Langenbeck's Archives of Surgery最新文献

Purpose: Acute arterial occlusive mesenteric ischemia (AAOMI) is a life-threatening emergency associated with high mortality rates. Revascularization is a key component of multimodal therapy; however, the optimal initial treatment strategy, open surgical (OR) versus endovascular revascularization (ER), remains a subject of ongoing debate. This study aimed to compare outcomes between open and endovascular revascularization in patients with AAOMI.

Methods: This retrospective single-center cohort study included all patients with AAOMI who underwent urgent revascularization between January 2004 and July 2024. Based on the initial revascularization method, patients were divided into two treatment groups: open surgical and endovascular. Outcomes included in-hospital mortality, bowel resection rate and extent, incidence of short bowel syndrome, and length of hospital and intensive care unit (ICU) stay.

Results: Of the 100 patients included, 79 were initially treated with open revascularization and 21 with endovascular revascularization. In-hospital mortality was 48.1% (38/79) of OR patients and 33.3% (7/21) of ER patients (p = 0.227). 42 patients (53.2%) with open surgical treatment required bowel resection, compared to 10 patients (47.6%) with endovascular-first revascularization (p = 0.651). The median extent of bowel resection was 69 cm in the OR group and 71 cm in the ER group (p = 0.350). No differences could be detected regarding short bowel syndrome. Median hospital stay was 15 days in the open surgical cohort vs. 11 days in the endovascular cohort (p = 0.484). Median ICU stay was 5 days in the OR group and 4 days in the ER group (p = 0.172).

Conclusion: Open surgical and endovascular revascularization resulted in comparable outcomes regarding in-hospital mortality, bowel resection, short bowel syndrome, and length of hospital and ICU stay in this retrospective cohort. Treatment decisions should be individualized based on occlusion type, patient condition, and institutional expertise. Prospective multicenter studies are warranted to further refine optimal management strategies for AAOMI.

Background: Postoperative evaluation in patients with acromegaly typically involves measuring insulin-like growth factor 1 (IGF-1) levels and assessing growth hormone (GH) suppression via an oral glucose tolerance test (OGTT). However, discrepancies between these results are not uncommon. Despite this, there are very few studies examining long-term clinical outcomes in patients with persistent discordance between GH nadir and IGF-1 levels. In this study, we focused on such patients and conducted a retrospective analysis to clarify their mid- to long-term outcomes, alongside a review of relevant literature.

Methods: We retrospectively reviewed patients with acromegaly who underwent transsphenoidal resection of pituitary tumors at a single institution and had serial endocrinological evaluations for more than one year between May 2005 and July 2020. Patients were divided into two groups: those with normal GH suppression during OGTT but elevated IGF-1 levels (Group I) and those with abnormal GH suppression but normal IGF-1 levels (Group II) at their 1-year postoperative evaluation. We investigated whether IGF-1 levels normalized or re-elevated over time, alongside monitoring clinical signs and comorbidity management.

Results: During the study period, 52 patients who were evaluated by serial IGF-1 and OGTT, 10 demonstrated discordance between GH nadir and IGF-1 levels-3 in Group I and 7 in Group II. In all Group I patients, delayed normalization of IGF-1 was observed, taking 3 to 5 years. No IGF-1 re-elevations occurred, and clinical signs and comorbidities were well controlled. In Group II, abnormal GH suppression during OGTT persisted in all patients; however, IGF-1 levels remained within the normal range without re-elevations. Clinical signs and comorbidities remained clinically stable without the need for additional therapy during the 11-year follow-up period.

Conclusion: Most patients achieved a mid- to long-term disease-controlled state without additional treatment. Given the potential risk of GH deficiency from further treatment, it may be reasonable to consider patients clinically controlled as long as IGF-1 levels remain normalized, with careful long-term monitoring recommended.

Background: Choledochal exploration remains a reliable and effective therapeutic strategy for the management of choledocholithiasis. Nevertheless, the optimal approach to bile duct closure following exploration-specifically the choice between T-tube drainage and primary suture closure-remains controversial, with no clear consensus established in current surgical practice.

Objective: This study aims to evaluate the safety and efficacy of self-detachable biliary stents in achieving primary closure following choledochotomy.Secondary research objective: Potential complications associated with the innovative surgical approach of using a self-dislodging biliary stent.

