Langenbeck's Archives of Surgery最新文献

Background and objective: Nice knots have been used as an assisted reduction technique in surgery for displaced and comminuted fractures. This study aims to investigate the clinical efficacy of Kirschner wire intramedullary fixation combined with improved Nice knot-end cerclage temporarily fixation-assisted reduction before plate osteosynthesis in treating displaced and comminuted clavicle fractures.

Methods: A retrospective study selected 210 patients with comminuted displaced clavicle fractures (January 2017-December 2020) in our hospital. The patients were divided into two groups via the fracture reduction method: the observation group (intramedullary Kirschner's wire fixation combined with modified Nice node-to-end cerclage temporarily fixation-assisted reduction; n = 42) and the control group (including four subgroups with 42 cases in each subgroup, with assisted reduction methods of clamp fixation, screw fixation, square knot fixation and Kirschner wire fixation; each subgroup n = 42). The operation time, intraoperative bleeding, visual analogue scale (VAS) score at 24 h after the operation, healing time, postoperative limb functional activities, patients' self-perception, subjective satisfaction and shoulder joint function were compared.

Results: The operation time and the intraoperative blood loss of the observation group was significantly lower than that of each subgroup in the control group (p < 0.05). The VAS score of the observation group 24 h after the operation was significantly lower than that of each subgroup in the control group apart from the screw fixation group (p < 0.05). The Neer score of the observation group was significantly higher than that of each subgroup in the control group apart from the square knot fixation group (p < 0.05). The square knot is relatively better than the other four methods. Patients were generally satisfied with the modified Nice treatment.

Conclusion: The use of a Kirschner wire intramedullary fixation combined with improved Nice knot-end cerclage temporarily fixation-assisted reduction before plate osteosynthesis in treating displaced and comminuted clavicle fractures can achieve satisfactory postoperative clinical results.

Purpose: To determine whether periprosthetic drain insertion for hernioplasty using sublay mesh augmentation influences retromuscular fluid collections (RFC) and the clinical course.

Methods: Forty-two patients with open repair of midline hernias (M2-4, W1, European Hernia Society classification) were allocated to groups with or without retromuscular drains. Subcutaneous drainages were used in both groups to avoid confounding from surgical site occurrences due to superficial, subcutaneous fluid collections. The participants underwent clinical and ultrasound assessments on postoperative days (POD) 14 and 30 to detect RFC, subcutaneous seromas, and wound complications. The sample size was estimated using the RFC of a test cohort with drainage; the assumed relevant volume (5 ml) was calculated comprising 84% (mean + 1 SD) of these patients.

Results: In the retromuscular drainage group, the RFC median volume was reduced by 75.2% on POD 14, and by POD 30, no RFC were found [0.2 vs. 25.8 (p < 0.001) and 0 vs. 4.0 (p = 0.02) on PODs 14 and 30, respectively]. The number of patients with RFC ≥ 5 mL was also significantly lower in the drainage group [4 vs. 12 (p = 0.02) and 1 vs. 8 (p = 0.02) on PODs 14 and 30, respectively]. No surgical site infections occurred in either group, but retromuscular hematoseroma led to one revision surgery and one needle aspiration in the group without drainage. In the drainage group, a significantly longer hospital stay (6.5 days vs. 4 days; p = 0.01) and longer regular analgetic intake (6 vs. 3 days; p = 0.03) were observed. Multivariable regression revealed that retromuscular drainage usage was the only independent predictor of the RFC volume.

Conclusion: We found that the use of retromuscular drains after hernioplasty with sublay hernia repair reduced periprosthetic fluid collections in our population but prolonged hospital stay. Whether the reduction of RFC can prevent SSO or revision surgery cannot be determined from our data, the relevance is therefore not assessable. Hence, further larger studies are required to determine the clinical relevance of drains.

Background: The progression of malnutrition and sarcopenia after esophagectomy for esophageal cancer negatively influences long-term prognosis. To improve nutritional status after esophagectomy, we introduced an intensified nutrition management (iNM) protocol, in which nutritional counselling by dietitians was provided more frequently. The aim of this study was to evaluate the efficacy of iNM compared with the conventional NM (cNM).

Methods: We included 126 patients who underwent esophagectomy before and after NM revision, and compared nutritional status and changes in body composition after esophagectomy between the cNM and iNM groups. Nutritional parameters were assessed, and we also calculated skeletal muscle index (SMI), skeletal muscle density (SMD), and visceral fat area (VFA) using computed tomography volumetry.

