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Comparison of Endoscopic Ultrasound-guided Cyanoacrylate Injection and Transjugular Intrahepatic Portosystemic Shunt in the Prevention of Gastric Varices Rebleeding. 内镜超声引导下注射氰基丙烯酸酯与经颈静脉肝内门体分流术在预防胃静脉曲张再出血方面的比较
IF 1.1 4区 医学 Q3 SURGERY Pub Date : 2024-10-01 DOI: 10.1097/SLE.0000000000001312
Zhuang Zeng, Zhihong Wang, Jing Jin, Fumin Zhang, Qianqian Zhang, Xuecan Mei, Derun Kong

Objective: The purpose of this study was to investigate the efficacy and safety of endoscopic ultrasound (EUS)-guided injection of cyanoacrylate (CYA) and transjugular intrahepatic portal shunts (TIPSs) in the treatment of patients with cirrhosis with ruptured gastric varices.

Methods: In this retrospective study, 105 patients with liver cirrhosis and gastric varicose veins who were admitted to the First Affiliated Hospital of Anhui Medical University between April 2018 and April 2023 without nonselective β-blockers treatment and no portal vein thrombosis were evaluated. The patients were divided into the transjugular intrahepatic portal shunt (TIPS) group (n = 60) and the EUS-CYA group (n = 45) for the purpose of evaluating postoperative rebleeding rates, complications, survival rates, and other factors.

Results: During the follow-up, there was no significant difference in the rebleeding rates between the TIPS group and EUS-CYA group within 3 months (5% vs 2.2%; P = 0.825; 10% vs 20%, P = 0.147). However, the TIPS group had significantly lower rebleeding rates than the EUS-CYA group at 6 months (10% vs 33.3%; P = 0.030) and 1 year or longer (11.7% vs 42.2%; P < 0.01). In terms of hepatic encephalopathy, the incidence rate of the TIPS group was significantly higher than that of the EUS-CYA group (20% vs 2.2%; P = 0.006). In addition, there was no difference in the survival rates between the two groups (93.3% vs 97.8%; P = 0.552).

Conclusions: TIPS is superior to EUS in preventing rebleeding in patients with ruptured varices of the fundus, but it has a higher incidence of hepatic encephalopathy, and there is no difference in long-term survival between the two groups.

研究目的本研究旨在探讨内镜超声(EUS)引导下注射氰基丙烯酸酯(CYA)和经颈静脉肝内门体分流术(TIPSs)治疗肝硬化合并胃静脉曲张破裂患者的有效性和安全性:在这项回顾性研究中,对安徽医科大学第一附属医院于2018年4月至2023年4月期间收治的105例未经非选择性β受体阻滞剂治疗且无门静脉血栓形成的肝硬化合并胃静脉曲张患者进行了评估。将患者分为经颈静脉肝内门体分流术(TIPS)组(n=60)和EUS-CYA组(n=45),以评估术后再出血率、并发症、生存率等因素:随访期间,TIPS 组和 EUS-CYA 组在 3 个月内的再出血率无明显差异(5% vs 2.2%;P= 0.825;10% vs 20%,P= 0.147)。然而,TIPS 组在 6 个月(10% vs 33.3%;P= 0.030)和 1 年或更长时间(11.7% vs 42.2%;P < 0.01)内的再出血率明显低于 EUS-CYA 组。在肝性脑病方面,TIPS 组的发病率明显高于 EUS-CYA 组(20% vs 2.2%;P= 0.006)。此外,两组的存活率没有差异(93.3% vs 97.8%;P= 0.552):TIPS在预防胃底静脉曲张破裂患者再出血方面优于EUS,但肝性脑病的发生率较高,两组患者的长期生存率没有差异。
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引用次数: 0
Long-Term Weight Loss and Comorbidity Resolution of Laparoscopic Sleeve Gastrectomy and Laparoscopic Roux-en-Y Gastric Bypass and the Impact of Preoperative Weight Loss on Overall Outcome. 腹腔镜袖带胃切除术和腹腔镜Roux-en-Y胃旁路术的长期体重减轻和合并症解决情况以及术前体重减轻对总体结果的影响。
IF 1.1 4区 医学 Q3 SURGERY Pub Date : 2024-10-01 DOI: 10.1097/SLE.0000000000001313
James Lucocq, Kate Homyer, Georgios Geropoulos, Vikram Thakur, Daniel Stansfield, Brian Joyce, Gillian Drummond, Bruce Tulloh, Andrew de Beaux, Peter J Lamb, Andrew G Robertson

Background: The impact of preoperative weight loss on long-term weight loss outcomes and comorbidity resolution in both laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) are poorly reported. Understanding this relationship is necessary to guide surgeons toward appropriate procedure and patient selection. The present study investigates long-term weight loss outcomes and comorbidity resolution following LSG and LRYGB and investigates the effect of preoperative variables on long-term outcomes.

Methods: All patients who underwent LSG and LRYGB (2008-2022) in a tertiary referral centre were followed up prospectively. From 2010, a 12-week intensive preoperative information course (IPIC) became standard practice to optimize preoperative weight loss. Excess weight loss outcomes (EWL≥50% and ≥70%) were compared between LSG and LRYGB using multivariate logistic regression and the effect of preoperative weight loss on weight loss and comorbidity resolution, improvement, and exacerbation were reported.

Results: A total of 319 patients (median age: 49 y; M:F, 75:244) were included (158 LSG: 161 LRYGB). During follow-up, 260 (81.5%) and 163 patients (51.1%) achieved EWL≥50% and ≥70%, respectively. Those with sustained EWL≥50% and EWL≥70% at the end of follow-up were more likely to have underwent a LRYGB versus a LSG (59.6% vs. 40.4%, P=0.002; 61.7% vs. 38.3%, P<0.001). IPIC and higher preoperative weight loss (HR: 2.59 to 3.72, P<0.001) increased rates of EWL≥50% and EWL70% for both procedures. Improvement or resolution of type-2 diabetes were significant (72.7%), but up to 27.3% of patients developed or suffered an exacerbation of a psychiatric illness.

