Langenbeck's Archives of Surgery最新文献

Purpose: Revisional bariatric surgery (RBS) has flourished during the last decades in many countries, due to suboptimal weight loss or long-term complications of primary bariatric surgery. Restrictive procedures, and in particular sleeve gastrectomy (SG), although widely performed as primary bariatric surgery, seems particularly prone to need surgical revision for the above-mentioned reasons during long-term follow-up. The aim of this systematic review was to compare the long-term (5-year) safety and efficacy between Roux-en-Y gastric bypass (RYGB) and single anastomosis duodeno-ileal bypass (SADI) after 'failed' SG.

Methods: A systematic review was performed from 2007 to September 2024. Articles were included if SADI or RYGB were performed as RBS after 'failed SG' with follow-up at least 5 years. Pooled analysis was performed to summarize the data.

Results: Among the seven studies eligible and included in this review, the SADI procedure showed comparable results to RYGB in terms of weight loss, nutritional deficiencies, and resolution of comorbidities during the long-term follow-up. However, RYGB proved superior in terms of remission of reflux disease and other functional problems after SG.

Conclusions: The present review found that SADI seems to be a promising and suitable method for suboptimal weight loss after SG, with comparable or even better results to RYGB after 5-year follow-up.

Background: Anal fissures, tears in the epithelium of the anal canal that cause pain and bleeding, have a lifetime prevalence of 11%. While surgical treatments, such as lateral internal sphincterotomy are traditional, they pose postoperative complications. Recent studies investigated less invasive options involving botulinum toxin injection, showing promise with fewer adverse effects. The aim of this study is to compare the outcomes of botulinum toxin injection to lateral internal sphincterotomy for chronic anal fissures.

Method: Up to October 2023, an extensive literature search was conducted in PubMed, Scopus, and Google Scholar to identify relevant papers. This systematic review and meta-analysis examined the comparative effectiveness of lateral internal sphincterotomy and botulinum toxin injection in the treatment of chronic anal fissures. The methodology adheres to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria, and the study protocol has been registered with the Open Science Framework (OSF).

Results: A total of 1,839 patients from 18 trials were included in the meta-analysis. Patients undergoing lateral internal sphincterotomy had higher healing compared to botulinum toxin injection (pooled effect = 0.77; 95% CI= [0.69- 0.83]; I² = 90.95%; P = 0.00).

Conclusion: Our study revealed the efficacy of lateral internal sphincterotomy over botulinum toxin injection in promoting healing for chronic anal fissures. These findings emphasize the clinical advantage of traditional surgical interventions in the management of this condition. However, further studies with long-term follow-up are required to confirm our observations.

Objective: Compare the efficacy and safety of robotic versus laparoscopic approach for rectal cancer treatment, addressing the ongoing debate within the medical community regarding the optimal surgical approach.

Background: Traditionally, surgery has been the cornerstone of rectal cancer treatment, aimed at tumor removal and intestinal function preservation. Recent advancements have introduced laparoscopic and robotic surgeries as minimally invasive alternatives to conventional methods. However, it faces limitations in instrument mobility and dexterity. Robotic approach, on the other hand, enhances these aspects by providing surgeons with advanced precision, a three-dimensional high-definition view, and superior tissue manipulation capabilities, making it an increasingly preferred option for rectal cancer treatment.

Methods: This systematic review and meta-analysis following PRISMA-2020 guidelines was carried out. This study analyzed phase 2 and 3 randomized controlled trials assessing the efficacy and safety of robotic versus laparoscopic approach in treating rectal cancer. Only studies meeting specific criteria were included, with congress abstracts, narrative reviews, case reports, and letters to the editor excluded.

Results: We identified 350 studies, 8 met the inclusion criteria, encompassing 2525 patients from diverse geographical locations. The main outcomes analyzed were regional recurrence, anastomotic leak, postoperative complications, and mortality. The findings indicated no significant differences between robotic and laparoscopic surgeries in terms of Grade III Clavien-Dindo complications, mortality, and anastomotic leakage. The diverse geographical origin of the studies suggests the applicability of the results across different health care settings, although system-specific considerations are essential.

Conclusion: Robotic approach does not show significant advantages over laparoscopic approach in terms of major complications and mortality rates in rectal cancer treatment, indicating that both surgical approaches are viable options with their specific benefits and limitations.

Background: Although cholecystectomy is a common surgery, it carries higher risks of postoperative complications and mortality for older adults. Age alone is not a reliable predictor of postoperative outcomes, whereas frailty may provide a more accurate assessment of a patient's health and functional status. Frailty, characterized by physical deterioration and reduced resilience, has been shown to predict mortality, prolonged recovery, and morbidity after various surgeries, including cholecystectomy. Thus, incorporating frailty evaluations into preoperative assessments can improve patient outcomes by individualizing treatment strategies. This systematic review and meta-analysis aims to evaluate how well frailty predicts postoperative outcomes following cholecystectomy.

