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Application and advantage analysis of triangular gastric suspension technique in laparoscopic distal pancreatectomy. 三角胃悬吊技术在腹腔镜胰腺远端切除术中的应用及优势分析
IF 2.4 2区 医学 Q2 SURGERY Pub Date : 2025-02-01 Epub Date: 2025-01-13 DOI: 10.1007/s00464-024-11505-3
Hao Chen, Keting Jiang, Xing Li, Qiong Ye, Jie Wang, Songsheng Zhou, Haibiao Wang, Kaijie Qiu

Background: Laparoscopic distal pancreatectomy is a safe and effective surgical method for treating benign and malignant tumors of the pancreatic body and tail. However, laparoscopic surgery requires good intraoperative exposure, and since the pancreas is obstructed by the stomach and duodenum, making surgical operations and the management of intraoperative emergencies challenging. Therefore, gastric traction is crucial in laparoscopic distal pancreatectomy. Common gastric suspension techniques include single and double gastric suspension. Here, we propose a new, simple, and effective gastric suspension method called the triangular gastric suspension.

Methods: We retrospectively analyzed the clinical data of 62 patients who underwent laparoscopic distal pancreatectomy at the Hepatobiliary and Pancreatic Surgery Department, The Affiliated LiHuiLi Hospital of Ningbo University from February 2017 to March 2024. The patients were divided into two groups based on whether triangular gastric suspension with silk sutures was used during surgery: the suspension group (28 cases) and the control group (34 cases). We analyzed various perioperative indicators between the two groups both before and after propensity score matching (PSM).

Results: With or without PSM, there were no statistically significant differences between the two groups in terms of age, gender, body mass index, American Society of Anesthesiologists classification, surgical approach, tumor pathological type and tumor length. Meanwhile, there were no statistically significant differences between the two groups in terms of pancreatic stump anastomosis, intraoperative transfusion, intraoperative R0 rate, postoperative pancreatic fistula grade, postoperative severe hemorrhage, reoperation, and delayed gastric emptying rate. However, the differences in operative time, intraoperative blood loss, and total hospital stay were statistically significant, with the suspension group showing better outcomes.

Conclusion: The triangular gastric suspension method provides significant advantages in reducing intraoperative blood loss and shortening operative time during laparoscopic distal pancreatectomy. It is a new, simple, and effective suspension method.

背景:腹腔镜胰腺远端切除术是治疗胰腺体尾部良恶性肿瘤的一种安全有效的手术方法。然而,腹腔镜手术需要良好的术中暴露,并且由于胰腺被胃和十二指肠阻塞,使得手术操作和术中紧急情况的处理具有挑战性。因此,胃牵引在腹腔镜胰远端切除术中至关重要。常见的胃悬浮技术有单胃悬浮和双胃悬浮。在这里,我们提出了一种新的,简单的,有效的胃悬液方法,称为三角形胃悬液。方法:回顾性分析2017年2月至2024年3月宁波大学附属李惠利医院肝胆胰外科行腹腔镜胰远端切除术的62例患者的临床资料。根据术中是否使用三角胃悬吊及丝线缝合将患者分为悬吊组(28例)和对照组(34例)。分析两组患者倾向评分匹配(PSM)前后围手术期各项指标。结果:有无PSM,两组患者在年龄、性别、体重指数、美国麻醉医师学会分类、手术入路、肿瘤病理类型、肿瘤长度等方面差异均无统计学意义。同时,两组在胰残端吻合、术中输血、术中R0率、术后胰瘘分级、术后大出血、再手术、胃排空延迟率等方面差异均无统计学意义。然而,手术时间、术中出血量和总住院时间的差异有统计学意义,悬浮组疗效更好。结论:三角形胃悬吊法在腹腔镜胰远端切除术中减少术中出血量、缩短手术时间具有明显优势。这是一种新型、简单、有效的悬浮方法。
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引用次数: 0
Quantification of hemi-hepatic ischemia using real-time multispectral oxygenation imaging with single snapshot imaging of optical properties (SSOP). 实时多光谱氧合成像与光学特性单快照成像(SSOP)定量半肝缺血。
IF 2.4 2区 医学 Q2 SURGERY Pub Date : 2025-02-01 Epub Date: 2024-12-04 DOI: 10.1007/s00464-024-11435-0
Kohei Mishima, Marta Goglia, Luca Baratelli, Arturo Pardo, Giorgio Carlino, Riccardo Oliva, Simone Famularo, Ariosto Hernandez-Lara, Elisa Reitano, Pietro Riva, Alfonso Lapergola, Jacques Marescaux, Michel De Mathelin, Eric Felli, Sylvain Gioux, Michele Diana

Background: Identifying liver ischemia is crucial in liver surgery. This study aimed to develop a hemi-hepatic ischemia model for assessing liver ischemia using single snapshot imaging of optical properties (SSOP), a noninvasive optical imaging modality that provides real-time measurements of tissue oxygen saturation (StO2).

Materials and methods: Twelve swine were randomly assigned to two groups: One undergoing total vascular inflow occlusion (TVIO) and the other undergoing hepatic artery occlusion (HAO). Preoperative 3D CT scans were used to locate the left-sided hepatic arteries and portal veins, which were clamped during surgery. Real-time SSOP imaging was conducted to measure StO2 in three lobes-the left lateral lobe (LL), left medial lobe (LM), and right medial lobe (RM)-as well as capillary lactate levels and Doppler blood flow. Measurements were recorded at baseline (T0), during ischemia (T1, 30 min after clamping), and during reperfusion (T2, 30 min after declamping).