Conclusions: Excess weight loss outcomes are similar for LSG and LRYGB but LRYGB results in higher rates of sustained excess weight loss during long-term follow-up. Preoperative weight loss improves long-term weight loss. Comorbidity resolution is significant but rates of psychiatric illness exacerbation are high following metabolic and bariatric surgery.

背景:在腹腔镜袖带胃切除术(LSG)和腹腔镜鲁氏胃旁路术(LRYGB)中,术前体重减轻对长期减肥效果和合并症缓解的影响鲜有报道。了解这种关系对于指导外科医生选择合适的手术和患者非常必要。本研究调查了 LSG 和 LRYGB 术后的长期减肥效果和合并症缓解情况,并调查了术前变量对长期效果的影响:方法:对一家三级转诊中心接受 LSG 和 LRYGB 手术的所有患者(2008-2022 年)进行了前瞻性随访。自2010年起,为期12周的术前信息强化课程(IPIC)成为优化术前减重的标准做法。使用多变量逻辑回归比较了 LSG 和 LRYGB 的超重结果(EWL≥50% 和≥70%),并报告了术前减重对体重减轻和合并症缓解、改善和加重的影响:共纳入 319 名患者(中位年龄:49 岁;男女比例:75:244)(158 名 LSG 患者:161 名 LRYGB 患者)。随访期间,分别有 260 名患者(81.5%)和 163 名患者(51.1%)达到 EWL≥50% 和 ≥70%。随访结束时EWL≥50%和EWL≥70%的患者更有可能接受了LRYGB而不是LSG(59.6%对40.4%,P=0.002;61.7%对38.3%,PC结论:LSG和LRYGB的超重减肥效果相似,但LRYGB在长期随访中的持续超重减肥率更高。术前减重可改善长期减重效果。合并症明显减轻,但代谢和减肥手术后精神疾病加重率较高。
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引用次数: 0
Application of Indocyanine Green Fluorescence Imaging During Laparoscopic Reoperations of the Biliary Tract Enhances Surgical Precision and Efficiency. 在胆道腹腔镜再手术中应用吲哚菁绿荧光成像提高手术精确度和效率
IF 1.1 4区 医学 Q3 SURGERY Pub Date : 2024-09-20 DOI: 10.1097/SLE.0000000000001324
Ding-Wei Xu, Xin-Cheng Li, Ao Li, Yan Zhang, Manqin Hu, Jie Huang

Background: A history of abdominal surgery is considered a contraindication for laparoscopic procedures. However, the advancements in laparoscopic instruments and techniques have facilitated the performance of increasingly intricate operations, even in patients with prior abdominal surgeries. ICG fluorescence imaging technology offers advantages in terms of convenient operation and clearer intraoperative bile duct imaging, as confirmed by numerous international clinical studies on its feasibility and safety. The application of ICG fluorescence imaging technology in repeat laparoscopic biliary surgery, however, lacks sufficient reports.

Methods: The clinical data of patients who underwent elective reoperation of the biliary tract in our department between January 2020 and June 2022 were retrospectively analyzed. ICG was injected peripherally before the operation, and near-infrared light was used for 3-dimensional imaging of the bile duct during the operation.

Results: Altogether, 143 patients were included in this study and divided into the fluorescence and nonfluorescence groups according to the inclusion criteria. Among the 26 patients in the fluorescence group, cholangiography was successfully performed in 24 cases, and the success rate of intraoperative biliary ICG fluorescence imaging was 92.31%. The intraoperative biliary tract identification time was significantly different between the fluorescence and nonfluorescence groups, but no statistical difference was observed in the final operation method, operative time, and intraoperative blood loss between the 2 groups. Although there was no significant difference in the postoperative ventilation rate, incidence of bile leakage, and stone recurrence rate at 6 months postoperatively between the 2 groups (P>0.05), a significant difference in postoperative hospitalization days was observed (P=0.032).

Conclusion: The application of ICG fluorescence imaging technology in laparoscopic reoperation of the biliary tract is useful for the early identification of the biliary tract during operation, thereby shortening the operative time and reducing the risk of damage to nonoperative areas. This approach also enhances the visualization of the biliary system and avoids secondary injury intraoperatively due to poor identification of the biliary system. This technique is safe for repeat biliary tract surgery and has a good application prospect.

