Langenbeck's Archives of Surgery最新文献

Background: Neuroinflammation is a common consequence of intracerebral hemorrhage (ICH), leading to neurological impairments. Research indicates that the gut microbiome can influence neuroinflammatory responses. Erianin, is a potential therapeutic agent in the treatment of inflammation. Yet, the specific impact of erianin on ICH-induced inflammation and its interaction with the gut microbiome remain areas of ongoing investigation.

Methods: ICH mouse model was established and treated with erianin. Neurobehavioral tests, brain water content, immunofluorescence, western blotting, and terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining were performed to measure the neurological defects and neuroinflammation and neuron apoptosis. Immunofluorescent staining and western blotting assay were performed to assess the activation states of microglia and inflammation. The quantitative real-time polymerase chain reaction (qRT-PCR), enzyme-linked immunosorbent assay (ELISA), and FITC-dextran assays were utilized to measure the intestinal barrier integrity. The composition of the gut microbiota was analyzed by sequencing the 16 S rRNA extracted from fecal samples.

Results: Administration of Erianin notably decreased inflammation in the brain and improved neurological function in ICH mice by inhibiting the proinflammatory activation of microglia. Additionally, Erianin bolstered intestinal barrier integrity, evidenced by decreased levels of lipopolysaccharide-binding protein. Furthermore, treatment with Erianin led to observable shifts in the gut microbiota. Notably, the activation of the ERK signaling pathway was found to counteract the neuroprotective effects of Erianin following ICH.

Conclusions: Erianin is a therapeutic candidate for addressing neuroinflammation triggered by ICH, with its mechanisms of action likely involving the modulation of ERK signaling and the gut microbiome.

Background: Liver transplantation (LT) remains the definitive treatment for end-stage liver disease, with intraoperative estimated blood loss (EBL) receiving limited attention despite its potential impact on outcomes. This study investigated the impact of EBL on graft survival (GS) in LT recipients and aimed to identify a clinically optimal EBL cutoff to guide surgical management.

Methods: This observational cohort study analyzed 914 adult patients who underwent primary orthotopic LT at Ohio State University Wexner Medical Center between January 2016 and December 2023. Intraoperative EBL was calculated by subtracting the volume of salvaged blood from the total volume lost during surgery, then normalized by dividing by the patient's body weight, resulting in adjusted EBL (aEBL). The primary outcome was GS, defined as the time from transplantation to graft failure, re-LT, or death. Kaplan-Meier analysis and Cox regression were used to evaluate GS, and a restricted cubic spline with five knots was applied to determine the optimal aEBL cutoff.

Results: Multivariate analysis confirmed aEBL as an independent risk factor for 1-year GS (HR:1.01, 95%CI:1.00-1.01, p < 0.001) and 3-year GS (HR:1.01, 95%CI:1.00-1.01, p < 0.001). The optimal aEBL cutoff was established at 25.0 mL/kg. Patients with aEBL < 25.0 mL/kg demonstrated superior GS rates at 90 days (p = 0.03), 1 year (p = 0.007), and 3 years (p = 0.003) compared to those with aEBL ≥ 25.0 mL/kg. Higher MELD-Na scores (OR:1.07, 95%CI:1.05-1.09, p < 0.001) and DCD donor status (OR:1.61, 95%CI:1.13-2.29, p = 0.01) were significant predictors of exceeding this threshold.

Conclusions: This study establishes aEBL as an independent risk factor for GS in LT recipients and identifies 25.0 mL/kg as a significant cutoff impacting both short-term and long-term outcomes. These findings underscore the importance of tailoring blood loss management to individual patient characteristics, particularly body weight, and suggest a practical approach to enhance outcomes for LT recipients.

Introduction: Quality of life of medical school students is impaired by anxiety or depression. As they spend more than of their time as assistants in the hospitals, it is expected that the quality of life of supervisors directly impacts that of students. The objective of this survey was to assess the quality of life of senior surgeons and medical students in visceral surgery at a university hospital in France.

