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Can We Predict Gastric Leaks After Laparoscopic Sleeve Gastrectomy by Evaluating the Complete Blood Count on Postoperative Day 1? 我们能否通过评估术后第 1 天的全血细胞计数来预测腹腔镜袖带胃切除术后的胃漏?
IF 1.1 4区 医学 Q3 SURGERY Pub Date : 2024-10-01 DOI: 10.1097/SLE.0000000000001305
Hakan Seyit, Fahri Gokcal, Halil Alis

Introduction: We assessed whether postoperative day-1 (POD-1) complete blood count (CBC) test parameters, including red cell distribution width (RDW), mean platelet volume (MPV), plateletcrit (PCT), platelet-to-lymphocyte ratio (PLR), and neutrophil-to-lymphocyte ratio (NLR), could identify patients with gastric leaks after laparoscopic sleeve gastrectomy (LSG).

Methods: Patients with postoperative gastric leaks (n=36) and patients with no complications who were selected by age-sex-BMI matching (n=254) were included in the study. The levels of RDW, MPW, PCT, PLR, and NLR were compared between groups in univariate analyses. Receiver operating characteristic (ROC) curve analysis was run for CBC parameters with a P -value<0.05 in univariate analyses. The area under the curve (AUC) was evaluated, and a cutoff value was determined. Sensitivity, specificity, likelihood ratio (LR), positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated.

Results: The level of PCT was significantly lower, while levels of PLR and NLR were significantly higher in patients with postoperative gastric leaks as compared with those without ( P <0.05). The AUC of both PCT and PLR was <0.750, while the AUC of NLR was 0.911. NLR cutoff at 3.6 yielded 80% sensitivity, 92% specificity, and an LR of 10. In the study cohort, PPV of 59%, NPV of 97%, and an accuracy of 90% were found.

Conclusions: Our results suggest that NLR at POD-1, with a cutoff value of 3.6, is a useful indicator of postoperative gastric leak who underwent LSG. We recommend the use of this easily calculated parameter in clinical practice.

导言:我们评估了术后第1天(POD-1)全血细胞计数(CBC)检验参数,包括红细胞分布宽度(RDW)、平均血小板体积(MPV)、血小板比容(PCT)、血小板与淋巴细胞比值(PLR)和中性粒细胞与淋巴细胞比值(NLR),是否能识别腹腔镜袖状胃切除术(LSG)后胃漏患者:研究纳入了术后胃漏患者(36 人)和通过年龄-性别-体重指数匹配筛选出的无并发症患者(254 人)。在单变量分析中比较了不同组间的 RDW、MPW、PCT、PLR 和 NLR 水平。用 P 值对 CBC 参数进行了接收者操作特征(ROC)曲线分析:与无胃漏患者相比,术后胃漏患者的 PCT 水平明显较低,而 PLR 和 NLR 水平则明显较高:我们的研究结果表明,POD-1 时的 NLR(临界值为 3.6)是判断 LSG 术后胃漏的有效指标。我们建议在临床实践中使用这一易于计算的参数。
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引用次数: 0
Analysis of Factors Determining Spleen Preservation during Laparoscopic Distal Pancreatectomy - A Cohort Study. 腹腔镜胰腺远端切除术中保留脾脏的决定因素分析 - 一项队列研究。
IF 1.1 4区 医学 Q3 SURGERY Pub Date : 2024-10-01 DOI: 10.1097/SLE.0000000000001309
Maciej Borys, Michał Wysocki, Krystyna Gałązka, Andrzej Budzyński

Background: Spleen preservation during laparoscopic distal pancreatectomy (LSPDP) should be pursued if safe and oncologically justified. The aim of the presented study was to compare surgical outcomes and identify risk factors for unplanned splenectomy during laparoscopic distal pancreatectomy and evaluate short and long-terms outcomes.

Methods: The following study is a retrospective cohort study of consecutive patients who underwent laparoscopic distal pancreatectomy, with the intention of preserving the spleen, for benign tumors of the body and tail of the pancreas between August 2012 and December 2022. Follow-up for patients' survival was completed in January 2023. In all, 106 patients were in total included in this study. Median age was 58 (41 to 67) years. The study population included 29 males (27.4%) and 77 females (72.6%).

Results: Spleen preservation was possible in 67 (63.2%) patients. The tumor size was larger in the splenectomy group (respectively, 30 (16.5 to 49) vs. 15 (11 to 25); P <0.001). Overall, serious postoperative morbidity was 13.4% in the LSPDP group and 20.5% in the second group ( P =0.494). There were no perioperative deaths. The postoperative pancreatic fistula rate was 18% in the splenectomy group and 14.9% in the LSPDP group, while B and C fistulas were diagnosed in 15.4% and 10.5% of patients, respectively. In the multivariate logistic regression model, tumor size >3 cm was found to independently increase odds for unplanned splenectomy (OR 8.41, 95%CI 2.89-24.46; standardized for BMI).