背景:腹部手术史被认为是腹腔镜手术的禁忌症。然而,腹腔镜器械和技术的进步使得越来越复杂的手术变得更加容易,即使是曾经接受过腹部手术的患者也不例外。ICG荧光成像技术具有操作方便、术中胆管成像更清晰等优点,其可行性和安全性已被大量国际临床研究证实。然而,ICG 荧光成像技术在重复腹腔镜胆道手术中的应用还缺乏足够的报道:方法:回顾性分析 2020 年 1 月至 2022 年 6 月期间在我科接受胆道择期再手术患者的临床资料。方法:回顾性分析 2020 年 1 月至 2022 年 6 月期间在我科接受胆道择期再手术的患者的临床资料,术前外周注射 ICG,术中使用近红外线灯对胆管进行三维成像:本研究共纳入 143 例患者,根据纳入标准分为荧光组和非荧光组。在荧光组的 26 例患者中,有 24 例成功进行了胆管造影,术中胆道 ICG 荧光成像的成功率为 92.31%。荧光组和非荧光组术中胆道识别时间有显著差异,但两组最终手术方式、手术时间和术中失血量无统计学差异。虽然两组术后通气率、胆汁漏发生率、术后6个月结石复发率无明显差异(P>0.05),但术后住院天数有明显差异(P=0.032):ICG荧光成像技术在腹腔镜胆道再手术中的应用有助于在手术过程中早期识别胆道,从而缩短手术时间,降低非手术区域受损的风险。这种方法还能增强胆道系统的可视性,避免术中因胆道系统识别不清而造成二次损伤。该技术对于重复胆道手术是安全的,具有良好的应用前景。
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引用次数: 0
The Battle of Endoscopic Bariatric Therapies for Obesity: Endoscopic Sleeve Gastroplasty Versus Endoscopically Inserted Intragastric Balloon-A Pairwise Meta-Analysis of Comparative Studies and a Call for Randomized Controlled Trials. 内镜减肥疗法与肥胖症之争:内镜袖带胃成形术与内镜插入胃内球囊--一项对比研究的成对分析及对随机对照试验的呼吁》(Endoscopic Sleeve Gastroplasty Versus Endoscopically Inserted Intragastric Balloon- A Pairwise Meta-Analysis of Comparative Studies and a Call for Randomized Controlled Trials)。
IF 1.1 4区 医学 Q3 SURGERY Pub Date : 2024-09-19 DOI: 10.1097/SLE.0000000000001321
Abdul-Rahman F Diab, Joseph A Sujka, Kathleen Mattingly, Mehak Sachdeva, Kenneth Hackbarth, Salvatore Docimo, Christopher G DuCoin

Background: Endoscopic sleeve gastroplasty (ESG) represents the latest primary endoscopic intervention for managing obesity. Both ESG and intragastric balloons (IGBs) have demonstrated effectiveness and safety for weight loss. However, there is a paucity of high-quality evidence supporting the superiority of one over the other, and no pairwise meta-analysis of comparative studies has been published to date. Our aim was to conduct a pairwise meta-analysis of comparative studies directly comparing ESG and IGB.

Methods: We systematically conducted a literature search on PubMed and Google Scholar following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Our search used specific search terms. The Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) Tool was used to evaluate the quality of the included studies. Data were analyzed using Review Manager (RevMan) 5.4.1 software with a random-effects model. The statistical method used was the Mantel-Haenszel method. For dichotomous data, the effect size was represented using odds ratio (OR), while mean difference (MD) was utilized as the effect size for continuous data.

Results: After screening 967 records, a total of 9 studies met the inclusion criteria for this meta-analysis (5302 patients). The quality assessment categorized 5 studies as having a moderate risk of bias, while 3 studies were classified as having a low risk of bias. Sufficient information was not available for one study to ascertain its overall quality. A statistically significant increase in total weight loss percentage (TWL%) at 1 and 6 months was observed with ESG compared with IGB. In addition, a statistically insignificant decrease in the incidence of adverse events and readmissions was observed with ESG. Furthermore, a statistically significant decrease in the incidence of reintervention was observed with ESG.

Conclusions: While this study suggests a higher TWL% associated with ESG compared with IGB, drawing definitive conclusions is challenging due to limitations identified during a comprehensive quality assessment of the available literature. We advocate for randomized controlled trials (RCTs) directly comparing the newer IGB (with a 12-mo placement duration) with ESG. However, this study consistently reveals higher rates of early reintervention (re-endoscopy) within the IGB group, primarily necessitated by the removal or adjustment of the IGB due to intolerance. Given the additional intervention required at 6 or 12 months to remove the temporarily placed IGB, this trend may imply that IGB is less economically viable than ESG. Cost-effectiveness analyses comparing ESG and IGB are warranted to provide valuable scientific insights.

