Langenbeck's Archives of Surgery最新文献

Purpose: To evaluate the impact of extended versus nonextended perioperative antibiotic prophylaxis (PAP) on reducing postoperative complications and hospital stays in patients undergoing radical cystectomy and urinary diversion.

Methods: We conducted this systematic review and meta-analysis in accordance with the PRISMA guidelines. A comprehensive literature search was conducted across PubMed, Scopus, Web of Science, and the Cochrane Library for studies comparing short-term (≤ 24 h) and extended (≥ 24 h) PAP in patients undergoing radical cystectomy and urinary diversion. The primary outcomes were surgical site infections (SSIs), urinary tract infections (UTIs), and length of hospital stay. The statistical analysis was performed via RevMan version 5.3. The results are presented as risk ratios (RRs) and mean differences (MDs). Results are presented as risk ratios (RRs) and mean differences (MDs). The quality of evidence was assessed using the GRADE methodology.

Results: A total of 214 studies were screened. Four studies involving 680 patients were included. No significant differences were detected between short-term and extended PAP in terms of SSIs (RR = 0.71 [95% CI 0.43-1.17]; P = 0.18]), febrile UTIs (RR = 1.19 [95% CI 0.91-1.56]; P = 0.20]), or length of hospital stay (MD = 0.76 days [95% CI [-2.72, 4.25]; P = 0.67]).

Conclusion: No significant difference was observed between 24-h and extended PAP for reducing postoperative complications after radical cystectomy and urinary diversion. Short-term PAP is a reliable and effective strategy and is recommended as the standard practice for reducing antimicrobial resistance and improving postoperative outcomes.

Objective: By comparing with routine nursing, we aim to explore the impacts of risk assessment nursing combined with psychological care on SAS scores, SDS scores, and patient compliance in surgical intensive care unit (SICU) patients.

Methods: This study is a single-center, randomized controlled trial (due to the nature of the study, blinding was not implemented for the researchers and patients, but blinding was implemented for data collectors, outcome assessors, and data statistical analysts). A total of 162 patients were randomly divided into a control group (routine specialist nursing) and an intervention group (risk assessment nursing combined with psychological care on the basis of the control group) (81 cases each) using a random number table method. Primary outcome measures included Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), and patient compliance. Secondary outcome measures included General Self-Efficacy Scale (GSES), World Health Organization Quality of Life Brief Version (WHOQOL-BREF), adverse events, and satisfaction of family members with nursing were recorded.

Results: After nursing care, the intervention group showed significant improvements over the control group in multiple indicators: the SAS scores (45.95 ± 2.40 vs. 51.77 ± 2.90; 95%CI: -2.576 to -1.797), SDS scores (38.78 ± 2.19 vs. 46.30 ± 2.88; 95%CI: -3.384 to -2.495), and incidence of adverse events (3.70% vs. 12.35%; 95%CI: 1.019 to 2.115) were lower (all P < 0.05); the GSES scores (33.11 ± 2.92 vs. 28.94 ± 3.11; 95%CI: 1.040 to 1.725), overall compliance rate (97.53% vs. 82.72%; 95%CI: 0.418 to 0.741), and family member satisfaction (95.06% vs. 85.19%; 95%CI: 0.480 to 0.962) were higher (all P < 0.05); meanwhile, the WHOQOL-BREF scores in all dimensions also showed significant improvements (all P < 0.001).

Conclusion: Compared with routine nursing, risk assessment nursing combined with psychological care improves emotional well-being, patient compliance, self-efficacy, and quality of life while reducing adverse events and enhancing family satisfaction in SICU patients.

Background: Laparoscopic cholecystectomy(LC) is the standard treatment for gallbladder disease. However, complex cases may require conversion to open surgery. Indocyanine green near-infrared fluorescence cholangiography(ICG NIRF-C) enhances biliary visualization, potentially reducing conversion rates, surgical time and complications.This study evaluates ICG's role in improving LC outcomes using five predictive risk scores.

Study design: Forty-four LC patients received a single 0.25 mg intravenous ICG dose during anesthesia induction. Data collected included demographics, biliary visualization before and after dissection, complications, operative time and risk scores.

Results: ICG fluorescence improved biliary visualization: common bile duct(CBD) was identified in 29% of cases before and 100% after dissection. Despite 61.4% of patients having a CLOC score > 6 and 43.2% a G10 score ≥ 3 no conversions occurred. Only 7% of cases exceeded 90 min (p = 0.03).

Conclusion: ICG NIRF-C enhanced biliary visualization and, in this cohort, was associated with absence of conversions and favorable operative‑time profiles across risk strata. These findings are observational and hypothesis‑generating, supporting further comparative evaluation, particularly in complex cases.

Purpose: Postoperative pancreatic fistula (POPF) is a severe complication of radical gastrectomy. Postoperative drain amylase levels (D-AMY) are correlated with POPF, but it's not for prevention. The aim of this study is to investigate whether intraoperative amylase levels (I-AMY) of intra-abdominal exudates is associated with increased D-AMY.

Methods: From April 2021 to September 2023, 112 consecutive GC patients underwent radical gastrectomy with lymphadenectomy were enrolled. We measured the I-AMY of fluid from the left upper abdominal cavity (Area A), caudate fossa at the right upper abdominal cavity (Area B), and Area B after lavage with 20 mL of saline (Lavage Area B). We analyzed the correlation of I-AMY and D-AMY on POD1 and POD3. In the most recent 39 patients, we tested the effectiveness of polyglycolic acid (PGA) sheets around the pancreas after lymphadenectomy to prevent POPF.