Conclusion: Unplanned splenectomy during the attempt of LSPDP does not increase the risk for postoperative morbidity and postoperative pancreatic fistula. The independent risk factor for unplanned splenectomy during LSPDP is tumor size above 3 cm.

背景:在腹腔镜远端胰腺切除术(LSPDP)中,如果安全且肿瘤学上合理,则应保留脾脏。本研究旨在比较腹腔镜胰腺远端切除术的手术效果,确定非计划性脾切除的风险因素,并评估短期和长期效果:以下研究是一项回顾性队列研究,对象是2012年8月至2022年12月期间因胰腺体部和尾部良性肿瘤接受腹腔镜胰腺远端切除术的连续患者,目的是保留脾脏。对患者生存情况的随访于2023年1月结束。本研究共纳入 106 名患者。中位年龄为 58(41 至 67)岁。研究对象包括 29 名男性(27.4%)和 77 名女性(72.6%):结果:67 例(63.2%)患者可以保留脾脏。结果:67 例(63.2%)患者可以保留脾脏,脾脏切除组的肿瘤大小更大(分别为 30(16.5 至 49) vs. 15(11 至 25);P3 厘米被发现会独立增加意外脾脏切除的几率(OR 8.41,95%CI 2.89-24.46;根据体重指数标准化):结论:尝试 LSPDP 过程中的意外脾切除不会增加术后发病率和术后胰瘘的风险。LSPDP期间计划外脾切除术的独立风险因素是肿瘤大小超过3厘米。
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引用次数: 0
Fully Covered Self-expandable Metallic Stents for Refractory Benign Pancreatic Duct Strictures: A Systematic Review and Meta-analysis. 治疗难治性良性胰管狭窄的全覆盖自扩张金属支架:系统综述与元分析》。
IF 1.1 4区 医学 Q3 SURGERY Pub Date : 2024-10-01 DOI: 10.1097/SLE.0000000000001315
Gajanan Rodge, Suprabhat Giri, Kailash Kolhe, Shivaraj Afzalpurkar, Sidharth Harindranath, Sridhar Sundaram, Aditya Kale

Background: Endoscopic treatment of refractory pancreatic duct (PD) strictures includes the placement of multiple plastic stents. Recent studies have shown the benefit of fully covered self-expandable metal stents (FCSEMS). This systematic review analyzes the efficacy and safety of FCSEMS in PD strictures.

Methods: A comprehensive search of all suitable studies was conducted using the databases of MEDLINE, EMBASE, and Scopus from inception to November 2022. The outcomes assessed were efficacy and safety of FCSEMS in PD strictures. Using a random-effects inverse-variance model, the pooled proportions were calculated.

Results: A total of 22 studies with 439 patients were included in the analysis. The pooled stricture resolution rate was 91.6% (95% CI: 87.4-95.7), while the pooled pain resolution rate was 84.9% (95% CI: 77.7-92.1). The pooled incidences of stent-related adverse events, including acute pancreatitis, pain requiring stent removal, and de novo stricture, were 3.9% (95% CI: 1.2-6.7), 0.8% (95% CI: 0.0-2.1), and 3.3% (95% CI: 0.7-5.8). The pooled incidence of stent migration, stricture recurrence, and the need for restenting were 12.9% (95% CI: 6.7-19.1), 9.3% (95% CI: 4.7-13.8), and 12.3% (95% CI: 6.9-17.8), respectively.

Conclusions: FCSEMSs can be considered in carefully selected patients with benign PD strictures with high resolution rate and acceptable adverse event rate. De-novo structure formation appears to be a significant problem. Further studies may help to decide the role of FCSEMS in the algorithm.

背景:难治性胰管(PD)狭窄的内窥镜治疗包括放置多个塑料支架。最近的研究显示了全覆盖自膨胀金属支架(FCSEMS)的益处。本系统综述分析了 FCSEMS 对 PD 狭窄的疗效和安全性:方法:使用 MEDLINE、EMBASE 和 Scopus 数据库对从开始到 2022 年 11 月的所有合适研究进行了全面检索。评估的结果是FCSEMS治疗PD狭窄的有效性和安全性。采用随机效应逆方差模型计算汇总比例:结果:共有 22 项研究、439 名患者被纳入分析。总的狭窄缓解率为 91.6%(95% CI:87.4-95.7),总的疼痛缓解率为 84.9%(95% CI:77.7-92.1)。支架相关不良事件(包括急性胰腺炎、需要移除支架的疼痛和新发狭窄)的汇总发生率分别为 3.9% (95% CI:1.2-6.7)、0.8% (95% CI:0.0-2.1)和 3.3% (95% CI:0.7-5.8)。支架移位、狭窄复发和需要重新植入的总发生率分别为12.9%(95% CI:6.7-19.1)、9.3%(95% CI:4.7-13.8)和12.3%(95% CI:6.9-17.8):对于经过严格筛选的良性腹腔肠系膜狭窄患者,可以考虑使用 FCSEMS,其症状缓解率高,不良反应率可接受。新结构的形成似乎是一个重要问题。进一步的研究可能有助于确定 FCSEMS 在算法中的作用。
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引用次数: 0
Peroral Endoscopic Myotomy: Short Versus Long Esophageal Myotomy for Achalasia Cardia: A Randomized Controlled Noninferiority Trial. 口周内镜下贲门失弛缓症肌切开术:短食管肌切开术与长食管肌切开术:随机对照非劣效性试验。
IF 1.1 4区 医学 Q3 SURGERY Pub Date : 2024-10-01 DOI: 10.1097/SLE.0000000000001303
Praveer Rai, Pankaj Kumar, Amit Goel, Thakur Prashant Singh, Prabhaker Mishra, Prashant Verma, Ajay Kumar, Vinod Kumar

