Langenbeck's Archives of Surgery最新文献

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.

Background: One anastomosis gastric bypass (OAGB) is safe and effective treatment for patients with severe obesity. OAGB with a biliopancreatic limb (BPL) of 200-250 cm often leads to metabolic and nutritional issues, which may be mitigated by using a shorter biliopancreatic limb (BPL) length (170-180 cm). However, the impact of shorter BPL lengths on efficacy remains uncertain.

Methods: A retrospective cohort study was conducted on patients who underwent OAGB at two Iranian centers between March 2018 and March 2021. Patients were divided into two groups based on BPL length: 170-180 cm and 200-250 cm. Groups were compared for weight loss, nutritional status, and comorbidity resolution over two years.

Results: Both groups achieved comparable weight loss (BMI reduction: 28.4 vs. 28.3 kg/m², p = 0.913), with complete hypertension resolution observed in 95.6%of hypertensive patients and complete diabetes remission in 90% of diabetic patients. Nutritional outcomes were comparable between groups (albumin, vitamin D, B12), though ferritin levels were numerically lower in the 200-250 cm group. Despite concerns about malnutrition following OAGB, our findings demonstrate that a 170-180 cm BPL achieves weight loss and comorbidity resolution comparable to a 200-250 cm BPL, with reduced nutritional risks.

Conclusion: OAGB with a 170-180 cm BPL yields weight loss and comorbidity resolution comparable to a 200-250 cm BPL, with potentially fewer nutritional deficiencies.

Purpose: Diabetic foot ulcer (DFU) remains a major complication of diabetes mellitus and is a leading cause of non-traumatic lower extremity amputations. Biomarkers are used to predict disease prognosis and guide treatment decisions. This study aimed to evaluate the prognostic utility of three systemic inflammation and nutrition-based biomarkers HALP score, CRP/Albumin ratio, and CALLY index in predicting the major amputation risk among patients with DFU.

Methods: A retrospective analysis was conducted on 252 DFU patients who underwent surgical debridement and/or amputation between January 2018 and December 2023. Demographic, clinical, and laboratory data were collected. Patients were grouped based on surgical intervention (minor vs. major amputation). The HALP score, CRP/Albumin ratio, and CALLY index were calculated from admission laboratory values. Cut-off values were determined using ROC analysis.

Results: Major amputation was performed in 19% of the patients. The HALP score was significantly lower, while the CRP/Albumin ratio was higher, and the CALLY index was lower in the major amputation group (p < 0.001 for all). The optimal cut-off values to predict major amputation were 19.96 for HALP (AUC = 0.750), 2.29 for CRP/Albumin (AUC = 0.853), and 0.71 for CALLY (AUC = 0.830). All three markers demonstrated significant correlations with markers of infection, inflammation, and ulcer severity.

Conclusion: The HALP score, CRP/Albumin ratio, and CALLY index are easily accessible prognostic tools that may assist clinicians in identifying DFU patients at higher risk for major amputation. Integration of these biomarkers into routine patient monitoring can improve risk assessment and guide timely surgical decision-making.