Langenbeck's Archives of Surgery最新文献

Purpose: Patients undergoing major emergency abdominal surgery are often elderly with multiple comorbidities and previous abdominal operations, contributing to procedural complexity. Factors such as adhesions increase technical challenges, potentially influencing postoperative recovery. This study examined how objectively defined intraoperative complexity markers are associated with postoperative morbidity and mortality in this high-risk cohort.

Methods: In a prospective cohort of 754 consecutive patients undergoing major emergency abdominal procedures, we investigated three indicators of intraoperative complexity: iatrogenic injury, blood loss ≥ 750 mL, and operative duration ≥ 2.5 h. A composite variable incorporating all three was also created to reflect overall complexity. We analyzed associations with postoperative outcomes, including complication severity, length of stay (LOS), reoperations, and mortality.

Results: At least one complexity marker was observed in 32% of patients. Bleeding ≥ 750 mL and prolonged operative time each independently increased the likelihood of extended hospitalization by 23.0 and 22.1% points, respectively. Iatrogenic injuries were identified in 14% and correlated with longer LOS and increased reoperations. Although complexity markers were consistently linked to higher morbidity, including elevated Comprehensive Complication Index scores, reoperations, and prolonged LOS. No significant association with mortality was observed.

Conclusion: Intraoperative complexity is frequent in major emergency abdominal surgery and is closely associated with postoperative morbidity and healthcare utilization. Bleeding exceeding 750 mL and operative time over 2.5 were the strongest associations with postoperative morbidity. These findings provide a pragmatic framework for quantifying surgical complexity and may inform future work on preoperative risk stratification and resource planning. The observed dissociation between morbidity and mortality may reflect improved perioperative care and patient selection, but should be interpreted cautiously given the limited number of deaths.

Purpose: Hepatic arterial anomalies are commonly encountered during pancreaticoduodenectomy. However, their impact on perioperative outcomes in robotic pancreaticoduodenectomy (RPD) remains unclear.

Methods: We retrospectively analyzed 79 consecutive patients who underwent RPD. Hepatic arterial anatomy was classified according to the systems of Michels and Hiatt. Perioperative outcomes were compared between patients with hepatic arterial variants and those with normal anatomy.

Results: Hepatic arterial anomalies were identified in 22 patients (27.8%). According to Hiatt's classification, 57 patients (72.2%) had normal type I anatomy, while type II and III variants were observed in 4 (5.1%) and 9 (11.4%) patients, respectively. Two patients exhibited type IV variants with both replaced right and left hepatic arteries. Data are presented in the order of absence and presence of arterial anomalies. Median age was similar (72 vs. 73 years, P = 0.86), with no difference in sex distribution (P = 0.25). Operative time (549 vs. 586 min, P = 0.92), blood loss (73 vs. 50 mL, P = 0.49), rates of clinically relevant postoperative pancreatic fistula (5.3% vs. 4.5%, P = 0.69), postoperative bleeding(0% vs. 4.5%, P = 0.27), pseudoaneurysm hemorrhage (5.3% vs. 0%, P = 0.55), and major complications (Clavien-Dindo grade ≥ 3a) (8.8% vs. 9.0%, P = 0.63) did not differ significantly.

Conclusion: The presence of hepatic arterial anomalies did not adversely affect perioperative outcomes in patients undergoing RPD. These findings suggest that, with appropriate preoperative planning and meticulous surgical technique, RPD can be performed safely in selected patients with hepatic arterial variants at experienced centers.

Background: One of the most common and significant complication of acute diverticulitis is visceral perforation. Current clinical guidelines suggest conservative medical therapy can be adopted for selected patients with perforation, especially those with pericolic air, while its role remains less clear in cases of distant air. The aim of our study is to evaluate the role of non-operative management (NOM) in case of pericolic and distant air.

Materials and methods: The authors conducted a comprehensive literature review; this search yielded 23 studies (17 retrospective, 5 prospective and 1 randomized control trial), including 2689 patients.

Results: Conservative management of patients with air in perforated diverticulitis was safe and feasible, with a overall pooled success rate of 90.2% (95% CI: 86.4-93). Specifically, among patients with pericolic extraluminal air, the success rate of NOM was 89.9%. In contrast, the role of NOM in cases with distant free air remains uncertain, with a lower success rate of only 27.8%.