Background and aims: The appropriate length of esophageal myotomy in peroral endoscopic myotomy (POEM) for achalasia cardia remains unclear. This study aimed to compare the outcome of short (≤3 cm) and long (≥6 cm) esophageal myotomy in patients with type I and II achalasia cardia.

Methods: This single-blinded, randomized controlled noninferiority trial was conducted at a tertiary center between July 2021 and December 2021. Patients with achalasia types I and II were randomized into short (≤3 cm) and long (≥6 cm) esophageal myotomy groups. The primary outcome of the study was clinical success (Eckardt score ≤3) 1 year after the procedure. The secondary outcomes included a comparison of technical success, operating duration, occurrence of intraoperative adverse events, alterations in integrated relaxation pressure (IRP), change in barium column height after 5 minutes (1 mo), and gastroesophageal reflux disease (3 mo) between the groups.

Results: Fifty-four patients were randomized into the short (n=27) or long (n=27) esophageal myotomy groups. Technical success rates were 100% (27/27) and 96.3% (26/27) in short myotomy (SM) and long myotomy (LM) groups, respectively. The clinical success rates were 96.3% (26/27) and 96.2% (25/26) in the SM and LM groups, respectively ( P =0.998). The mean (±SD) length of the esophageal myotomy was 2.75±0.36 cm in the SM and 6.69±1.35 cm in the LM groups ( P <0.001). The mean (±SD) procedure time for the SM and LM groups was 61.22±8.44 and 82.42±14.70 minutes ( P <0.001), respectively. The mean integrated relaxation pressure (IRP), Eckardt score, adverse events, reflux esophagitis, symptomatic gastroesophageal reflux disease, and esophageal acid exposure (>6%) did not differ significantly between the 2 groups following POEM treatment.

Conclusions: Short myotomy is noninferior to long myotomy in terms of clinical success, gastroesophageal reflux disease, and intraoperative adverse events at the short-term follow-up ( P >0.05). Short myotomy resulted in a reduced operative time ( P <0.05).

背景和目的:口周内镜下贲门失弛缓症肌切开术(POEM)中食管肌切开术的适当长度仍不明确。本研究旨在比较短(≤3厘米)和长(≥6厘米)食管肌切开术对I型和II型贲门失弛缓症患者的疗效:这项单盲随机对照非劣效性试验于2021年7月至2021年12月在一家三级中心进行。I型和II型贲门失弛缓症患者被随机分为短(≤3厘米)和长(≥6厘米)食管肌切开术组。研究的主要结果是手术 1 年后的临床成功率(Eckardt 评分≤3)。次要结果包括两组间技术成功率、手术时间、术中不良事件发生率、综合松弛压(IRP)变化、5分钟后钡柱高度变化(1个月)和胃食管反流病(3个月)的比较:54名患者被随机分为短食管肌切术组(27人)或长食管肌切术组(27人)。短肌切开术(SM)组和长肌切开术(LM)组的技术成功率分别为 100%(27/27)和 96.3%(26/27)。SM组和LM组的临床成功率分别为96.3%(26/27)和96.2%(25/26)(P=0.998)。POEM治疗后,SM组食管肌层切口的平均长度(±SD)为2.75±0.36厘米,LM组食管肌层切口的平均长度为6.69±1.35厘米(P6%),两组间无显著差异:结论:在短期随访中,短肌切开术在临床成功率、胃食管反流疾病和术中不良事件方面均不优于长肌切开术(P>0.05)。短肌切开术缩短了手术时间(P
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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
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
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":" ","pages":""},"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":" ","pages":""},"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。
{"title":"Impact of Infrared Indocyanine Green Fluorescence imaging-guided Laparoscopic Hepatectomy on Securing the Resection Margin for Colorectal Liver Metastasis.","authors":"Toru Kato, Masafumi Imamura, Daisuke Kyuno, Yasutoshi Kimura, Kazuharu Kukita, Takeshi Murakami, Eiji Yoshida, Toru Mizuguchi, Ichiro Takemasa","doi":"10.1097/SLE.0000000000001320","DOIUrl":"https://doi.org/10.1097/SLE.0000000000001320","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142056586","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
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Surgical Laparoscopy, Endoscopy & Percutaneous Techniques
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