Langenbeck's Archives of Surgery最新文献

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.

Background: Osseointegration represents an innovative technique within the field of limb amputation. The management of a permanent stoma through the residuum presents significant challenges, primarily due to the insufficient literature and limited surgical techniques available. This study aims to unravel soft tissue management strategies that seek to enhance surgical outcomes.

Methods and results: It is a retrospective study containing a total of 406 patients (251transfemoral and 155 transtibial) amputees who underwent (264 trans-femoral and 177 transtibial) osseointegration at Macquarie University Hospital and Norwest Private Hospital were systematically evaluated over the period spanning from December 2010 to December 2023. Out of a total of 264 transfemoral cases, 87(32.9%) cases necessitated stump refashioning surgery. In transtibial osseointegration, 37/177 cases (20.9%) of stump refashioning events were observed among the cohort.

Conclusion: This study describes the surgical technique and the importance of careful soft tissue management in stump refashioning. It addresses issues of stoma pain, overhanging soft tissue, and infections to prevent potential complications and improve quality of life.

Purpose: Accurate localisation of hyperfunctioning parathyroid glands is crucial for successful parathyroid surgery. In patients with inconclusive imaging, intraoperative bilateral internal jugular venous sampling (BIJVS) has been reported; but its utility remains unclear. The purpose of the review is to evaluate published techniques and reported effectiveness of BIJVS in parathyroid surgery.

Methods: PubMed, Ovid and Cochrane databases were searched for articles on intraoperative BIJVS in parathyroid surgery. All original English language human studies reporting on lateralisation rates, diagnostic accuracy or cure rates following use of intraoperative BIJVS were included. Exclusion criteria included case reports, reviews, IJV sampling in non-parathyroid pathology and IJV sampling for confirming cure. Data on patient numbers, definitions used for lateralisation and correlation with clinical outcomes were extracted by one reviewer and cross-checked by a second reviewer. The review was prospectively registered on the Open Science Framework (OSF; DOI: https://doi.org/10.17605/OSF.IO/TSQA6 ).

Results: Of 753 screened, 12 studies including 502 patients where BIJVS was performed were included. Lateralisation definitions were reported in 7 studies. Among studies with relevant data, lateralisation gradient was defined as ranging from 5 to 20% and lateralisation rates varied from 51 to 100%. The positive and negative predictive values ranged from 76 to 100% (6 studies) and 0-53% respectively (3 studies). Reported cure rates following BIJVS guided surgery were high (> 98%), but the definition for cure was only reported in 8 studies.

Conclusions: BIJVS can aid localisation in parathyroid surgery. A significant lateralisation gradient may permit unilateral surgery, but a lack of gradient does not imply bilateral disease. However, the absence of a standard definition for lateralisation and inconsistent reporting limits widespread adoption of this technique.

Background: The association between intraoperative lactate levels and postoperative prognosis following emergency surgery remains inconclusive. We aimed to investigate the prognostic significance of intraoperative lactate levels in predicting in-hospital mortality.

Methods: This single-center, retrospective, observational study was conducted at Peking Union Medical College Hospital from 2017 to 2023. Intraoperative peak lactate levels were analyzed using a restricted cubic spline (RCS) model, with in-hospital mortality designated as the primary outcome. Secondary outcomes were length of stay, ICU stay, and ventilation duration. Prespecified subgroup analyses (by ASA grade and surgery type) and a sensitivity analysis excluding in-hospital deaths for secondary endpoints were performed.

Results: Among the 2,452 patients included in the study, 161 died postoperatively. Both univariate and multivariate regression analyses demonstrated that the intraoperative peak lactate level was associated with perioperative mortality (odds ratio [OR] 1.306, 95% CI 1.262-1.352, P < 0.001; OR 1.249, 95% CI 1.185-1.318, P < 0.001). The association was consistent across surgery types and appeared stronger in patients with higher ASA grade. The restricted cubic spline model indicated higher intraoperative peak lactate levels were nonlinearly associated with increased in-hospital mortality. Length of hospital stay (LOS), LOS in the intensive care unit (ICU), and duration of mechanical ventilation exhibited a nonlinear (inverted U-shaped) pattern relationship with intraoperative peak lactate levels, with an initial increasing trend followed by a subsequent decline as peak lactate concentrations rose.

Conclusions: Intraoperative peak lactate levels showed a dose-dependent nonlinear association with increased in-hospital mortality following emergency surgery and play a significant role in predicting postoperative mortality in noncardiac emergency surgery patients.

Trial registration: Not applicable.