Results: In the TVIO group, SSOP imaging revealed a distinct demarcation line on the liver surface. StO2 levels measured by SSOP significantly decreased from T0 to T1, dropping by 29.8% in the LL (46.0 ± 5.1 vs. 16.2 ± 5.1%, p = 0.011) and 36.3% in the LM (42.7 ± 5.9 vs. 6.4 ± 4.0%, p = 0.001). Additionally, capillary lactate levels increased substantially in the LL (1.3 ± 0.4 vs. 8.5 ± 2.4 mmol/L, p = 0.041) and in the LM (1.3 ± 0.4 vs. 8.2 ± 2.1 mmol/L, p = 0.021). In contrast, the HAO group showed a less pronounced reduction in StO2: 13.6% in the LL (32.7 ± 6.4 vs. 19.1 ± 5.4%, p = 0.007) and 19.8% in the LM (35.3 ± 8.2 vs. 15.5 ± 5.8%, p = 0.011), with no significant increase in capillary lactate levels. An inverse correlation was found between StO2 and capillary lactate levels (r = - 0.76, p < 0.001).

Conclusion: SSOP is a real-time, contrast-free imaging technique that effectively evaluates liver ischemia by accurately measuring tissue oxygenation, as validated by perfusion biomarkers.

背景:肝缺血识别在肝脏手术中至关重要。本研究旨在建立一种半肝缺血模型,利用光学特性单快照成像(SSOP)来评估肝脏缺血,SSOP是一种无创光学成像方式,可提供组织氧饱和度(StO2)的实时测量。材料和方法:将12头猪随机分为两组,一组进行全血管流入阻断(TVIO),另一组进行肝动脉阻断(HAO)。术前使用3D CT扫描定位左侧肝动脉和门静脉,术中夹持。实时SSOP成像测量左外侧叶(LL)、左内叶(LM)和右内叶(RM)三个脑叶的StO2以及毛细血管乳酸水平和多普勒血流。记录基线(T0)、缺血(T1,钳位后30分钟)和再灌注(T2,去钳位后30分钟)时的测量。结果:在TVIO组中,SSOP成像显示肝脏表面有明显的分界线。SSOP测定的StO2水平从T0到T1显著下降,其中LL组下降29.8%(46.0±5.1比16.2±5.1%,p = 0.011), LM组下降36.3%(42.7±5.9比6.4±4.0%,p = 0.001)。此外,下肢毛细血管乳酸水平(1.3±0.4 vs. 8.5±2.4 mmol/L, p = 0.041)和下肢毛细血管乳酸水平(1.3±0.4 vs. 8.2±2.1 mmol/L, p = 0.021)显著升高。相比之下,HAO组的StO2降低不太明显:LL组为13.6%(32.7±6.4比19.1±5.4%,p = 0.007), LM组为19.8%(35.3±8.2比15.5±5.8%,p = 0.011),毛细血管乳酸水平无显著升高。StO2与毛细血管乳酸水平呈负相关(r = - 0.76, p)。结论:SSOP是一种实时、无对比的成像技术,可以通过准确测量组织氧合来有效评估肝脏缺血,并得到灌注生物标志物的验证。
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引用次数: 0
Comparison of short‑ and long‑term outcomes between laparoscopic and open pancreaticoduodenectomy in overweight patients: a propensity score‑matched study. 超重患者腹腔镜胰十二指肠切除术和开放式胰十二指肠切除术的短期和长期结果比较:倾向评分匹配研究
IF 2.4 2区 医学 Q2 SURGERY Pub Date : 2025-02-01 Epub Date: 2024-12-03 DOI: 10.1007/s00464-024-11418-1
Shuai Xu, Yinlong Xu, Shulin Wang, Qingsen Chu, Huating Zhang, Wei Gong, Yantian Xu, Jun Liu

Background: Overweight is thought to affect the outcome of minimally invasive surgery. There is still a lack of controlled studies of laparoscopic pancreaticoduodenectomy (LPD) versus open pancreaticoduodenectomy (OPD) in overweight patients. This study was designed to compare short-term and long-term outcomes in overweight patients treated with LPD and OPD.

Methods: Clinical and follow-up data on overweight patients who received LPD or OPD at Shandong Provincial Hospital from January 2015 to December 2022 were analyzed retrospectively. The bias between groups were balanced by 1:1 propensity score matching (PSM). Kaplan-Meier survival curves described long-term survival outcomes in overweight pancreatic ductal adenocarcinoma (PDAC) patients.

Results: A total of 502 overweight patients were enrolled in the study. There were 276 patients in the LPD group and 226 in the OPD group. After matching, 196 patients were enrolled in each group. Compared with the OPD group, the LPD group had fewer estimated blood loss (EBL) (140 vs. 200 mL, P < 0.001), more lymph node dissection (14 vs. 12, P = 0.010), and shorter postoperative length of stay (LOS) (13 vs. 16 days, P < 0.001). There were no significant differences in severe complications, 90-day readmission and mortality rates (all P > 0.05). The subgroup analysis of obese patients also showed that the LPD group had fewer intraoperative EBL, more lymph node dissection, and shorter LOS. The survival analysis showed that overweight patients with PDAC who underwent LPD or OPD had similar overall survival (OS) (23.8 vs.25.7 months, P = 0.963) after PSM.

