model.

Methods: We retrospectively analyzed clinical data from deceased donor KTx recipients undergoing transplantation between January 2007 and December 2023 at University Hospital Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen. Receiver operating characteristics (ROC) curves were analyzed to validate the prognostic model based on donor age, donor serum creatinine, recipient body mass index, re-transplantation > 2nd KTx, and cold ischemia time. Glomerular filtration rates were categorized using the Kidney Disease: Improving Global Outcomes (KDIGO) categories G1 - G5.

Results: A total of 494 kidney transplantations were performed at our institution, 350 (70.9%) thereof from donation after brain death. The median one-year estimated glomerular filtration rate (eGFR) was 42 [12-94] mL/min/1.73 m². A validation for all eGFR categories was only possible with recalibration of the constant and coefficients of the original model, whereas without recalibration it could only be validated for KDIGO G2 and G4. Unfavourable recipient/donor-pairings with eGFR categories G4 and G5 one year after KTx could be predicted with an area under the ROC curve (AUC) > 0.700 in the validation and the original study cohort.

Conclusion: We successfully validated the prognostic model for prediction of eGFR categories G4 and G5, which is of high clinical importance to identify outcomes with marginal graft function one year after KTx, thereby facilitating the avoidance of futile recipient/donor-pairings during allocation.

Background: Varicose veins of the lower limbs, particularly involving the great saphenous vein (GSV), are a common vascular condition often requiring intervention. Conventional surgeries entail higher morbidity and prolonged recovery. To minimize complications while ensuring efficacy, a novel hybrid technique -Endovenous Chemical Ablation and Trendelenburg's operation (eCAT) -was developed. This study aimed to evaluate the efficacy and safety of the eCAT operation for treating GSV varicosities.

Methods: A single-arm open-label interventional study was conducted on 500 patients with primary lower limb varicose veins (2014-2021). The eCAT procedure, developed by Walied Khereba at Al-Azhar University (New Damietta), combined Trendelenburg's operation with polidocanol foam sclerotherapy under local anaesthesia. The primary outcome was GSV ablation efficacy at 1 week, 3 months, and 1 year. Secondary outcomes included postoperative complications, pain reduction, and factors influencing success.

Results: GSV ablation succeeded in all cases (100%). At 1 week, 88% of veins were fully occluded and 12% partially; at 3 months, full occlusion decreased to 76%, then improved to 88% at 1 year. Postoperative complications included oedema (30%), hyperpigmentation (20%), and residual varicosities (40%), all resolved by 1 year. Median pain scores decreased from 4 (IQR: 1) preoperatively to 2 (IQR: 1) at 1 week and 1 (IQR: 0) at both 3 months and 1 year (P = 0.001). Age, gender, and standing occupation significantly impacted early surgical success.

Conclusion: The eCAT is a safe, effective, and minimally invasive procedure for GSV varicosities treatment, achieving durable clinical outcomes with minimal complications and significant pain reduction.

Background and objectives: Persistent controversy surrounds the identification of risk factors contributing to postoperative complications and unfavorable neurological prognoses following cranioplasty (CP) after decompressive craniectomy (DC). This study sought to assess these postoperative outcomes in individuals undergoing 3D titanium mesh CP due to traumatic brain injury (TBI) or hemorrhagic stroke, as well as to determine predictors linked to postoperative complications and suboptimal neurological recovery.

Methods: A retrospective, single-center analysis was performed on patients undergoing 3D titanium mesh CP after DC. The primary outcome measure encompassed postoperative complications occurring within 12 months post-CP. The secondary endpoint involved the Glasgow Outcome Scale score assessed at 12 months following CP. We examined various parameters to identify predictors associated with postoperative complications and unfavorable neurological outcomes.

Results: A total of 118 male patients (66%) were included, with trauma accounting for DC in 123 cases (68%). The overall incidence of postoperative complications was 45%, while poor neurological outcomes were observed in 30% of cases. Intraoperative dural depression during CP was correlated with an increased likelihood of postoperative epidural effusion; a time interval exceeding three months between DC and CP was associated with a heightened risk of hydrocephalus; bilateral CP demonstrated an elevated risk of wound dehiscence and infection. For poor GOS outcomes, pre-DC GCS score and DC due to stroke were identified as contributing factors, though no association was found with surgical timing.

Conclusion: Early 3D titanium mesh CP, performed within three months after DC in TBI or stroke patients, appears to be a safe procedure without an increased incidence of postoperative complications or poor neurological prognosis. Conversely, delayed CP exceeding three months post-DC may increase the hydrocephalus's likelihood. Patients experiencing intraoperative dural depression during CP should be closely monitored for the potential development of postoperative epidural effusion. Additionally, those undergoing bilateral CP are at greater risk for wound dehiscence and infection. Compared to individuals with TBI-induced DC, stroke patients undergoing CP tend to exhibit poorer neurological recovery.

Aims: To investigate effect of cyanoacrylate-based glue on postoperative leak and bleeding after pancreatectomy and sleeve gastrectomy.

Methods: A PRISMA-compliant systematic review and meta-analysis using random effects modelling was performed including studies investigating effect of cyanoacrylate-based glue on postoperative leak and bleeding in patients undergoing pancreatectomy and sleeve gastrectomy. Proportion meta-analysis and comparison meta-analysis were modelled to evaluate the outcomes.

Results: Analysis of 1800 patients from nine studies showed no difference in the risk of postoperative leak between the cyanoacrylate-based glue and no glue groups in all pancreatic resections (OR: 1.26, p = 0.700), in pancreaticoduodenectomy with total duct occlusion (OR: 3.21, p = 0.360), in pancreaticoduodenectomy with pancreaticojejunostomy (OR: 0.42, p = 0.550), in distal pancreatectomy (OR: 1.50, p = 0.330), and in sleeve gastrectomy (OR: 0.14, p = 0.07). Moreover, there was no difference in the risk of postoperative bleeding between the cyanoacrylate-based glue and no glue groups in all pancreatic resections (OR: 1.44, p = 0.460), in pancreaticoduodenectomy with total duct occlusion (OR: 0.35, p = 0.520), in pancreaticoduodenectomy with pancreaticojejunostomy (OR: 2.75, p = 0.080), in distal pancreatectomy (OR: 0.72, p = 0.670), and in sleeve gastrectomy (OR: 0.37, p = 0.14). Cyanoacrylate-based glue did not reduce the risk of grade A (OR: 1.16, p = 0.82), grade B (OR: 1.29, p = 0.460), and grade C (OR: 0.36, 3.16, p = 0.360) postoperative pancreatic fistula.

Conclusions: Level 2 evidence with moderate certainty suggests that cyanoacrylate-based glue does not reduce the risk of postoperative leak and bleeding after pancreatectomy and sleeve gastrectomy. More studies with larger sample sizes are required to exclude type 2 error.