Results: There were no significant differences in baseline characteristics or surgical outcomes between the groups. Compared with the cNM group, nutritional counselling was provided more frequently (P < 0.001) in the iNM group, and compliance rate increased from 56.3 to 91.9% (P < 0.001). Body weight loss at 4 and 6 months and SMI reduction at 6 months were significantly improved in the iNM group compared with the cNM group (P < 0.001, P = 0.032, and P = 0.023, respectively). There were no significant differences in the changes in SMD, VFA, serum albumin level, and prealbumin level between the two groups.

Conclusions: Outpatient iNM significantly mitigated the reduction in body weight and SMI 3-6 months after esophagectomy.

Purpose: Surgeons' adaptability to robotic manipulation remains underexplored. This study evaluated the participants' first-touch robotic training skills using the hinotori surgical robot system and its simulator (hi-Sim) to assess adaptability.

Methods: We enrolled 11 robotic surgeons (RS), 13 laparoscopic surgeons (LS), and 15 novices (N). After tutorial and training, participants performed pegboard tasks, camera and clutch operations, energizing operations, and suture sponge tasks on hi-Sim. They also completed a suture ligation task using the hinotori surgical robot system on a suture simulator. Median scores and task completion times were compared.

Results: Pegboard task scores were 95.0%, 92.0%, and 91.5% for the RS, LS, and N groups, respectively, with differences between the RS group and LS and N groups. Camera and clutch operation scores were 93.1%, 49.7%, and 89.1%, respectively, showing differences between the RS group and LS and N groups. Energizing operation scores were 90.9%, 85.2%, and 95.0%, respectively, with a significant difference between the LS and N groups. Suture sponge task scores were 90.6%, 43.1%, and 46.2%, respectively, with differences between the RS group and LS and N groups. For the suture ligation task, completion times were 368 s, 666 s, and 1095 s, respectively, indicating differences among groups. Suture scores were 12, 10, and 7 points, respectively, with differences between the RS and N groups.

Conclusion: First-touch simulator-based robotic skills were partially influenced by prior robotic surgical experience, while suturing skills were affected by overall surgical experience. Thus, robotic training programs should be tailored to individual adaptability.

Background: The growing use of staplers, manual and powered, especially in minimally invasive surgeries, necessitates evaluating their efficacy in gastrointestinal and thoracic surgeries. Parameters analysed include anastomotic and air leakage rates, bleeding, infection, cost, and operative duration.

Methods: We searched Cochrane Library, CINAHL, EMBASE, PubMed, and Web of Science using terms like "surgical staplers," "manual staplers," "automatic staplers," and "powered staplers." We assessed study quality using the Joanna Briggs Institute (JBI) Critical Appraisal tools and conducted meta-analysis using Review Manager software.

Results: A total of 43,104 patients with a mean age of 60.8 were involved in the studies. The meta-analysis revealed a significant reduction in anastomotic leaks in GI surgery patients (OR 0.31, p = 0.0001) and a significant decrease in postoperative air leakage in thoracic surgery patients (OR 0.65, p = 0.05) when powered staplers were employed. Additionally, we observed a significant decline in hemostasis-related complications for both thoracic and GI surgeries (OR 0.48, p = 0.002) with the use of powered staplers. Although individually costlier than manual staplers, powered staplers significantly decreased total hospitalisation costs (MD -1725.82, p < 0.00001) amoungst the thoracic surgeries, due to the cost saved on remedying the lower rate of complications compared to manual staplers. It also decreased the average operative times in thoracic and GI surgeries, although not significant (p = 0.06, p = 0.07 respectively).

Conclusion: Powered staplers surpass manual staplers by reducing operative duration, total hospital costs, and complications like anastomotic leaks and bleeding. Hence, they are poised to become the preferred alternative in future surgeries.

Introduction: Surgical procedures, even under local anesthesia, can induce significant stress and anxiety in patients. Innovative approaches to alleviate anxiety are crucial for improving patient outcomes. Sedatives and anxiolytics may alleviate this discomfort, but they can also subject patients to undesirable side effects, diminishing their overall effectiveness, and, finally, delaying discharge. We present the first case series of a patients underwent inguinal hernia surgical repair under local anesthesia using VRH (HypnoVR) to avoid use of sedatives and anxiolytics.

Methods: 12 consecutive patients were enrolled to undergo elective monolateral inguinal hernia repair surgery via an open approach using HypnoVR, at Colorectal Surgery Unit of Fondazione Policlinico Universitario Campus Bio-Medico di Roma. Vital signs (heart rate, SpO2, blood pressure) were detected for all patients before surgery, during local anesthesia, during the whole intervention and after surgery.

Results: No intraoperative or postoperative complications have been recorded and only one postoperative complication occurred (seroma), which not required invasive treatment but only drug administration. All patient's vital parameters were recorded during all operative and perioperative phasis. No use of intraoperative analgesic, sedative or anxiolytic were needed. All patients were discharged no later than 3 h after surgery.