背景:内镜袖带胃成形术(ESG)是控制肥胖症的最新初级内镜干预方法。ESG和胃内气球(IGBs)都已证明对减肥有效且安全。然而,支持两者优越性的高质量证据却很少,而且迄今为止还没有发表过对比研究的成对荟萃分析。我们的目的是对直接比较 ESG 和 IGB 的对比研究进行成对荟萃分析:我们按照系统综述和荟萃分析首选报告项目(PRISMA)指南在 PubMed 和 Google Scholar 上进行了系统的文献检索。我们的检索使用了特定的检索词。非随机干预研究中的偏倚风险(ROBINS-I)工具用于评估纳入研究的质量。数据采用随机效应模型,使用Review Manager (RevMan) 5.4.1软件进行分析。使用的统计方法是曼特尔-海恩泽尔法。对于二分法数据,用几率比(OR)表示效应大小;对于连续法数据,用平均差(MD)表示效应大小:结果:在筛选了 967 条记录后,共有 9 项研究符合本次荟萃分析的纳入标准(5302 名患者)。质量评估结果显示,5 项研究存在中度偏倚风险,3 项研究存在低度偏倚风险。有一项研究的信息不足,无法确定其总体质量。与 IGB 相比,ESG 在 1 个月和 6 个月时的总减重百分比 (TWL%) 有明显的统计学增长。此外,ESG 的不良事件发生率和再入院率的下降在统计学上并不明显。此外,ESG 的再介入发生率在统计学上也有显著下降:虽然这项研究表明 ESG 的 TWL% 比 IGB 高,但由于对现有文献进行全面质量评估时发现的局限性,得出明确结论具有挑战性。我们主张进行随机对照试验(RCT),直接比较较新的 IGB(置管时间为 12 个月)和 ESG。然而,本研究一致显示,IGB 组的早期再介入(再内镜检查)率较高,主要是由于不耐受而必须移除或调整 IGB。鉴于需要在 6 个月或 12 个月时进行额外干预以移除临时放置的 IGB,这一趋势可能意味着 IGB 在经济上不如 ESG 可行。有必要对 ESG 和 IGB 进行成本效益分析比较,以提供有价值的科学见解。
{"title":"The Battle of Endoscopic Bariatric Therapies for Obesity: Endoscopic Sleeve Gastroplasty Versus Endoscopically Inserted Intragastric Balloon-A Pairwise Meta-Analysis of Comparative Studies and a Call for Randomized Controlled Trials.","authors":"Abdul-Rahman F Diab, Joseph A Sujka, Kathleen Mattingly, Mehak Sachdeva, Kenneth Hackbarth, Salvatore Docimo, Christopher G DuCoin","doi":"10.1097/SLE.0000000000001321","DOIUrl":"https://doi.org/10.1097/SLE.0000000000001321","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic sleeve gastroplasty (ESG) represents the latest primary endoscopic intervention for managing obesity. Both ESG and intragastric balloons (IGBs) have demonstrated effectiveness and safety for weight loss. However, there is a paucity of high-quality evidence supporting the superiority of one over the other, and no pairwise meta-analysis of comparative studies has been published to date. Our aim was to conduct a pairwise meta-analysis of comparative studies directly comparing ESG and IGB.</p><p><strong>Methods: </strong>We systematically conducted a literature search on PubMed and Google Scholar following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Our search used specific search terms. The Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) Tool was used to evaluate the quality of the included studies. Data were analyzed using Review Manager (RevMan) 5.4.1 software with a random-effects model. The statistical method used was the Mantel-Haenszel method. For dichotomous data, the effect size was represented using odds ratio (OR), while mean difference (MD) was utilized as the effect size for continuous data.</p><p><strong>Results: </strong>After screening 967 records, a total of 9 studies met the inclusion criteria for this meta-analysis (5302 patients). The quality assessment categorized 5 studies as having a moderate risk of bias, while 3 studies were classified as having a low risk of bias. Sufficient information was not available for one study to ascertain its overall quality. A statistically significant increase in total weight loss percentage (TWL%) at 1 and 6 months was observed with ESG compared with IGB. In addition, a statistically insignificant decrease in the incidence of adverse events and readmissions was observed with ESG. Furthermore, a statistically significant decrease in the incidence of reintervention was observed with ESG.</p><p><strong>Conclusions: </strong>While this study suggests a higher TWL% associated with ESG compared with IGB, drawing definitive conclusions is challenging due to limitations identified during a comprehensive quality assessment of the available literature. We advocate for randomized controlled trials (RCTs) directly comparing the newer IGB (with a 12-mo placement duration) with ESG. However, this study consistently reveals higher rates of early reintervention (re-endoscopy) within the IGB group, primarily necessitated by the removal or adjustment of the IGB due to intolerance. Given the additional intervention required at 6 or 12 months to remove the temporarily placed IGB, this trend may imply that IGB is less economically viable than ESG. Cost-effectiveness analyses comparing ESG and IGB are warranted to provide valuable scientific insights.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142295900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Shorter Drainage Tube to the Pancreatic Stump Reduces Pancreatic Fistula After Distal Pancreatectomy. 胰腺残端较短的引流管可减少胰腺远端切除术后的胰腺瘘。
IF 1.1 4区 医学 Q3 SURGERY Pub Date : 2024-08-30 DOI: 10.1097/SLE.0000000000001318
Tomoyuki Nagaoka, Katsunori Sakamoto, Kohei Ogawa, Takahiro Hikida, Chihiro Ito, Miku Iwata, Akimasa Sakamoto, Mikiya Shine, Yusuke Nishi, Mio Uraoka, Masahiko Honjo, Kei Tamura, Yasutsugu Takada

Background: We investigated the relationship between the length of a prophylactic closed-suction drainage tube and clinically relevant postoperative pancreatic fistula (CR-POPF) in distal pancreatectomy (DP).

Materials and methods: The clinical data of 76 patients who underwent DP using a reinforced stapler for the division of the pancreas at Ehime University Hospital between December 2017 and May 2023 were retrospectively analyzed. Laparoscopic DP was performed in 41 patients (53.9%). Closed-suction drainage was performed using a 19 Fr ExuFlow Round Drain with a vacuum bulb. The drainage tube length was defined as the distance between the peripancreatic stump site and the abdominal wall insertion site using abdominal radiography.

Results: CR-POPF was observed in 12 patients (15.8%). Univariate analyses demonstrated that male sex (P=0.020), American Society of Anesthesiologists Physical Status (P=0.017), current smoking (P=0.005), and drainage tube length (P<0.001) were significantly associated with CR-POPF. The optimal cut-off value of drainage tube length for CR-POPF was 220 mm (area under the receiver operating characteristic curve=0.80). In multivariate analyses, drainage tube length (≥220 mm) was the sole independent predictor for CR-POPF (odds ratio, 6.59; P=0.023). According to computed tomography performed ∼1 week after surgery, the median volume of peripancreatic fluid collection was significantly higher in the long drainage tube group than in the short drainage tube group (P<0.001).

Conclusion: A drainage tube inserted at a shorter distance to the pancreatic stump may reduce the incidence of CR-POPF after DP.