Conclusion: It is safe and feasible for overweight patients undergoing LPD to have less EBL, more lymph node harvesting, and a shorter LOS. There was no statistically significant difference in long-term survival outcomes among overweight PDAC patients between the two approaches.

背景:超重被认为会影响微创手术的结果。在超重患者中,腹腔镜胰十二指肠切除术(LPD)与开放式胰十二指肠切除术(OPD)的对照研究仍然缺乏。本研究旨在比较超重患者接受LPD和OPD治疗的短期和长期结果。方法:回顾性分析2015年1月至2022年12月山东省立医院接受LPD或OPD治疗的超重患者的临床及随访资料。组间偏倚采用1:1倾向评分匹配(PSM)进行平衡。Kaplan-Meier生存曲线描述了超重胰腺导管腺癌(PDAC)患者的长期生存结果。结果:共有502名超重患者入组研究。LPD组276例,OPD组226例。配对后,每组入组196例。与OPD组相比,LPD组的估计失血量(EBL)更少(140 mL vs 200 mL, p0.05)。肥胖患者的亚组分析也显示,LPD组术中EBL较少,淋巴结清扫较多,LOS较短。生存分析显示,超重的PDAC患者接受LPD或OPD后,PSM后的总生存期(OS)相似(23.8个月vs.25.7个月,P = 0.963)。结论:超重患者行LPD术后EBL减少、淋巴结清扫增多、LOS缩短是安全可行的。两种方法对超重PDAC患者的长期生存结果无统计学差异。
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引用次数: 0
Society of American Gastrointestinal and Endoscopic Surgeons guidelines development: patient engagement update to standard operating procedure. 美国胃肠和内窥镜外科医师协会指南发展:患者参与更新标准手术程序。
IF 2.4 2区 医学 Q2 SURGERY Pub Date : 2025-02-01 Epub Date: 2025-01-21 DOI: 10.1007/s00464-025-11530-w
Nisha Narula, Bethany J Slater, Patricia Sylla, Sunjay S Kumar, Elisa Calabrese, Joe Nadglowski, Deborah S Keller

Introduction: The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Guidelines Committee develops evidence-based surgical guidelines. Involvement of patient partners is important to ensure patient concerns and values are adequately addressed and incorporated. This standard operating procedure (SOP) for the process of patient partner involvement within the guidelines is described here.

Methods: This document outlines the SAGES Patient Partners SOP to involve patient partners in a consistent and reproducible manner.

Results: SAGES has now developed a SOP to include patient partners so that patient views are represented in current guidelines.

Conclusion: Guidelines must be patient centric and in order to do so must include patient partners. The SAGES Guidelines Patient Engagement Update to Standard operating Procedure aims to provide an outline for systematically doing so.

简介:美国胃肠和内窥镜外科医生协会(SAGES)指南委员会制定循证手术指南。患者伴侣的参与对于确保充分处理和纳入患者的关切和价值观非常重要。本标准操作程序(SOP)的过程中,患者的合作伙伴参与的指导方针是在这里描述。方法:本文件概述了SAGES患者合作伙伴SOP,以一致和可复制的方式让患者合作伙伴参与。结果:SAGES现在已经制定了一个SOP,包括患者的合作伙伴,以便患者的意见在当前的指南中得到体现。结论:指南必须以患者为中心,为了做到这一点,必须包括患者的合作伙伴。SAGES指南患者参与标准操作程序更新旨在为系统地进行此类操作提供大纲。
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引用次数: 0
Effectiveness of cholangioscopy guided biopsy versus ERCP guided brushings in diagnosing malignant biliary strictures. 胆道镜引导下活检与ERCP引导下冲洗诊断恶性胆道狭窄的有效性。
IF 2.4 2区 医学 Q2 SURGERY Pub Date : 2025-02-01 Epub Date: 2024-12-19 DOI: 10.1007/s00464-024-11422-5
George Skenteris, Trey Singletary, Lindsay Grasso, Stella Self, David P Schammel, Christine M G Schammel, Wes Jones, A Michael Devane

Background: Evaluation of lesions of the biliary tract are essential to diagnose given the dismal outcomes of cholangiocarcinoma. Historically, these diagnoses were made using brush biopsies obtained under Endoscopic Retrograde Cholangiopancreatography (ERCP). To increase the accuracy of biliary biopsies, SpyGlassTM Discover cholangioscopy guided biopsy has been developed, providing greater tissue yield and direct visualization of the biliary epithelium. We evaluated the diagnostic accuracy of ERCP guided brushings and SpyGlassTM Discover guided biopsies at a single institution.

Methods: Following IRB approval, all diagnostic biliary biopsies utilizing both ERCP guided brushings and/or SpyGlassTM Discover between 8/2015 and 6/2022 were retrospectively evaluated. Demographic and clinicopathologic data were collected. Fischer's t-tests and Chi-square analyses were completed as appropriate (p < 0.05).

Results: Overall, 46 patients with an average age of 61 years were included in this study; 59% of the patients were female and 41% were male. 87% of patients had at least one SpyGlassTM Discover guided biopsy and one ERCP guided brushing and 13% of patients had at least one SpyGlassTM Discover guided biopsy alone. SpyGlassTM Discover correctly identified 82% of malignancies while brushings identified only 47% of malignancies.

Conclusions: SpyGlassTM Discover guided biopsies yield a greater diagnostic result than ERCP guided brushings. Therefore, SpyGlassTM Discover should be considered as the standard for diagnosing biliary lesions at our institution in conjunction with ERCP procedure. The classification of visual characteristics of biliary lesions should be investigated in the future as the high-resolution image generated by SpyGlassTM Discover can allow for detailed visual observation of strictures and potentially aid in better characterization and location of disease.