Results: In 73 patients without PGA sheets, I-AMY in Area B and Lavage Area B were significantly correlated with D-AMY on POD1 and POD3 (Area B: POD1, Pearson's r = 0.737, p < 0.001; POD3, r = 0.457, p < 0.001; Lavage Area B: POD1, r = 0.652, p < 0.001; POD3, r = 0.353, p = 0.0022). Based on a receiver operating characteristic curve analysis, the cutoff value of I-AMY for predicting Biochemical leak (BL) or POPF was 1197 U/L in Area B (sensitivity: 50%, specificity: 88%) and 32 U/L in Lavage Area B (sensitivity: 81%, specificity: 52%). Unexpectedly, PGA sheets did not reduce D-AMY levels.

Conclusion: Intraoperative I-AMY measurement of exudates or lavage fluids in the caudate fossa may be useful for predicting BL or POPF after radical gastrectomy.

Objective: This research evaluated the effectiveness of risk management strategies in enhancing nursing management quality and improving patient satisfaction in the operating room setting.

Methods: A quasi-experimental design was adopted to compare outcomes between two patient groups in the operating room. The observation group (n = 49) received nursing care guided by structured risk management protocols, while the routine group (n = 42) received conventional nursing management. Outcome indicators included the incidence of nursing-related risk events, comprehensive nursing quality scores (covering basic care, aseptic practices, documentation quality, item management, and safety protocols), nursing staff's risk management cognition (awareness, attitude, and behavior), and patient satisfaction levels.

Results: Compared to the routine group, the observation group demonstrated a significantly lower incidence of nursing risk events (P < 0.05). Scores for nursing quality across all domains-including aseptic practices and safety management-were markedly higher in the risk-managed group (P < 0.05). Nursing staff in the observation group also exhibited enhanced risk cognition, more proactive attitudes, and stronger risk management behaviors (P < 0.05). Furthermore, patient satisfaction scores were significantly improved in the risk-managed group.

Conclusion: Implementation of structured risk management strategies in the operating room leads to measurable improvements in nursing quality, enhances staff risk awareness and practices, and significantly boosts patient satisfaction. These findings support broader integration of risk-based nursing protocols into perioperative care systems to ensure safer and higher-quality patient outcomes.

Purpose: Jejunostomy feeding tubes are commonly used during esophagectomy to provide postoperative nutritional support, but their impact on clinical outcomes remains uncertain.

Methods: This retrospective study included 507 patients who underwent esophagectomy for esophageal cancer at the Northern Oesophagogastric Unit between 2012 and 2014 and 2016-2019. Routine postoperative jejunostomy feeding was introduced in 2015. Outcomes measured were percentage weight change at 2, 6, 12, and 24 weeks postoperatively, length of hospital stay, weight loss in patients with major complications (Clavien-Dindo > 3), and long-term survival.

Results: Of the 507 patients, 290 received routine jejunostomy feeding and 217 did not. Jejunostomy-fed patients experienced significantly less weight loss at all measured time points, with weight loss at 2 weeks of 3.22% versus 7.24% (p < 0.001), at 6 weeks of 3.28% versus 8.30% (p < 0.001), at 3 months of 5.49% versus 10.38% (p < 0.001), and at 6 months of 6.89% versus 11.46% (p = 0.006). The greatest benefit was observed in patients receiving neoadjuvant chemotherapy followed by surgery, with the most pronounced difference at 3 months (5.23% vs. 11.63%). Median hospital stay was shorter in the jejunostomy group (11 versus 15 days), and long-term survival tended to be higher among jejunostomy-fed patients, although this did not reach statistical significance, although there was no significant difference in weight loss among patients with major complications.

Conclusion: Routine postoperative jejunostomy feeding significantly reduces early postoperative weight loss after esophagectomy, particularly in patients receiving neoadjuvant chemotherapy. These benefits diminish by six months. Jejunostomy feeding may also shorten hospital stay and could be associated with improved long-term survival.

Aims: Management of patients with suspected acute appendicitis (AA) varies and often depends on the admitting surgeon's preferences. Here we investigated surgeons' perspectives on the management of AA and their own preferences if they themselves were admitted with suspected AA.

Methods: A 17-point web-based questionnaire was distributed to all acute general surgical departments in Denmark over a 1-month period. Four items regarded demographics, 9 items addressed the treatment of patients with suspected AA and the last 4 items explored surgeons' personal treatment preferences.

Results: 213 complete responses were received, with most respondents < 50 years old (86%). Most respondents rarely or never use scoring systems (77%) when assessing patients with suspected AA. Most felt pre-operative imaging wasn't indicated in patients < 50 years with typical presentations (4%), although this rose in the case of atypical presentations (56%). Less than 5% routinely discuss non-operative management with patients who are otherwise fit for surgery. In afebrile patients with AA, 9% would operate during the night based on a clinical diagnosis, rising to 21% if the diagnosis was confirmed on imaging, and to 49% if the patient also had raised inflammatory markers. Regarding preferences for their own treatment, only a minority would want to be assessed using scoring systems (13%), whereas almost half would want pre-operative imaging (47%).

Conclusion: Considerable variation is noted in surgeons' perspectives on the management of patients with AA. Discrepancies are noted in surgeons' routine clinical practice and their preferences for their own treatment, particularly regarding pre-operative imaging.