Methods: From January 2021 to May 2023, a total of 112 patients diagnosed with choledocholithiasis were enrolled in this study. Among them, 60 patients were assigned to the TTD group, in which laparoscopic choledochotomy with T-tube drainage was performed, while 52 patients were included in the PDC group, receiving primary duct closure combined with placement of a self-detachable biliary stent. Postoperative outcomes were compared between the two groups, including operative time, time to first defecation, length of hospital stay, perioperative changes in hematological and liver function parameters, as well as the incidence of complications such as intra-abdominal hemorrhage, bile leakage, electrolyte disturbances, and wound infection.

Results: There were no significant differences between the two groups with respect to operative time and intraoperative blood loss (P > 0.05). However, the time to first defecation and length of hospital stay were significantly shorter in the PDC group compared with the TTD group (P < 0.05). Postoperative WBC, TB, DB, and ALB levels did not differ significantly between the two groups (P > 0.05), whereas postoperative ALT, AST, and TBA levels were significantly different (P < 0.05). In addition, the overall incidence of postoperative complications was significantly lower in the PDC group than in the TTD group (P < 0.05).

Conclusion: Laparoscopic choledochal exploration followed by primary closure with a self-detachable biliary stent appears to be a safe, effective, and economically favorable strategy for the management of choledocholithiasis. This technique has the potential to serve as an alternative to conventional T-tube drainage, offering comparable safety while reducing postoperative complications and healthcare costs.

Introduction: Pancreatoduodenectomy (PD) is a complex procedure associated with up to 20-30% morbidity and 1-2% mortality. In the present study, we aimed to evaluate the outcomes of PD in patients with cirrhotic liver and assessed predictors of perioperative morbidity and mortality.

Materials and methods: This is a retrospective study from a prospectively maintained database. Amongst the patients who underwent PD between January 2013 till June 2024, only patients who had underlying cirrhotic liver were included in the study.

Results: A total of 24 patients were included. On binary logistic regression history of pancreatitis in the preoperative period (OD-25.8), stent block (OD-64.9), cholangitis (OD-273), and preoperative platelets less than 1.37(OD-40), preoperative INR more than 1.31(OD-40) and platelets count on POD1 less than 1.23 lakhs (OD-40) were associated with mortality.

Conclusion: Patients with clinically significant portal hypertension with thrombocytopenia and a deranged coagulation profile are associated with a high risk of mortality.

Purpose: Diarrhea after pancreatic surgery is gaining growing importance since extended pancreatic resections have been increasingly performed. The aim of this study was to determine the incidence of diarrhea after pancreatic surgery with a special focus on the extent of resection and subgroups at higher risk for diarrhea.

Methods: Retrospectively collected data of all consecutive patients undergoing pancreatic surgery between 01/2021 and 11/2023 were analyzed. Information on bowel movements was prospectively documented. Diarrhea was defined as > 3 bowel movements per day for at least 72 h despite pancreatic enzyme replacement and in the absence of laxatives or prokinetics. Extended resections were differentiated according to the type of vascular resection and arterial divestment. Clinicopathological characteristics and outcomes were compared among these groups and risk factors for diarrhea were identified.

Results: A total of 320 patients were included. Following any type of pancreatectomy, 71/320 (22.2%) patients developed diarrhea. The incidence of diarrhea after partial pancreatoduodenectomy, distal pancreatectomy and total pancreatectomy was 26.6%, 11.5% and 35.3%, respectively (p = 0.004). Arterial divestment/resection and venous resection were significantly associated with an increased risk for postoperative diarrhea in 87% (OR = 31.14; 95%-CI: 8.77, 170.08; p < 0.001) and 52.2% of patients (OR = 5.14; 95%-CI: 2.51, 10.52; p < 0.001), respectively. Postoperative diarrhea was significantly associated with a prolonged length of hospital stay (19 vs. 13 days; 95%-CI: 3.00, 7.00; p < 0.001).

Conclusion: Diarrhea after pancreatic resection is a common postoperative complication affecting especially patients undergoing extended resections with vascular resections and arterial divestment. Diarrhea significantly impairs postoperative recovery leading to a prolonged hospital stay.

Purpose: Postoperative pancreatic fistula is a common and serious complication after pancreaticoduodenectomy that significantly impairs patient recovery and prognosis. Despite extensive research, the field lacks systematic bibliometric visualization analyses, which hinders comprehensive understanding of its research landscape, evolutionary trends and key advancements. This study aims to address this gap by systematically analyzing relevant literature to clarify global research patterns and emerging directions.