背景:鉴于胆管癌预后不佳,评估胆道病变对诊断至关重要。从历史上看,这些诊断是通过内镜逆行胆管胰胆管造影(ERCP)下的刷活检进行的。为了提高胆道活检的准确性,SpyGlassTM Discover胆道镜引导活检已经开发出来,提供更高的组织产量和胆道上皮的直接可视化。我们在同一家机构评估了ERCP引导下的刷牙和SpyGlassTM Discover引导下的活检的诊断准确性。方法:在获得IRB批准后,回顾性评估2015年8月至2022年6月期间使用ERCP引导下的刷牙和/或SpyGlassTM Discover进行的所有胆道活检诊断。收集人口统计学和临床病理资料。适当时完成Fischer t检验和卡方分析(p)结果:总体而言,46例平均年龄为61岁的患者纳入本研究;女性占59%,男性占41%。87%的患者至少进行了一次SpyGlassTM Discover引导活检和一次ERCP引导刷牙,13%的患者至少单独进行了一次SpyGlassTM Discover引导活检。SpyGlassTM Discover正确识别了82%的恶性肿瘤,而刷牙只识别了47%的恶性肿瘤。结论:SpyGlassTM Discover引导下活检的诊断效果优于ERCP引导下的刷牙。因此,SpyGlassTM Discover应作为本院胆道病变诊断的标准,与ERCP手术相结合。由于SpyGlassTM Discover生成的高分辨率图像可以对胆道病变进行详细的视觉观察,并可能有助于更好地表征和定位疾病,因此胆道病变的视觉特征分类应该在未来进行研究。
{"title":"Effectiveness of cholangioscopy guided biopsy versus ERCP guided brushings in diagnosing malignant biliary strictures.","authors":"George Skenteris, Trey Singletary, Lindsay Grasso, Stella Self, David P Schammel, Christine M G Schammel, Wes Jones, A Michael Devane","doi":"10.1007/s00464-024-11422-5","DOIUrl":"10.1007/s00464-024-11422-5","url":null,"abstract":"<p><strong>Background: </strong>Evaluation of lesions of the biliary tract are essential to diagnose given the dismal outcomes of cholangiocarcinoma. Historically, these diagnoses were made using brush biopsies obtained under Endoscopic Retrograde Cholangiopancreatography (ERCP). To increase the accuracy of biliary biopsies, SpyGlassTM Discover cholangioscopy guided biopsy has been developed, providing greater tissue yield and direct visualization of the biliary epithelium. We evaluated the diagnostic accuracy of ERCP guided brushings and SpyGlassTM Discover guided biopsies at a single institution.</p><p><strong>Methods: </strong>Following IRB approval, all diagnostic biliary biopsies utilizing both ERCP guided brushings and/or SpyGlassTM Discover between 8/2015 and 6/2022 were retrospectively evaluated. Demographic and clinicopathologic data were collected. Fischer's t-tests and Chi-square analyses were completed as appropriate (p < 0.05).</p><p><strong>Results: </strong>Overall, 46 patients with an average age of 61 years were included in this study; 59% of the patients were female and 41% were male. 87% of patients had at least one SpyGlassTM Discover guided biopsy and one ERCP guided brushing and 13% of patients had at least one SpyGlassTM Discover guided biopsy alone. SpyGlassTM Discover correctly identified 82% of malignancies while brushings identified only 47% of malignancies.</p><p><strong>Conclusions: </strong>SpyGlassTM Discover guided biopsies yield a greater diagnostic result than ERCP guided brushings. Therefore, SpyGlassTM Discover should be considered as the standard for diagnosing biliary lesions at our institution in conjunction with ERCP procedure. The classification of visual characteristics of biliary lesions should be investigated in the future as the high-resolution image generated by SpyGlassTM Discover can allow for detailed visual observation of strictures and potentially aid in better characterization and location of disease.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":"1140-1146"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142865459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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
Association of DCI with number of preoperative comorbidities and 30-day outcomes following inguinal hernia repair: an analysis of the ACHQC database. 腹股沟疝修补术后 DCI 与术前合并症数量和 30 天预后的关系:ACHQC 数据库分析。
IF 2.4 2区 医学 Q2 SURGERY Pub Date : 2025-02-01 Epub Date: 2024-11-13 DOI: 10.1007/s00464-024-11381-x
Maha Mourad, Julie E Kim, Sharon E Phillips, Vishal M Kothari, Ivy N Haskins

Introduction: The Distressed Communities Index (DCI) is a stratification tool that captures socioeconomic disparities based on zip code. To date, no prior study has investigated the association of DCI score and inguinal hernia repair outcomes. This study aims to evaluate the association between DCI score and 30-day outcomes following inguinal hernia repair using the Abdominal Core Health Quality Collaborative (ACHQC) database. We hypothesize that patients with higher DCI scores will have a higher number of comorbidities and 30-day postoperative events.

Methods and procedures: All patients who underwent inguinal hernia repair from 2015 to 2023 with an available DCI score and 30-day follow-up data available were included. Patients were stratified into DCI quintiles based on zip code. Primary outcomes of interest were 30-day hernia-specific postoperative outcomes. Pearson's chi-squared and Kruskal-Wallis tests were used to compare DCI scores with comorbid conditions and perioperative outcomes.