Methods: The survey was conducted from 1st to 31st December 2024 using the Google Form platform. Two scales of quality of life were utilized: the WHOQOL-BREF and the PROQOL. A correlation matrix was performed to study the association between aspects of quality of life. Multivariate linear regressions were performed for modelling QoL scores.

Results: Among the 106 subjects who responded to the questionnaire, 67 were senior surgeons (63.2%) and 39 were students (36.8%). The mean score on the Stress Traumatic Scale of the PROQOL was the only difference between groups and was found to be lower in the student group (19.9+/-6.9) in comparison to the senior surgeon group (22.9+/-8) (p=0.06). Interestingly, the mental health of the students was found to be improved with the highest score of mental health among the senior surgeons. Of particular interest is the observation that the burnout scale of the students was improved with the best score of the mental health of the senior surgeons.

Conclusion: This study advocates for a strong correlation between the QoL of senior surgeons and that of students.

Purpose: Inflammatory bowel disease (IBD) encompasses two main conditions - Crohn's disease (CD) and ulcerative colitis (UC). Its pathogenesis is vastly unknown but genetics, environmental factors and the gut microbiome are thought to play vital roles. While dysbiosis is thought to be a feature of IBD, its exact role in pathogenesis is unclear.

Methods: Relevant studies were identified through searching Medline and Embase from database inception to January 2025. Only gastrointestinal microbiome studies comparing IBD human patients with healthy controls (HC), performed on faecal, mucosal biopsy, saliva, or oral swab samples were examined. Studies were excluded if they included ≤ 10 IBD patients, did not compare IBD to HC, reported on IBD with other gastrointestinal infections, all were taking IBD medications, or included post-operative bowel resection patients.

Results: Of 83 identified observational studies, most reported reduced alpha and beta diversity in IBD, more prevalent in CD than UC. There was depletion of protective butyrate producing Firmicutes bacteria including Faecalibacterium (specifically F. prausnitzii), Eubacteria, Roseburia, Lachnospiraceae, Ruminococcaceae (mainly R. bromii). There was decreased Bacteroidetes phylum in IBD, with depletion of Bacteroides genus in CD but increased in UC. There was increased Proteobacteria and its family Enterobacteriaceae in IBD.

Conclusions: The gut microbiome in IBD demonstrated reduced biodiversity, more pronounced in CD, with increased pathogenic and reduced beneficial bacteria. While this study demonstrated important associations between the microbiome and IBD, the exact mechanism, whether it be from a multistep process, a causative agent, or interplay between mucosal immunology and dysbiosis, is yet be elucidated.

Background: Postpancreatectomy hemorrhage (PPH) is a severe complication in pancreatic surgery. This study focused on early PPH (E-PPH), aiming to identify its characteristics, evaluate the existing grading criteria by the International Study Group of Pancreatic Surgery (ISGPS), and explore effective treatment strategies.

Methods: Patients undergoing pancreatic surgery between March 2020 and January 2024 in two institutions were screened from prospectively maintained databases. Patients with E-PPH were divided into intervention group and the conservative group. The sites of hemorrhage were determined and categorized. Clinical presentation and outcomes were compared among different grades and interventions.

Results: Among 4062 patients who underwent pancreatic surgery, 113 cases of E-PPH were identified, with an incidence of 2.8%. E-PPH was more concentrated within 24 h (76.2%) and occurred more extraluminally (78.2%). The intervention group had a higher proportion of hemodynamic instability (40.9%) and ICU stays (54.5%). E-PPH in the mesenteric region was more common in pancreaticoduodenectomy (81.9%) and open surgery (90.9%). Branches of the common hepatic artery and superior mesenteric vessel were the majority responsible vessels. Appropriate E-PPH treatment was effective, with successful hemostasis in all intervention cases. The occurrence of ICU admission, the length of ICU and postoperative hospital stay and 90-day mortality were not significantly different between different grades with intervention.