Methods: In accordance with PRISMA guidelines, we searched PubMed, Embase, and Web of Science on August 14th, 2024, without restrictions on publication year or language. The quality of the studies was assessed using the Newcastle-Ottawa scale, and meta-analysis was conducted using odds ratios with 95% confidence intervals as the effect size, employing a random-effects model.

Results: Nine cohort studies comprising a total of 128,421 participants were included. The pooled results showed significantly higher odds of short-term mortality (OR: 5.54, 95% CI: 1.65-18.60, p = 0.006), postoperative morbidity (OR: 2.65, 95% CI: 1.51-4.64, p = 0.001), major morbidity (OR: 3.61, 95% CI: 1.52-8.59), and respiratory failure (OR: 3.85, 95% CI: 1.08-13.79) among frail patients. Additionally, frail patients had longer hospital stays (mean difference: 2.98 days, 95% CI: 1.91-4.04) and significantly higher odds of postoperative infection and sepsis. However, no association was evident with reoperation rates.

Conclusion: This study highlights the value of utilizing frailty assessment tools in preoperative settings for predicting outcomes after cholecystectomy. These tools could improve decision-making in both emergency and elective situations, aiding in the choice between surgical and medical management, as well as between open and laparoscopic procedures tailored to each patient.

Objective: To compare the differences in surgical outcomes of robot-assisted treatment and laparoscopy for benign ovarian tumors among pediatric patients.

Methods: A total of 39 patients underwent robot-assisted surgery, and their outcomes were compared with 55 patients treated with laparoscopy during the same period by the same surgeons.

Results: There were no significant differences between the two groups in terms of age (7.5 ± 4.5 vs. 8.8 ± 3.8 years, p = 0.2496), weight (29.3 ± 17.7 vs. 31.7 ± 14.6 kg, p = 0.4383), or tumor size (5.0 ± 3.3 vs. 5.1 ± 3.8 cm, p = 0.8541). However, the operative time was significantly longer in the robotic surgery group (102.7 ± 33.5 vs. 89.3 ± 50.9 min, p = 0.0112). There was no significant difference in intraoperative blood loss. Fewer patients in the robotic surgery group opted for day surgery compared to the laparoscopy group (15.4% vs. 54.5%, p < 0.001). There was no significant difference in the length of hospital stay between the two groups of patients who chose inpatient surgery (5.6 ± 3.4 vs. 4.4 ± 2.9 d, p = 0.1213). There was no conversion to open surgery and no early postoperative complications in both groups.

Conclusion: Robot-assisted surgery and laparoscopy yield comparable outcomes for the treatment of benign ovarian tumors in children, although robotic surgery has a longer operative time.

Purposes: Evaluate the changes in quality of life (QoL) in patients affected by tertiary hyperparathyroidism (THPT) after surgical treatment using the Parathyroidectomy Assessment of Symptoms (PAS) and Short Form-36 (SF-36) questionnaires.

Methods: Single centre longitudinal retrospective, single-institution analysis of 34 patients with THPT and submitted to parathyroidectomy between 2015 and 2021. The PAS and SF-36 questionnaires were administered before surgery and 24 months after discharge.

Results: A significative QoL amelioration was registered in physical SF-36 (42.4 ± 11.7 vs 56.7 ± 9.2; P < 0.001), mental SF-36 (47.3 ± 12.1 vs 61.8 ± 7.9; P < 0.001) and PAS score (582 ± 163 vs 293 ± 141; P < 0.001) with a significative improvement of all the 13 symptoms considered. We found that pre-operative intact parathormone (iPTH) levels, preoperative T-score and time of haemodialysis before RTX were predictors of both PAS and SF-36 mental score modifications. A positive correlation was also fund between pre-operative PAS values and their post operative cutback.

Conclusions: Parathyroidectomy for THPT brings to a concrete amelioration of all the disease-related and nonspecific symptoms with significative improvement of QoL. To develop a tailored approach of every patient's needs, from diagnosis to future treatment, we suggest to introduce the symptoms assessment scale as standard stage in periodic evaluations.

Purpose: The Madrid Posterior Component Separation technique (Madrid PCS) is an approach for abdominal wall reconstruction that leverages anatomical landmarks to optimize outcomes. This manuscript describes ten essential steps for performing the Madrid PCS, focusing on technique, safety, and efficiency.

Methods: A comprehensive step-by-step approach is outlined, beginning with the initial incision and adhesiolysis, progressing through retromuscular dissection, and concluding with lateral release and subxiphoid dissection. Emphasis is placed on key anatomical landmarks, tissue planes, and surgical maneuvers critical for each phase. Detailed tips and tricks, challenging scenarios, and potential risks are provided to enhance the reproducibility and safety of the procedure.

Results: Applying these ten steps provides an organized and methodical approach to the Madrid PCS. The focus on anatomical landmarks minimizes the risk of complications such as nerve injury, peritoneal tears, and inadvertent organ damage, while ensuring for the optimal placement of prosthetic materials.

Conclusion: Adherence to these ten steps, based on anatomical landmarks, significantly improves the safety and effectiveness of the Madrid PCS technique. By understanding the nuances of the procedure, surgeons can achieve consistent and reproducible results in complex abdominal wall reconstructions.