Conclusion: Virtual Reality Hypnosis is a promising tool for anxiety management in surgical settings. Our series highlights the positive impact of HypnoVR in reduction and management of surgical patient anxiety and discomfort, allowing to perform inguinal hernia repair using only local anesthesia, with good patients' satisfaction.

Background: Endpoints that patients and clinicians consider important may differ based on patients' preferences and values. Several methods are available to elicit patient preferences in a succinct and methodologically valid manner.

Purpose: We conducted a scoping review of methods used to elicit patient preferences in invasive procedures to provide a framework for researchers and clinicians to incorporate these measures into future efforts.

Methods: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and health and psychological instruments database were searched from inception until September 2020. Articles that examined patient preferences for any invasive procedure were eligible for inclusion. Selection and extraction were completed in duplicate. Preference elicitation methods were identified and summarized.

Results: Three hundred ninety-four articles (n = 76,921 patients) were included representing several surgical specialties. Of included studies, 11.7% (n = 46) used both quantitative and qualitative methods, 81.2% (n = 320) used quantitative methods only, and 7.1% (n = 28) used qualitative methods only to elicit preferences. The most frequently employed quantitative method to elicit preferences was simple choice selection, while one-on-one interviews with participants was the most frequently used qualitative method. Preference elicitation was the primary outcome in 74.6% (n = 294) of included studies.

Conclusion: There are several methods to elicit patient preferences in surgical research. Qualitative methods are valuable for exploring views and generating consensus statements. Quantitative methods are better suited for assessing relative preferences, establishing preference thresholds, or ascertaining the presence of preferences. The choice of method should align with the specific research objectives.

Background: The use of pre-operative very low-calorie diets (VLCD) is established within bariatric and gallbladder surgery. However, their use in patients with high BMI and hepatic steatosis (HS) requiring upper abdominal procedures is unclear. This review aims to assess the safety, adherence, and outcomes of a pre-operative VLCD prior to non-bariatric elective surgery.

Methods: A systematic search on PubMed MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL and AMED was performed to identify the included studies. Studies were included, if they administered a VLCD to patients undergoing non-bariatric elective surgery and reported on outcomes.

Results: Eight studies were included in this review and all administered a VLCD through either dietician led diet plans or meal replacement shakes. The adherence to the VLCD was heterogeneously measured but was excellent overall with a good safety profile. The VLCD was able to significantly reduce HS and resulted in a less technically difficult operation with reduced intra-operative blood loss. There was no significant impact on intraoperative or early post-operative outcomes.

Conclusion: This review highlights that a VLCD can be administered safely during the pre-operative period and overall adherence is excellent, however heterogeneously measured. There was an overall positive impact on reducing hepatic steatosis, operative difficulty and intraoperative blood loss, however no significant impact on overall morbidity and mortality.

Introduction: Suspected appendicitis is the most common indication for non-obstetric surgery during pregnancy. Diagnosis and management of these patients can be challenging. Atypical clinical presentation has been described before, but the current literature consists mostly of small case series. Therefore, we conducted a large retrospective study to analyze the frequency and diagnostic accuracy of clinical signs, laboratory findings and imaging modalities in pregnant woman undergoing surgery for suspected appendicitis compared to a control group of non-pregnant women of childbearing age. We further describe intra- and postoperative findings in both groups.

Methods: Data from consecutive patients who underwent appendectomy for suspected appendicitis during pregnancy were retrieved from the electronic patient database and analyzed. Preoperative clinical, laboratory and imaging findings as well as intra- and postoperative characteristics were compared between pregnant and non-pregnant women.

Results: Between January 2008 and June 2023, 99 pregnant woman and 1796 non-pregnant woman between the ages of 16 and 49 underwent emergency surgery for suspected appendicitis. Pregnant women were less likely to have right lower quadrant tenderness (p = 0.002), guarding (p = 0.011) and rebound tenderness (p = 0.097). A greater percentage of pregnant women had a symptom duration of more than 24 h before presentation (p = 0.003) Abdominal ultrasound showed a reduced diagnostic accuracy in pregnant women (p = 0.004). MRI was used in eight pregnant women and showed a diagnostic accuracy of 100%. Pregnant women had a longer operating time (p = 0.006), a higher rate of open appendectomies or conversion (p < 0.001) and a longer postoperative hospital stay (3.2 days vs. 2.2 days, p < 0.001). The perforation rate was also higher in pregnant women at 16% vs. 10% (p = 0.048).

Conclusion: The diagnosis of acute appendicitis during pregnancy presents a challenge for the clinician. Our data confirm the paradigm of "atypical presentation" which should lead to an extended diagnostic workup. Ultrasound showed less diagnostic accuracy in pregnant women in our study. MRI is a useful tool to reduce uncertainty and the rate of negative appendectomies.