背景:我们研究了预防性闭式吸引引流管的长度与胰腺远端切除术(DP)术后胰瘘(CR-POPF)临床相关性之间的关系:回顾性分析了2017年12月至2023年5月期间在爱媛大学医院使用加强型订书机进行胰腺分割DP的76例患者的临床数据。41名患者(53.9%)接受了腹腔镜胰腺分割术。闭式抽吸引流是使用带真空球的 19 Fr ExuFlow 圆形引流管进行的。引流管长度的定义是使用腹部放射线检查胰周残端部位与腹壁插入部位之间的距离:结果:12 名患者(15.8%)出现 CR-POPF。单变量分析表明,男性性别(P=0.020)、美国麻醉医师协会体格状态(P=0.017)、目前吸烟(P=0.005)和引流管长度(PC结论:引流管插入距离较短时,胰周残端部位与腹壁插入部位之间的距离较长:在距离胰腺残端较短的位置插入引流管可降低 DP 后 CR-POPF 的发生率。
{"title":"Shorter Drainage Tube to the Pancreatic Stump Reduces Pancreatic Fistula After Distal Pancreatectomy.","authors":"Tomoyuki Nagaoka, Katsunori Sakamoto, Kohei Ogawa, Takahiro Hikida, Chihiro Ito, Miku Iwata, Akimasa Sakamoto, Mikiya Shine, Yusuke Nishi, Mio Uraoka, Masahiko Honjo, Kei Tamura, Yasutsugu Takada","doi":"10.1097/SLE.0000000000001318","DOIUrl":"https://doi.org/10.1097/SLE.0000000000001318","url":null,"abstract":"<p><strong>Background: </strong>We investigated the relationship between the length of a prophylactic closed-suction drainage tube and clinically relevant postoperative pancreatic fistula (CR-POPF) in distal pancreatectomy (DP).</p><p><strong>Materials and methods: </strong>The clinical data of 76 patients who underwent DP using a reinforced stapler for the division of the pancreas at Ehime University Hospital between December 2017 and May 2023 were retrospectively analyzed. Laparoscopic DP was performed in 41 patients (53.9%). Closed-suction drainage was performed using a 19 Fr ExuFlow Round Drain with a vacuum bulb. The drainage tube length was defined as the distance between the peripancreatic stump site and the abdominal wall insertion site using abdominal radiography.</p><p><strong>Results: </strong>CR-POPF was observed in 12 patients (15.8%). Univariate analyses demonstrated that male sex (P=0.020), American Society of Anesthesiologists Physical Status (P=0.017), current smoking (P=0.005), and drainage tube length (P<0.001) were significantly associated with CR-POPF. The optimal cut-off value of drainage tube length for CR-POPF was 220 mm (area under the receiver operating characteristic curve=0.80). In multivariate analyses, drainage tube length (≥220 mm) was the sole independent predictor for CR-POPF (odds ratio, 6.59; P=0.023). According to computed tomography performed ∼1 week after surgery, the median volume of peripancreatic fluid collection was significantly higher in the long drainage tube group than in the short drainage tube group (P<0.001).</p><p><strong>Conclusion: </strong>A drainage tube inserted at a shorter distance to the pancreatic stump may reduce the incidence of CR-POPF after DP.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142112259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Impact of Infrared Indocyanine Green Fluorescence imaging-guided Laparoscopic Hepatectomy on Securing the Resection Margin for Colorectal Liver Metastasis. 红外吲哚菁绿荧光成像引导的腹腔镜肝切除术对确保结直肠肝转移灶切除边缘的影响
IF 1.1 4区 医学 Q3 SURGERY Pub Date : 2024-08-26 DOI: 10.1097/SLE.0000000000001320
Toru Kato, Masafumi Imamura, Daisuke Kyuno, Yasutoshi Kimura, Kazuharu Kukita, Takeshi Murakami, Eiji Yoshida, Toru Mizuguchi, Ichiro Takemasa

Background: Laparoscopic hepatectomy for colorectal liver metastases (CRLM) is performed worldwide. However, owing to a lack of palpatory information and difficulties associated with accurate intraoperative ultrasonographic diagnosis, the tumor may be exposed at the hepatic transection margin. This study aimed to investigate the pathological significance of near-infrared (NIR) fluorescence imaging with indocyanine green (ICG)-guided laparoscopic hepatectomy and determine its usefulness in securing the resection margin for CRLMs.

Methods: Fifty-nine patients who underwent laparoscopic hepatectomy for CRLM using NIR fluorescence imaging between February 2017 and June 2021 at Sapporo Medical University Hospital were included. Generally, all patients received intravenous ICG (2.5 mg/body) as a fluorescence agent 1 to 2 days before surgery. During the surgical procedure, real-time NIR fluorescence imaging was repeatedly performed to assess the surgical margins.

Results: Of the 94 tumors in 59 patients, laparoscopic NIR fluorescence imaging identified 56 tumors (59.6%) on the liver surface. Pathological analysis indicated clear margins in 96.6% (57/59) of patients. Examination of paraffin-embedded sections, which were successful in only 20 of 94 cases (21.3%), revealed that there were no tumor cells positive for NIR fluorescence, and the median distance of the continuous fluorescent signal from the tumor margin was 1.074 mm.

Conclusions: We demonstrated a high R0 rate using NIR fluorescence-guided hepatectomy. This technique has the potential to improve intraoperative tumor identification and tumor margin assurance and reduce the rate of positive resection margins in patients with CRLMs.