Results: 30,927 patients were included for analysis; 12,206 patients were classified as prosperous (40%), 7190 patients as comfortable (23%), 4884 patients as mid-tier (16%), 3485 patients as at-risk (11%), and 3162 as distressed (10%). Distressed patients were more likely to have ASA 3 or higher and comorbidities including hypertension, diabetes, ESRD, and COPD (p < 0.001). Patients with higher DCI scores were significantly more likely to undergo an emergency operation and have a longer OR time (p < 0.001). Distressed patients were also more likely to experience a major wound complication requiring readmission (p = 0.05) and reoperation (p < 0.001).

Conclusion: DCI scores are strongly linked to surgical risk and outcomes following inguinal hernia repair. Special consideration should be given to DCI scores when optimizing patients prior to inguinal hernia repair.

导言:窘迫社区指数(DCI)是一种分层工具,可根据邮政编码捕捉社会经济差异。迄今为止,还没有研究调查过 DCI 分数与腹股沟疝修补术结果之间的关系。本研究旨在利用腹部核心健康质量协作(ACHQC)数据库评估 DCI 评分与腹股沟疝修补术后 30 天预后之间的关联。我们假设,DCI评分越高的患者合并症越多,术后30天发生的事件也越多:纳入2015年至2023年接受腹股沟疝修补术的所有患者,这些患者均有DCI评分和30天随访数据。根据邮政编码将患者分为DCI五等分。主要研究结果为 30 天疝气特异性术后结果。采用皮尔逊卡方检验和 Kruskal-Wallis 检验比较 DCI 评分与合并症和围手术期结果:30,927 名患者被纳入分析;12,206 名患者被归类为富裕(40%),7,190 名患者被归类为舒适(23%),4,884 名患者被归类为中等(16%),3,485 名患者被归类为高危(11%),3,162 名患者被归类为窘迫(10%)。窘迫患者更有可能患有 ASA 3 或更高以及包括高血压、糖尿病、ESRD 和慢性阻塞性肺病在内的并发症(P 结论:DCI 评分与手术风险密切相关:DCI 评分与腹股沟疝修补术后的手术风险和结果密切相关。在腹股沟疝修补术前对患者进行优化时,应特别考虑 DCI 评分。
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引用次数: 0
Loop duodenal switch confers more complications with little gain of weight loss compared to Roux-en-Y gastric bypass. 与 Roux-en-Y 胃旁路术相比,环十二指肠转换术的并发症更多,而体重却几乎没有减轻。
IF 2.4 2区 医学 Q2 SURGERY Pub Date : 2025-02-01 Epub Date: 2024-11-18 DOI: 10.1007/s00464-024-11264-1
Stephanie Joseph, Jean-Christophe Rwigema, Derrius Anderson, Shun Ishi, Trevor Crafts, Kristine Kuchta, Woody Denham, John Linn, H Mason Hedberg, Michael B Ujiki

Background: There are several surgical options each with their potential for complications, differences in length of procedure, and in meaningful outcomes. This study aims to explore those outcomes after Roux-en-Y Gastric Bypass (RYGB) and Loop Duodenal Switch (LDS).

Objective: The purpose of this project is to offer a comparative analysis of RYGB and LDS at the NorthShore University Health System for up to 4 years postoperatively.

Methods: A retrospective review of a prospectively maintained database was queried for all patients who underwent RYGB and LDS from 2019 to 2023. Demographic, preoperative, post-operative data, and Quality of Life (QOL) data were included. χ2 and Kruskal-Wallis tests were used for comparison. Statistical significance was set at p < 0.05.

Results: Patient database included 238 patients who underwent RYGB, and 54 who underwent LDS. Initial BMI was significantly higher in LDS compared to RYGB (56.9 ± 8.0; 46.5 ± 7.3; p < 0.01). There were no statistically significant differences between reported comorbidities. There were no differences in intraoperative complications between the two groups, however postoperative complications were significantly higher in the LDS population (16.7%, 7.1%; p < 0.01). Percent total body weight loss (%TBWL) was significantly different at 2 years post operatively with LDS having more %TBWL than RYGB (LDS: N = 10, %TBWL = 44.7 ± 14.1%; RYGB: N = 47) There were no statistically significant differences at any other postoperative time point. Subgroup analysis was completed in patients with initial BMI 50. There were no significant differences at any postoperative time point. QOL data showed no significant difference between both procedures at all postoperative timepoints.

Conclusion: Patients who undergo LDS are more likely to experience postoperative complications compared to RYGB with no added benefit in weight loss or comorbidity resolution up to 3 years post operatively.