Conclusion: Non-operative management (NOM) appears safe and effective for patients with perforated diverticulitis and pericolic extraluminal air, provided there are no clinical signs of generalized peritonitis. In contrast, its role in cases with distant free air is highly uncertain: the pooled success rate is lower, even among hemodynamically stable patients. Based on these findings, early surgical management should be strongly considered for patients with distant free air, while NOM should only be attempted in highly selected cases under strict clinical and radiological monitoring. Conversely, NOM can be confidently recommended for patients with pericolic air who are stable and without diffuse peritonitis.

Purpose: To evaluate the impact of extended versus nonextended perioperative antibiotic prophylaxis (PAP) on reducing postoperative complications and hospital stays in patients undergoing radical cystectomy and urinary diversion.

Methods: We conducted this systematic review and meta-analysis in accordance with the PRISMA guidelines. A comprehensive literature search was conducted across PubMed, Scopus, Web of Science, and the Cochrane Library for studies comparing short-term (≤ 24 h) and extended (≥ 24 h) PAP in patients undergoing radical cystectomy and urinary diversion. The primary outcomes were surgical site infections (SSIs), urinary tract infections (UTIs), and length of hospital stay. The statistical analysis was performed via RevMan version 5.3. The results are presented as risk ratios (RRs) and mean differences (MDs). Results are presented as risk ratios (RRs) and mean differences (MDs). The quality of evidence was assessed using the GRADE methodology.

Results: A total of 214 studies were screened. Four studies involving 680 patients were included. No significant differences were detected between short-term and extended PAP in terms of SSIs (RR = 0.71 [95% CI 0.43-1.17]; P = 0.18]), febrile UTIs (RR = 1.19 [95% CI 0.91-1.56]; P = 0.20]), or length of hospital stay (MD = 0.76 days [95% CI [-2.72, 4.25]; P = 0.67]).

Conclusion: No significant difference was observed between 24-h and extended PAP for reducing postoperative complications after radical cystectomy and urinary diversion. Short-term PAP is a reliable and effective strategy and is recommended as the standard practice for reducing antimicrobial resistance and improving postoperative outcomes.

Objective: By comparing with routine nursing, we aim to explore the impacts of risk assessment nursing combined with psychological care on SAS scores, SDS scores, and patient compliance in surgical intensive care unit (SICU) patients.

Methods: This study is a single-center, randomized controlled trial (due to the nature of the study, blinding was not implemented for the researchers and patients, but blinding was implemented for data collectors, outcome assessors, and data statistical analysts). A total of 162 patients were randomly divided into a control group (routine specialist nursing) and an intervention group (risk assessment nursing combined with psychological care on the basis of the control group) (81 cases each) using a random number table method. Primary outcome measures included Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), and patient compliance. Secondary outcome measures included General Self-Efficacy Scale (GSES), World Health Organization Quality of Life Brief Version (WHOQOL-BREF), adverse events, and satisfaction of family members with nursing were recorded.

Results: After nursing care, the intervention group showed significant improvements over the control group in multiple indicators: the SAS scores (45.95 ± 2.40 vs. 51.77 ± 2.90; 95%CI: -2.576 to -1.797), SDS scores (38.78 ± 2.19 vs. 46.30 ± 2.88; 95%CI: -3.384 to -2.495), and incidence of adverse events (3.70% vs. 12.35%; 95%CI: 1.019 to 2.115) were lower (all P < 0.05); the GSES scores (33.11 ± 2.92 vs. 28.94 ± 3.11; 95%CI: 1.040 to 1.725), overall compliance rate (97.53% vs. 82.72%; 95%CI: 0.418 to 0.741), and family member satisfaction (95.06% vs. 85.19%; 95%CI: 0.480 to 0.962) were higher (all P < 0.05); meanwhile, the WHOQOL-BREF scores in all dimensions also showed significant improvements (all P < 0.001).

Conclusion: Compared with routine nursing, risk assessment nursing combined with psychological care improves emotional well-being, patient compliance, self-efficacy, and quality of life while reducing adverse events and enhancing family satisfaction in SICU patients.

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.