背景:腹腔镜肝切除术治疗结直肠肝转移瘤(CRLM)在全球范围内广泛开展。然而,由于缺乏触诊信息以及术中超声波准确诊断的困难,肿瘤可能暴露在肝横切缘处。本研究旨在探讨吲哚菁绿(ICG)引导下腹腔镜肝切除术的近红外(NIR)荧光成像的病理学意义,并确定其在确保CRLMs切除边缘方面的作用:纳入2017年2月至2021年6月期间在札幌医科大学附属医院使用近红外荧光成像对CRLM进行腹腔镜肝切除术的59例患者。一般情况下,所有患者在术前1至2天静脉注射ICG(2.5毫克/体)作为荧光剂。在手术过程中,反复进行实时近红外荧光成像以评估手术边缘:结果:在59名患者的94个肿瘤中,腹腔镜近红外荧光成像在肝脏表面发现了56个肿瘤(59.6%)。病理分析显示,96.6%(57/59)的患者边缘清晰。对石蜡包埋切片的检查显示,94 例患者中仅有 20 例(21.3%)成功进行了近红外荧光成像,没有肿瘤细胞呈阳性,连续荧光信号距离肿瘤边缘的中位距离为 1.074 毫米:结论:我们证明了近红外荧光引导肝切除术的高R0率。这项技术有望提高术中肿瘤识别率和肿瘤边缘保证率,降低 CRLM 患者切除边缘阳性率。
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引用次数: 0
The Role of CT-guided Core Needle Biopsy in Pancreatic Tumors: An Initial Evaluation in Modern Oncology. CT 引导下核心针活检在胰腺肿瘤中的作用:现代肿瘤学的初步评估。
IF 1.1 4区 医学 Q3 SURGERY Pub Date : 2024-08-15 DOI: 10.1097/SLE.0000000000001319
Eduardo P Eyheremendy, Cristian A Angeramo, Patricio Méndez

Purpose: Neoadjuvant chemotherapy has recently become the standard of care for borderline resectable pancreatic ductal adenocarcinoma (PDAC), and there have even been numerous reports evaluating its potential benefits in resectable PDAC. However, neoadjuvant therapy first requires a histological or cytological diagnosis. This study aimed to analyze the safety and diagnostic yield of CT-guided core needle biopsy (CNB).

Material and methods: A retrospective analysis of patients with pancreatic tumor requiring a CNB during the period 2015 to 2023 were included. Biopsies were performed with an 18-20 G Tru-Core needle using a coaxial system and automatic biopsy gun. Demographics, procedural variables, postoperative outcomes, and histological results were analyzed.

Results: A total of 43 pancreatic biopsies were performed in 42 patients. The mean age was 60 years (35 to 81 y), and 24 (56%) were males. Tumors were more frequently localized in the head (42%) and body (42%) of the pancreas. The mean size of the pancreatic lesions was 53.77 mm (17 to 181 mm) and the mean number of samples per biopsy was 4 (1 to 12). Most procedures were performed via direct access (81%). No major complications were observed. Histological diagnosis was obtained in 40 (93%) patients, with a sensitivity of 93%, specificity of 100% and an overall accuracy rate of 93%. The probability of performing a molecular diagnostic test increased with the year of biopsy (OR 3.34, 95% CI 1.33-8.40, P=0.01).

Conclusions: CNB is an efficient and safe method for obtaining high-quality material. This approach could be essential as molecular profiling continues to improve the diagnosis, prognosis, and treatment of PDAC.

目的:新辅助化疗最近已成为可切除胰腺导管腺癌(PDAC)的标准治疗方法,甚至有许多报告评估了新辅助化疗对可切除PDAC的潜在益处。然而,新辅助治疗首先需要组织学或细胞学诊断。本研究旨在分析CT引导下核心针活检(CNB)的安全性和诊断率:回顾性分析了2015年至2023年期间需要进行CNB的胰腺肿瘤患者。活检使用 18-20 G Tru-Core 穿刺针,使用同轴系统和自动活检枪进行。对人口统计学、手术变量、术后结果和组织学结果进行了分析:结果:42 名患者共进行了 43 例胰腺活检。平均年龄为 60 岁(35 至 81 岁),男性 24 人(56%)。肿瘤多位于胰腺头部(42%)和胰腺体部(42%)。胰腺病变的平均大小为 53.77 毫米(17 至 181 毫米),每次活检的平均样本数为 4 个(1 至 12 个)。大多数手术都是通过直接入路进行的(81%)。未发现重大并发症。40例(93%)患者获得了组织学诊断,敏感性为93%,特异性为100%,总体准确率为93%。进行分子诊断检测的概率随着活检年份的增加而增加(OR 3.34,95% CI 1.33-8.40,P=0.01):CNB是一种高效、安全的获取高质量材料的方法。结论:CNB 是一种高效、安全的获取高质量材料的方法,随着分子图谱分析不断改进 PDAC 的诊断、预后和治疗,这种方法将变得至关重要。
{"title":"The Role of CT-guided Core Needle Biopsy in Pancreatic Tumors: An Initial Evaluation in Modern Oncology.","authors":"Eduardo P Eyheremendy, Cristian A Angeramo, Patricio Méndez","doi":"10.1097/SLE.0000000000001319","DOIUrl":"https://doi.org/10.1097/SLE.0000000000001319","url":null,"abstract":"<p><strong>Purpose: </strong>Neoadjuvant chemotherapy has recently become the standard of care for borderline resectable pancreatic ductal adenocarcinoma (PDAC), and there have even been numerous reports evaluating its potential benefits in resectable PDAC. However, neoadjuvant therapy first requires a histological or cytological diagnosis. This study aimed to analyze the safety and diagnostic yield of CT-guided core needle biopsy (CNB).</p><p><strong>Material and methods: </strong>A retrospective analysis of patients with pancreatic tumor requiring a CNB during the period 2015 to 2023 were included. Biopsies were performed with an 18-20 G Tru-Core needle using a coaxial system and automatic biopsy gun. Demographics, procedural variables, postoperative outcomes, and histological results were analyzed.</p><p><strong>Results: </strong>A total of 43 pancreatic biopsies were performed in 42 patients. The mean age was 60 years (35 to 81 y), and 24 (56%) were males. Tumors were more frequently localized in the head (42%) and body (42%) of the pancreas. The mean size of the pancreatic lesions was 53.77 mm (17 to 181 mm) and the mean number of samples per biopsy was 4 (1 to 12). Most procedures were performed via direct access (81%). No major complications were observed. Histological diagnosis was obtained in 40 (93%) patients, with a sensitivity of 93%, specificity of 100% and an overall accuracy rate of 93%. The probability of performing a molecular diagnostic test increased with the year of biopsy (OR 3.34, 95% CI 1.33-8.40, P=0.01).</p><p><strong>Conclusions: </strong>CNB is an efficient and safe method for obtaining high-quality material. This approach could be essential as molecular profiling continues to improve the diagnosis, prognosis, and treatment of PDAC.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141988969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Feeding Tube Clinic Effect on Nutrition. 喂食管门诊对营养的影响。
IF 1.1 4区 医学 Q3 SURGERY Pub Date : 2024-08-01 DOI: 10.1097/SLE.0000000000001277
Kevin Choy, Danielle Abbitt, Amber Moyer, John T Moore, Krzysztof J Wikiel, Teresa S Jones, Thomas N Robinson, Edward L Jones