背景:目前有多种手术方案,每种方案都有可能出现并发症,手术时间长短不同,手术效果也不同。本研究旨在探讨 Roux-en-Y 胃旁路术(RYGB)和环状十二指肠转换术(LDS)的疗效:本项目旨在对 NorthShore 大学医疗系统的 RYGB 和 LDS 术后 4 年的疗效进行比较分析:方法:对前瞻性维护的数据库进行回顾性审查,查询 2019 年至 2023 年接受 RYGB 和 LDS 的所有患者。研究纳入了人口统计学、术前、术后数据和生活质量(QOL)数据。采用 χ2 和 Kruskal-Wallis 检验进行比较。统计显著性以 p 为标准:患者数据库包括 238 名接受 RYGB 的患者和 54 名接受 LDS 的患者。与 RYGB 相比,LDS 患者的初始体重指数明显更高(56.9 ± 8.0; 46.5 ± 7.3; p 结论:与 RYGB 相比,接受 LDS 的患者术后出现并发症的几率更高,而且术后 3 年内体重减轻或合并症缓解的效果并不明显。
{"title":"Loop duodenal switch confers more complications with little gain of weight loss compared to Roux-en-Y gastric bypass.","authors":"Stephanie Joseph, Jean-Christophe Rwigema, Derrius Anderson, Shun Ishi, Trevor Crafts, Kristine Kuchta, Woody Denham, John Linn, H Mason Hedberg, Michael B Ujiki","doi":"10.1007/s00464-024-11264-1","DOIUrl":"10.1007/s00464-024-11264-1","url":null,"abstract":"<p><strong>Background: </strong>There are several surgical options each with their potential for complications, differences in length of procedure, and in meaningful outcomes. This study aims to explore those outcomes after Roux-en-Y Gastric Bypass (RYGB) and Loop Duodenal Switch (LDS).</p><p><strong>Objective: </strong>The purpose of this project is to offer a comparative analysis of RYGB and LDS at the NorthShore University Health System for up to 4 years postoperatively.</p><p><strong>Methods: </strong>A retrospective review of a prospectively maintained database was queried for all patients who underwent RYGB and LDS from 2019 to 2023. Demographic, preoperative, post-operative data, and Quality of Life (QOL) data were included. χ<sup>2</sup> and Kruskal-Wallis tests were used for comparison. Statistical significance was set at p < 0.05.</p><p><strong>Results: </strong>Patient database included 238 patients who underwent RYGB, and 54 who underwent LDS. Initial BMI was significantly higher in LDS compared to RYGB (56.9 ± 8.0; 46.5 ± 7.3; p < 0.01). There were no statistically significant differences between reported comorbidities. There were no differences in intraoperative complications between the two groups, however postoperative complications were significantly higher in the LDS population (16.7%, 7.1%; p < 0.01). Percent total body weight loss (%TBWL) was significantly different at 2 years post operatively with LDS having more %TBWL than RYGB (LDS: N = 10, %TBWL = 44.7 ± 14.1%; RYGB: N = 47) There were no statistically significant differences at any other postoperative time point. Subgroup analysis was completed in patients with initial BMI 50. There were no significant differences at any postoperative time point. QOL data showed no significant difference between both procedures at all postoperative timepoints.</p><p><strong>Conclusion: </strong>Patients who undergo LDS are more likely to experience postoperative complications compared to RYGB with no added benefit in weight loss or comorbidity resolution up to 3 years post operatively.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":"1261-1268"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142669251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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
Clinical value of capsule endoscopy, CT enterography and enteroscopy in the diagnosis of suspected small bowel bleeding. 胶囊内镜、CT 肠造影和肠镜在诊断疑似小肠出血中的临床价值。
IF 2.4 2区 医学 Q2 SURGERY Pub Date : 2025-02-01 Epub Date: 2024-11-22 DOI: 10.1007/s00464-024-11405-6
Yiling Xiong, Ruiri Jin, Sheng Chen, Xingxing Liu, Zhenyu Wu, Die Zhang, Chunyan Zeng, Youxiang Chen

Background: Fewer studies have been conducted on the diagnostic value of capsule endoscopy, CT enterography and enteroscopy in suspected small bowel bleeding. This study aimed at analyzing the diagnostic and clinical value of capsule endoscopy, CT enterography and enteroscopy for suspected small bowel bleeding.

Methods: This retrospective study compared the diagnostic rate and consistency of findings among groups. In addition, diagnostic rates were compared between combined enteroscopy versus uncombined enteroscopy associated with capsule endoscopy or CT enterography, as well as the influencing factors of diagnostic outcomes. The complete enteroscopy rates and diagnostic rates were analyzed for the one-day enteroscopy group and the non-one-day enteroscopy group.

Results: There was no significant difference in diagnostic rates between capsule endoscopy (n = 70) and CT enterography (n = 122) (χ2 = 3.334; p = 0.068), while the diagnostic rate of enteroscopy (n = 396) is higher than capsule endoscopy (χ2 = 10.064; p = 0.002) and CT enterography (χ2 = 42.661; p < 0.001). Diagnostic rates were much higher in patients with a successful completion of docking inspection (n = 64) than in undocked patients (n = 60) (85.9% vs 46.7%; p < 0.001), even though these patients still had combined capsule endoscopy or CT enterography. The complete enteroscopy rates (χ2 = 0.364; P = 0.546) and diagnostic rates (χ2 = 2.511; P = 0.113) of enteroscopy in the one-day group (n = 55) were not significantly different from those in the non-one-day group (n = 25).

Conclusions: Enteroscopy is the more reliable method of diagnosing suspected small bowel bleeding among enteroscopy, capsule endoscopy and CT enterography. Moreover, uncompleted enteroscopy combined with capsule endoscopy or CT enterography may not yet be a substitute for successful completion of docking enteroscopy in clinical practice.