Background: To identify the impact of surgical compliance on survival in patients with kidney cancer and to explore the factors that influence surgical compliance.

Methods: Clinical date of kidney cancer patients were identified from the SEER databases, and the patients were divided into surgical compliance group and surgical noncompliance group. Cox survival analysis and Kaplan-Meier curves were used to evaluate the effect of surgical compliance on overall survival (OS) and cancer-specific survival (CSS). A diagnostic nomogram was constructed to quantify individual differences in compliance, and receiver operating characteristics (ROC) curves and calibration curves were used to assess the accuracy of the nomogram. Propensity score matching (PSM) was performed to balance potential baseline confounding factors.

Results: Of the 133,950 patients eligible for surgical resection, 2,814 (2.1%) patients did not opt for surgery ultimately. Surgical noncompliance was associated with poor prognosis. In all patients, Cox regression analysis showed that surgical noncompliance was an independent predictor for OS [before: HR = 2.490, 95% CI 2.374-2.612, p < 0.001; after: HR = 2.380, 95% CI 2.202-2.573, p < 0.001] and CSS [before: HR = 2.490, 95% CI 2.318-2.675, p < 0.001; after: HR = 2.035, 95% CI 1.813-2.285, p < 0.001] of kidney cancer patients before and after PSM. Multivariable logistic regression revealed that older age, afro-american origin, lower household income, and advanced tumor grade were associated with surgical noncompliance. The ROC and calibration curves showed that the diagnostic nomogram had high predictive accuracy.

Conclusion: Surgical compliance was an independent prognostic factor for OS and CSS in patients with kidney cancer, and surgical noncompliance was associated with poor survival.

Background: Although the optimal extent of lymph node dissection in esophagogastric junction cancer (EGJC) has been reported, the efficacy of mediastinal lymph node dissection remains unclear. We aimed to identify risk factors for mediastinal lymph node metastasis and its prognostic impact in patients with EGJC.

Methods: A total of 100 consecutive patients who underwent curative surgery for EGJC were eligible. We examined the rates of metastasis, prognosis, and therapeutic value index at each mediastinal lymph node station. In addition, multivariate analyses were performed to identify risk factors for mediastinal lymph node metastasis.

Results: The rates of upper, middle, and lower mediastinal lymph node metastases were 12.0%, 20.7%, and 13.2%, respectively. The 5-year overall survival rate was lower in patients with mediastinal lymph node metastasis than in those without mediastinal lymph node metastasis (11.1% vs. 59.2%, p < 0.01). The therapeutic value index was 0 in patients with upper/middle mediastinal lymph node metastasis, and mediastinal lymph node metastasis was an independent prognostic factor (hazard ratio 6.59, 95% confidence interval [CI] 2.48-17.9, p < 0.01). Additionally, the length of esophageal invasion and the presence of hiatal hernia were independent predictors of mediastinal lymph node metastasis (odds ratio 8.21, 95%CI 1.44-46.8, p = 0.02 and odds ratio 7.13, 95%CI 1.22-41.8, p = 0.03).

Conclusion: No survival benefit of mediastinal lymph node dissection was observed. Intensive multidisciplinary treatment could be considered in patients with predicted mediastinal lymph node metastasis, such as those with longer esophageal invasion and those with hiatal hernia.

Aim: Sufficient liver function is crucial in extracellular matrix growth, hemostasis, and wound healing. Repeated abdominal surgery is a known risk factor for the development of wound complications. This study aimed to evaluate this high-risk constellation in patients undergoing associated liver partition and portal vein ligation for staged hepatectomy (ALPPS) and repeated liver resections (RLR) in comparison to single liver resection (SLR).

Method: Forty patients who underwent ALPPS between 2011 and 2020 were evenly matched with patients undergoing RLR or SLR (n = 40 per group) using propensity scores. Postoperative outcomes were compared and factors associated with wound complications were analyzed.

Results: Postoperative wound complications were significantly more frequent in ALPPS group (p = 0.001). The reoperation rate was not significantly different between the three groups (p = 0.143). However, surgical reintervention due to wound complications occurred more frequently in the ALPPS group in relation to RLR and SLR (17.5% vs. 7.5% and 5% respectively). Length of stay was significantly longer in the ALPPS group (p = 0.033). ALPPS was an independent risk factor for postoperative wound complication (OR = 8.55, 95% CI:1.07-68.44, p = 0.043). Risk factor analysis identified age ≥ 60 years (OR = 27.64, 95% CI:3.09-246.75, p = 0.003), BMI ≥ 30 kg/m² (OR = 30.21, 95% CI:3.35-271.83, p = 0.002), and low postoperative albumin levels (OR = 168.41, 95% CI:7.76-3651.18, p = 0.001) as independent predictors of postoperative wound complications after major liver resection.

Conclusion: Patients undergoing ALPPS and RLR are faced with a high risk of developing wound complications. Older age, obesity, a history of previous abdominal surgery, and a decreased postoperative albumin level were independent risk factors for wound complications.