Background: Optimizing nutrition is essential for recovery after major surgery or severe illness. Feeding tubes (FT) can be placed in patients limited by oral enteral nutrition. Given the myriad of locations in which these procedures are performed (radiology, intensive care unit, and endoscopy suite), routine follow-up is challenging. The purpose of this study was to evaluate the impact of an FT clinic on nutrition. We hypothesized that enrollment in the FT clinic would result in improved nutritional outcomes.

Methods: Retrospective review of Veteran Affairs Medical Center patients with FTs placed from January 2010 to January 2020. Demographics and body mass index (BMI) were recorded. Serum albumin recorded within 1 month of tube placement was compared to within 1 month of tube removal, death, or at the end of the study period. FT clinic participation required at least 2 visits. Indications for FT placement and duration were recorded. Patients were excluded when both BMI and albumin values were incomplete, and if FTs were placed for decompression.

Results: Ninety-three patients underwent FT placement during the study period; 5 (5%) were excluded. The average age was 64.8±9.7 years, with the majority being male, 85 patients (97%). Eighteen (20%) patients were seen in the FT clinic (FTC) and 70 (80%) were managed outside of FTC (nFTC). There were no differences in age, gender, or indication for FT. Mean albumin increased 0.42±0.85 g/dL in the FTC group versus -0.07±0.72 g/dL in the nFTC group ( P =0.037). The FTC group BMI increased, 0.38 kg/m 2 vs. -1.48 kg/m 2 in nFTC patients, P =0.041. The FTC patients maintained their tubes longer (36.5 vs. 7.0 mo, P =0.0014).

Conclusions: Patients managed in a dedicated FT clinic experienced an improvement in their serum albumin values and increases in their BMI. In addition, they also maintained their FTs longer. To optimize nutrition and reduce weight loss, patients who require FTs should be enrolled in a dedicated FT clinic.

背景:优化营养对大手术或重病后的恢复至关重要。对于口服肠内营养有限的患者,可以放置喂食管(FT)。由于进行这些手术的地点繁多(放射科、重症监护室和内窥镜室),因此常规随访具有挑战性。本研究旨在评估 FT 诊所对营养的影响。我们假设,加入 FT 诊所将改善营养状况:方法:回顾性分析退伍军人事务医疗中心在 2010 年 1 月至 2020 年 1 月期间安置 FT 的患者。记录人口统计学和体重指数(BMI)。将置管后 1 个月内记录的血清白蛋白与拔管后 1 个月内、死亡时或研究期结束时记录的血清白蛋白进行比较。FT 诊所的参与至少需要 2 次就诊。记录了放置输液管的指征和持续时间。如果 BMI 和白蛋白值不完整,或因减压而置入 FT 时,患者将被排除在外:研究期间,93 名患者接受了 FT 置入术,其中 5 人(5%)被排除在外。平均年龄为(64.8±9.7)岁,男性患者占多数,共 85 人(97%)。18名患者(20%)在 FT 诊所(FTC)就诊,70 名患者(80%)在 FTC 以外就诊(nFTC)。在年龄、性别和 FT 适应症方面没有差异。FTC 组的平均白蛋白增加了(0.42±0.85)克/分升,而 nFTC 组的平均白蛋白增加了(-0.07±0.72)克/分升(P=0.037)。FTC 组患者的体重指数增加了 0.38 kg/m2,而 nFTC 组患者的体重指数为-1.48 kg/m2,P=0.041。FTC患者保留输卵管的时间更长(36.5个月 vs. 7.0个月,P=0.0014):结论:在专门的输血治疗诊所接受治疗的患者,其血清白蛋白值有所改善,体重指数(BMI)也有所提高。此外,他们的全脂奶粉维持时间也更长。为了优化营养和减少体重减轻,需要进行体外受精的患者应到专门的体外受精诊所就诊。
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引用次数: 0
Ligamentum Teres Augmentation for Hiatus Hernia Repair After Bariatric Surgery: A Systematic Review and Meta-analysis. 减肥手术后用于裂孔疝修复的韧带增强术:系统性回顾和元分析。
IF 1.1 4区 医学 Q3 SURGERY Pub Date : 2024-08-01 DOI: 10.1097/SLE.0000000000001295
Shahrukh Chaudhry, Soroush Farsi, Hayato Nakanishi, Chetan Parmar, Omar M Ghanem, Benjamin Clapp

Objective: Hiatal hernia (HH) and symptomatic gastroesophageal reflux disease are common complications after metabolic bariatric surgery. This meta-analysis aims to investigate the safety and efficacy of ligamentum teres augmentation (LTA) for HH repair after metabolic and bariatric surgeries (MBS).