背景:关于胶囊内镜、CT 肠造影和肠镜对疑似小肠出血的诊断价值的研究较少。本研究旨在分析胶囊内镜、CT 肠造影和肠镜对疑似小肠出血的诊断和临床价值:这项回顾性研究比较了各组的诊断率和检查结果的一致性。方法:这项回顾性研究比较了各组间的诊断率和检查结果的一致性。此外,还比较了联合肠镜检查和未联合肠镜检查与胶囊内镜检查或 CT 肠造影检查的诊断率,以及诊断结果的影响因素。分析了一天肠镜检查组和非一天肠镜检查组的完整肠镜检查率和诊断率:胶囊内镜检查(n = 70)与 CT 肠造影检查(n = 122)的诊断率无明显差异(χ2 = 3.334; p = 0.068),而肠镜检查(n = 396)的诊断率高于胶囊内镜检查(χ2 = 10.064; p = 0.002)和CT肠造影(χ2 = 42.661; P 2 = 0.364; P = 0.546),一天组(n = 55)肠镜检查的诊断率(χ2 = 2.511; P = 0.113)与非一天组(n = 25)无显著差异:结论:在肠镜检查、胶囊内镜检查和 CT 肠造影检查中,肠镜检查是诊断疑似小肠出血的更可靠方法。此外,在临床实践中,未完成的肠镜联合胶囊内镜或 CT 肠造影检查可能还不能替代成功完成的对接肠镜检查。
{"title":"Clinical value of capsule endoscopy, CT enterography and enteroscopy in the diagnosis of suspected small bowel bleeding.","authors":"Yiling Xiong, Ruiri Jin, Sheng Chen, Xingxing Liu, Zhenyu Wu, Die Zhang, Chunyan Zeng, Youxiang Chen","doi":"10.1007/s00464-024-11405-6","DOIUrl":"10.1007/s00464-024-11405-6","url":null,"abstract":"<p><strong>Background: </strong>Fewer studies have been conducted on the diagnostic value of capsule endoscopy, CT enterography and enteroscopy in suspected small bowel bleeding. This study aimed at analyzing the diagnostic and clinical value of capsule endoscopy, CT enterography and enteroscopy for suspected small bowel bleeding.</p><p><strong>Methods: </strong>This retrospective study compared the diagnostic rate and consistency of findings among groups. In addition, diagnostic rates were compared between combined enteroscopy versus uncombined enteroscopy associated with capsule endoscopy or CT enterography, as well as the influencing factors of diagnostic outcomes. The complete enteroscopy rates and diagnostic rates were analyzed for the one-day enteroscopy group and the non-one-day enteroscopy group.</p><p><strong>Results: </strong>There was no significant difference in diagnostic rates between capsule endoscopy (n = 70) and CT enterography (n = 122) (χ<sup>2</sup> = 3.334; p = 0.068), while the diagnostic rate of enteroscopy (n = 396) is higher than capsule endoscopy (χ<sup>2</sup> = 10.064; p = 0.002) and CT enterography (χ<sup>2</sup> = 42.661; p < 0.001). Diagnostic rates were much higher in patients with a successful completion of docking inspection (n = 64) than in undocked patients (n = 60) (85.9% vs 46.7%; p < 0.001), even though these patients still had combined capsule endoscopy or CT enterography. The complete enteroscopy rates (χ<sup>2</sup> = 0.364; P = 0.546) and diagnostic rates (χ<sup>2</sup> = 2.511; P = 0.113) of enteroscopy in the one-day group (n = 55) were not significantly different from those in the non-one-day group (n = 25).</p><p><strong>Conclusions: </strong>Enteroscopy is the more reliable method of diagnosing suspected small bowel bleeding among enteroscopy, capsule endoscopy and CT enterography. Moreover, uncompleted enteroscopy combined with capsule endoscopy or CT enterography may not yet be a substitute for successful completion of docking enteroscopy in clinical practice.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":"792-801"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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
Patient reported outcomes and decision regret scores in redo-paraesophageal hernia repair. 患者报告食管旁疝修补术的结果和决定后悔评分。
IF 2.4 2区 医学 Q2 SURGERY Pub Date : 2025-02-01 Epub Date: 2024-12-02 DOI: 10.1007/s00464-024-11415-4
Daphne Remulla, Sara M Maskal, Ryan C Ellis, Kimberly P Woo, William C Bennet, Aldo Fafaj, Salvador Navarrete, David M Krpata, Benjamin T Miller, Clayton C Petro, Ajita S Prabhu, Michael J Rosen, Lucas R Beffa

Introduction: Recurrent paraesophageal hernia (PEH) repair presents significant technical challenges, with limited data weighing the benefit to the operative risk. This study aims to describe our experience with recurrent PEH repair, including long-term surgical and patient reported outcomes (PROs).

Methods: We conducted a retrospective review of recurrent PEH repairs from June 2018-March 2023 using our institutional database. A blinded review of post-operative imaging was conducted to assess for recurrence. Quality of life (QOL) and decision regret were measured using the GERD Health-Related Quality-of-Life (GERD-HRQL) questionnaire and Decision Regret Scale (DRS) at maximum follow up.

Results: Eighty-eight patients underwent recurrent PEH repair at our institution for PEH, classified as type II (13.6%), type III (72.7%) and type IV (13.6%). There was significant heterogeneity in operative techniques used: one-third of patients had mesh placed at the hiatus, 11.4% had a Collis gastroplasty, and one-third of patients underwent fundoplication. Intraoperative complications included gastric (5.7%), esophageal (2.3%), vascular (1.1%) and pulmonary (1.1%) injuries. Follow up was available for 73 patients with median follow up of 35.2 months. Of patients with radiographic follow up, 20 (35.7%) had a radiographic recurrence: 12 (21.4%) were 2-5 cm and 8 (14.3%) were > 5 cm. Patients reporting PROs (53 patients; 60.2%) reported low symptom severity (mean GERD-HRQL 13.1 ± 12) and low decision regret (mean DRS 13.3 ± 19.4) with 75.5% scoring in the lowest quartile (DRS < 25). Radiographic recurrence was associated with worse QOL (p < 0.05), but no significant difference in decision regret (p = 0.125).