Conclusion: Appropriate therapy for E-PPH could lead to a favorable prognosis. The current definitions and grades for PPH are inadequate and require further modification.

Purpose: The aim of the study was to examine whether there is an incidence difference on surgical site infections between surgeons using different surgical attire during intramedullary fixation for proximal femoral fractures.

Methods: 1,431 patients were included and divided into two groups; surgeons wearing balaclava- or skull caps (490 vs 941). The occurrence of surgical site infection was retrospectively assessed and divided into superficial- and deep wound infections.

Results: The occurrence of superficial wound infections did not differ significantly between the two groups, with three patients in the balaclava and six in the skull cap group (0.6% vs 0.6%, p = 1.00). Similarly, there was no significant difference in the occurrence of deep wound infections between the groups, with one case in the balaclava and eight in the skull cap group (0.2% vs 0.9%, p = 0.18).

Conclusion: This study found no statistically significant difference in the incidence of surgical site infections (including both superficial and deep wound infections) between balaclava caps and skull caps. These results suggest that the type of surgical attire does not have a significant impact on the occurrence of surgical site infections in intramedullary nailing for proximal femoral fractures. Therefore, factors such as cost, and sustainability should be considered when selecting surgical attire. In this context, the skull cap would be the preferred option.

Objective: To investigate the efficacy and safety of laparoscopic surgery in treatment of pediatric hepatic cystic echinococcosis(HCE).

Methods: The clinical data of 78 children with HCE infection who were treated at the Department of Pediatric Surgery of the First Affiliated Hospital of Xinjiang Medical University between April 2016 and September 2023 were retrospectively analyzed. The cohort comprised 52 males and 26 females. The age range of the subjects is from 2 to 15 years old. The children were divided into 2 groups according to the surgical methods employed: the laparoscopic group comprised 38 children who had undergone laparoscopic surgery, while the conventional group consisted of 40 children who had been treated with conventional surgery. A comparative analysis of the clinical data was conducted between those groups, encompassing baseline data, operation time, intraoperative blood loss, Postoperative I-feed score, facial visual analogue scale (f-VAS) 8 h after surgery, postoperative hospital stay, residual cavity infection rate, incidence of biliary leakage, incidence of postoperative hypernatremia, incidence of residual fluid, incidence of residual cavity infections and recurrence rate.

Results: No significant differences were observed in the baseline data, operation time, residual effusion rate, residual infection rate, postoperative hypernatremia rate, biliary leakage rate and recurrence rate between the two groups (P > 0.05). However, statistically significant differences were noted in intraoperative bleeding, Postoperative I-feed score, 8-h postoperative f-VAS score and postoperative length of hospital stay (P < 0.05).

Background: Closure of the peritoneum has been a standard practice in appendectomy. However, it has been proposed that closure of the peritoneum following any abdominal surgery is more likely to give rise to adhesions and increased postoperative pain. This study was based on the hypothesis that peritoneal non-closure would result in decreased postoperative pain without causing any significant increase in complications like surgical site infection or wound dehiscence.

Objective: The primary objective of this study was to compare the pain scores in patients undergoing open appendectomy and peritoneal closure, with non-closure using the visual analogue scale (VAS) on postoperative day 1.

Results: Median VAS score on postoperative day 1 was found to be 4 (3,4) in the patients where the peritoneum was left open as compared to 5 (4,5) in patients where the peritoneum was closed (p < 0.001). Similarly, on postoperative day 2, the median VAS score in the peritoneum closure group was 4 (3,4) as compared to 3 (3,5) in the non-closure group. 29 out of 69 patients (42%) in the peritoneal closure group required rescue analgesia as compared to 11 out of 71 patients (15.5%) in the group with non-closure of the peritoneum (p < 0.001). The median duration of analgesia received, across both study groups was found to be 5 days.

Conclusion: This study showed that peritoneal non-closure during open appendectomy is associated with less post-operative pain. It also significantly reduces the need for rescue analgesia and decreases the total number of days of analgesia used. There is no significant increase in surgical site infection and wound dehiscence after 30 days through the above intervention, implying no difference in morbidity with the intervention.