Materials and methods: CENTRAL, Embase, PubMed, and Scopus were searched for articles from their inception to September 2023 by 2 independent reviewers using the Preferred Reporting Items for Systematic Reviews and Meta-analysis system.

Results: Five studies met the eligibility criteria, with a total of 165 patients undergoing LTA for HH repair after MBS. The distribution of patients based on surgical procedures included 63% undergoing sleeve gastrectomy, 21% Roux-en-Y gastric bypass, and 16% having one anastomosis gastric bypass. The pooled proportion of reflux symptoms before LTA was 77% (95% CI: 0.580-0.960; I2 = 89%, n = 106). A pooled proportion of overall postoperative symptoms was 25.6% (95% CI: 0.190-0.321; I2 = 0%, n = 44), consisting of reflux at 14.5% (95% CI: 0.078-0.212; I2 = 0%, n = 15). The pooled proportion of unsuccessful LTA outcomes was 12.5% (95% CI: 0.075-0.175; I2 = 0%, n = 21).

Conclusion: Our meta-analysis demonstrated that LTA appears to be a safe and efficacious procedure in the management of HH after MBS.

目的:贲门疝(HH)和无症状胃食管反流病是代谢减肥手术后常见的并发症。本荟萃分析旨在研究新陈代谢减肥手术(MBS)后采用韧带增强术(LTA)修复食管裂孔疝的安全性和有效性:由两名独立审稿人采用系统综述和荟萃分析首选报告项目系统对CENTRAL、Embase、PubMed和Scopus上从开始到2023年9月的文章进行检索:5项研究符合资格标准,共有165名患者在MBS术后接受了LTA进行HH修复。根据手术方式划分,63%的患者接受袖带胃切除术,21%接受Roux-en-Y胃旁路术,16%接受单吻合胃旁路术。LTA前出现反流症状的总比例为77%(95% CI:0.580-0.960;I2 = 89%,n = 106)。总体术后症状的汇总比例为 25.6%(95% CI:0.190-0.321;I2 = 0%,n = 44),其中反流症状占 14.5%(95% CI:0.078-0.212;I2 = 0%,n = 15)。LTA不成功的汇总比例为12.5% (95% CI: 0.075-0.175; I2 = 0%, n = 21):我们的荟萃分析表明,LTA似乎是治疗MBS后HH的一种安全有效的方法。
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引用次数: 0
Percutaneous Endoscopy and Image-guided Retrieval of Dropped Gallstones - A Case Series. 经皮内窥镜和图像引导取回掉落的胆结石--一个病例系列。
IF 1.1 4区 医学 Q3 SURGERY Pub Date : 2024-08-01 DOI: 10.1097/SLE.0000000000001287
Ali Husnain, Allison Reiland, Albert A Nemcek, Riad Salem, Alexander P Nagle, Ezra Teitelbaum, Ahsun Riaz

Background: Recurrent abscesses can happen due to dropped gallstones (DGs) after laparoscopic cholecystectomy (LC). Recognition and appropriate percutaneous endoscopy and image-guided treatment options can decrease morbidity associated with this condition.

Materials and methods: We report a minimally invasive endoscopy and image-guided technique for retrieval of dropped gallstones in a series of 6 patients (M/F=3/3; median age: 75.5 years [68 to 82]) presenting with recurrent or chronic intra-abdominal abscesses secondary to dropped gallstones. Technical success was defined as the visualization and retrieval of all stones. DGs were identified on pre-procedure imaging. Number of abscesses recurrence was 12 (1/6), 1 (3/6), and 0 (2/6) with a median interval of 2 months (1 to 21) between cholecystectomy and abscess development.

Results: Percutaneous endoscopy and fluoroscopy guidance were utilized in all cases. Technical success was achieved in 4 patients (66%). The median procedure time was 65.8 minutes (39 to 136). The median fluoroscopy time and dose were 12.6 min (3.3 to 67) and 234 mGy (31 to 1457), respectively. There were no intraprocedure and postprocedure complications. No abscess recurrence was reported among successful procedures during a median follow-up of 193 days (51 to 308).

Conclusion: Percutaneous image and endoscopy-guided lithotripsy/lithectomy are safe and effective. This technique is a suitable alternative to open surgery for dropped gallstones.

Level of evidence: Level 4, Case Series.

背景:腹腔镜胆囊切除术(LC)后,胆结石(DGs)脱落可导致复发性脓肿。识别并采取适当的经皮内镜和图像引导治疗方案可降低与这种情况相关的发病率:我们报告了一种微创内镜和图像引导技术,该技术适用于6例因胆结石掉落导致复发性或慢性腹腔内脓肿的患者(男/女=3/3;中位年龄:75.5岁[68至82岁])。技术成功的定义是所有结石均被显露和取出。胆管结石是在手术前的影像学检查中发现的。脓肿复发次数分别为12次(1/6)、1次(3/6)和0次(2/6),胆囊切除术与脓肿形成之间的中位间隔为2个月(1至21个月):所有病例均采用经皮内镜和透视引导。4名患者(66%)获得了技术成功。手术时间中位数为 65.8 分钟(39 至 136 分钟)。透视时间和剂量的中位数分别为 12.6 分钟(3.3 到 67 分钟)和 234 毫戈瑞(31 到 1457 毫戈瑞)。术中和术后均无并发症。在中位随访193天(51至308天)期间,成功的手术中没有脓肿复发的报告:结论:经皮图像和内窥镜引导碎石/肝切除术安全有效。结论:经皮图像和内窥镜引导碎石/取石术是安全有效的,该技术可替代开腹手术治疗掉落的胆结石:4级,病例系列。
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引用次数: 0
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Surgical Laparoscopy, Endoscopy & Percutaneous Techniques
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