Methods: A bibliometric analysis was conducted on literature regarding postoperative pancreatic fistula after pancreaticoduodenectomy published from January 2006 to December 2024. Data were retrieved from Web of Science Core Collection and Scopus databases. After removing duplicates, filtering by document type, language and time, and assessing eligibility, 4295 records were included. VOSviewer and Microsoft Excel were used to analyze publication trends, collaboration networks, core author contributions, keyword clustering and co-citation networks.

Results: The number of publications increased steadily with original research articles dominating. Japan the United States China Italy and Germany were the top contributing countries while England had the highest average citation rate per article. University of Verona, Universiteit van Amsterdam, and Heidelberg University were key contributing institutions. Core research themes included postoperative pancreatic fistula classification and definition, risk factors, preventive measures, and surgical technique comparison.

Conclusion: This study comprehensively maps the global research landscape and trends of postoperative pancreatic fistula after pancreaticoduodenectomy. The findings provide valuable insights for identifying research hotspots and guiding future studies, thereby promoting standardized and systematic advancement in this field.

Background: This cohort study investigated the efficacy of minimally invasive plate osteosynthesis combined with an enhanced recovery after surgery in the treatment of proximal humeral fractures (PHF).

Methods: This retrospective study examined 72 patients with PHF treated from March 2019 to June 2021. All patients were divided into two groups: a control group undergoing minimally invasive plate osteosynthesis (MIPO) and a study group receiving MIPO combined with an enhanced recovery after surgery (ERAS). Outcomes compared included operative time, intraoperative blood loss, hospital length of stay, time to first feeding, time to first flatus, and time to initial mobilization, postoperative pain (VAS), functional recovery (Barthel index), and fracture healing rates. The impact of ERAS on MIPO outcomes in patients with PHF was then analyzed.

Results: The study group demonstrated superior healing outcomes compared to the control group (P < 0.05). Post-treatment pain, significantly decreased in both groups, with the study group exhibiting lower scores (P < 0.05). After treatment, the Constant-Murley score of the study group was higher than the control group at one week, three months, and six months after operation (P < 0.05). Hospital stays were significantly shorter in the study group, as were times to first feeding, flatus, mobilization, and fracture healing (P < 0.05). After treatment, Barthel index scores improved in both groups, with the study group achieving higher scores at final evaluation. Conversely, the study group reported lower scores in physical, social, and cognitive health function (P < 0.05) indicating a greater degree of quality-of-life.

Conclusion: This study showed that combining minimally invasive plate osteosynthesis (MIPO) with an Enhanced Recovery after Surgery (ERAS) protocol yields better outcomes for proximal humeral fractures than MIPO alone. Wider adoption of ERAS-enhanced MIPO can optimize perioperative care and support longer-term function in PHF patients.

Introduction: Duct-to-mucosa pancreaticojejunostomy (PJ) is a widely accepted. However, it is difficult to implement during laparoscopic surgery, particularly for a small main pancreatic duct (MPD). We attempted to perform PJ without suturing the main pancreatic duct (WSMPD) and examined its safety and feasibility.

Materials and methods: We retrospectively reviewed 126 patients who underwent laparoscopic pancreaticoduodenectomy (LPD) between 2019 and 2024. Among them, 64 patients underwent Blumgart PJ and 62 underwent WSMPD PJ. The patients' demographics and short-term clinical safety were examined.

Results: After 1:1 PSM, the WSMPD group had significantly shorter operation and PJ durations and higher biochemical leakage than those in the Blumgart group. However, no significant differences were observed in other postoperative complications between the groups. Furthermore, the operation and PJ durations were shorter in the WSMPD group than in the Blumgart group, regardless of the MPD size (> 3 mm or ≤ 3 mm). In the Blumgart group, patients with MPD ≤ 3 mm had longer PJ duration and hospital stay as well as higher hospital expenses, incidence of B + C grade pancreatic fistula, and incidence of abdominal infection than those with MPD > 3 mm. In the WSMPD group, no significant differences were observed among the patients.

Conclusions: WSMPD PJ is a safe, effective, and easy-to-perform method that simplifies LPD procedures. It is particularly suitable for cases involving small MPDs.