Introduction: Stoma outlet obstruction (SOO) is a serious postoperative complication that can lead to significant morbidity, including prolonged hospitalization, increased healthcare costs, and reduced quality of life. This study, the first systematic review and meta-analysis on SOO, aims to identify and analyze key risk factors of SOO, calculate its pooled incidence, and systematically review its diagnostic features, clinical symptoms, imaging modalities, management strategies, prognosis, and associated outcomes.

Methods: This systematic review and meta-analysis followed PRISMA 2020 guidelines and included 16 retrospective cohort studies, identified through a comprehensive search of multiple databases, with data on risk factors for SOO. The study analyzed four key variables reported by three or more studies, assessed study quality using the MASTER scale, and synthesized findings using the quality effects model to evaluate heterogeneity and publication bias.

Results: This study included 16 retrospective cohort studies involving 2,228 patients, of whom 362 developed SOO. Increased rectus abdominis muscle thickness was found to significantly increase the risk of SOO (odds ratio [OR] 4.04, 95% confidence interval [CI] 2.36-6.93). High output stoma was another associated risk factor (OR 4.16, 95% CI 2.03-8.51). The type of ileostomy also played a critical role, with loop ileostomy showing a significantly higher risk of SOO compared to end ileostomy (OR 6.53, 95% CI 2.83-15.03). Although age was assessed as a potential risk factor, it did not show a statistically significant association with SOO (OR 1.69, 95% CI 0.44-6.54).

Conclusion: This systematic review and meta-analysis identified significant risk factors for SOO, including increased rectus abdominis muscle thickness, high output stoma, loop ileostomy. We also reported other contributing factors, such as ileal pouch-anal anastomosis, shorter ileal pouch-to-ileostomy distance, oral inferior technique, smaller aperture size, higher BMI, and increased subcutaneous fat thickness. The findings emphasize the importance of tailored surgical techniques, such as stoma maturation using the oral superior technique, ensuring no twist at the mesentery, avoiding stoma limb angulation, creating the stoma slightly more proximally in cases of ileal pouch-anal anastomosis, and optimizing aperture size, along with vigilant postoperative care to reduce SOO incidence and improve patient outcomes.

Background: Acute infected necrotizing pancreatitis is characterized by high rates of systemic infection with organ failure and mortality. The step-up approach combining percutaneous drainage with laparoscopic-assisted pancreatic necrosectomy (LAPN) or transgastric necrosectomy shows a lower incidence of complications and mortality than open necrosectomy. This study aimed at comparing minimal-invasive percutaneous and endoscopic step-up approach.

Methods: A retrospective analysis of patients undergoing the step-up approach for infected necrotizing pancreatitis between 2019 and 2023 was conducted. Percutaneous treatment involved CT-guided percutaneous drainage followed by LAPN if needed, while the endoscopic approach used transgastric drainage and endoscopic necrosectomy. Primary outcome was a composite of major complications or 6-month mortality. Secondary outcomes included complication rates, number of reinterventions, duration of hospital stay and mortality.

Results: The study included 31 patients. Eighteen patients underwent the percutaneous step-up approach, consisting of CT-guided drainage, followed by LAPN in 11 cases (61.1%). Thirteen patients were treated endoscopically which involved transgastric drainage, followed by necrosectomy in 7 cases (53.8%). The composite of major complications or death occurred in 55.6% of the percutaneous group and in 53.8% of the endoscopic group. Postoperative major complications were reported in eight patients in the percutaneous group and five in the endoscopic group. Four patients required LAPN after endoscopic necrosectomy due to insufficient improvement.

Conclusion: LAPN and endoscopic necrosectomy are effective in controlling local and systemic infection in severe necrotizing pancreatitis. LAPN remains important in managing extensive infected necrosis, particularly when transgastric methods cannot fully address the necrosis cavity.