Conclusion: We found significant heterogeneity amongst recurrent PEH repair techniques with continued high recurrence rate during follow up. Radiographic recurrence was correlated with worse QOL, yet patients reported low symptom severity and low decision regret, suggesting continued value in these challenging operations. Future studies should aim to identify more effective techniques to reduce recurrence rates in this patient population.

复发性食道旁疝(PEH)修复存在重大的技术挑战,有限的数据衡量手术风险的益处。本研究旨在描述我们对复发性PEH修复的经验,包括长期手术和患者报告的结果(PROs)。方法:我们使用我们的机构数据库对2018年6月至2023年3月期间的复发性PEH修复进行了回顾性分析。对术后影像进行盲法回顾以评估复发。在最大随访时,使用GERD健康相关生活质量(GERD- hrql)问卷和决策后悔量表(DRS)测量生活质量(QOL)和决策后悔。结果:88例PEH患者在我院接受了复发性PEH修复,分为II型(13.6%)、III型(72.7%)和IV型(13.6%)。使用的手术技术存在显著的异质性:三分之一的患者在裂孔处放置补片,11.4%的患者进行了Collis胃成形术,三分之一的患者进行了眼底复制。术中并发症包括胃(5.7%)、食管(2.3%)、血管(1.1%)和肺(1.1%)损伤。73例患者随访,中位随访35.2个月。在x线随访的患者中,20例(35.7%)x线复发:2-5 cm 12例(21.4%),5 -5 cm 8例(14.3%)。报告PROs的患者(53例;60.2%)报告症状严重程度低(平均GERD-HRQL 13.1±12)和决策后悔低(平均DRS 13.3±19.4),最低四分位数评分为75.5% (DRS结论:我们发现复发性PEH修复技术之间存在显著异质性,随访期间复发率持续较高。影像学复发与较差的生活质量相关,但患者报告症状严重程度低,决策后悔率低,提示这些具有挑战性的手术的持续价值。未来的研究应旨在确定更有效的技术来降低这类患者的复发率。
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引用次数: 0
BE-CALM: a clinical score to predict weight loss after conversion from sleeve gastrectomy to Roux-en-Y gastric bypass. BE-CALM:预测袖带胃切除术转为 Roux-en-Y 胃旁路术后体重减轻的临床评分。
IF 2.4 2区 医学 Q2 SURGERY Pub Date : 2025-02-01 Epub Date: 2024-12-16 DOI: 10.1007/s00464-024-11460-z
Dylan Cuva, Manish Parikh, Avery Brown, Eduardo Somoza, John K Saunders, Julia Park, Jeffrey Lipman, Peter Einersen, Patricia Chui

Background: Conversion from sleeve gastrectomy (SG) to Roux-en-Y gastric bypass (RYGB) may be indicated for patients due to insufficient weight loss or weight regain.

Objectives: To assess weight loss outcomes and factors predictive of improved weight loss in patients undergoing RYGB after SG and create an algorithm to estimate postoperative weight loss in these patients.

Setting: University Hospital.

Methods: Retrospective review of patients who underwent conversion from SG to RYGB from 2015 to 2022 was performed, assessing pre-and post-operative weights for each procedure.

Results: 114 patients were included (84% female, pre-SG BMI 49.3 ± 10.2). Post-SG, patients achieved a maximum %TBWL of 31.2% ([6.6-58.2] ± 10.1%), %EWL of 56.8%([13.3-97.3] ± 16.4%), and total body weight regain of 53.9%([0.0-144.4] ± 31.3%). Conversion to RYGB resulted in peak %TBWL of 18.8% at 8 months, leveling off at 13.5% thereafter. Factors predictive of greater weight loss post-conversion included higher BMI at time of SG (each 5 kg/m2 increase yielded 0.8% greater %TBWL [95% CI 0.5-1%, p < 0.0001]) and peak %EWL ≥ 40% after SG (yielding 5.5% more %TBWL, 95%CI 3.9-7.1%, p < 0.0001). Conversely, those who had ≥ 20% weight regain after SG had 4.1% less %TBWL (95%CI 2.5-5.7%, p < 0.0001) after conversion. These factors were used to create BE-CALM, an algorithm to predict %TBWL one year after conversion to RYGB.

Conclusions: Conversion from SG to RYGB is effective for further weight loss. Patients who have higher starting BMI, ≥ 40% %EWL or ≤ 20% weight regain after SG demonstrate the most effective weight loss post-conversion.

背景:袖带胃切除术(SG)转为 Roux-en-Y 胃旁路术(RYGB)可能适用于体重减轻不足或体重反弹的患者:目的:评估袖带胃切除术后接受 RYGB 患者的体重减轻结果和预测体重减轻改善的因素,并创建一种算法来估计这些患者的术后体重减轻情况:地点:大学医院:方法:对2015年至2022年期间接受SG转RYGB手术的患者进行回顾性研究,评估每次手术的术前和术后体重:共纳入 114 名患者(84% 为女性,SG 术前体重指数为 49.3 ± 10.2)。SG术后,患者的TBWL最大为31.2%([6.6-58.2] ± 10.1%),EWL最大为56.8%([13.3-97.3] ± 16.4%),总重量恢复为53.9%([0.0-144.4] ± 31.3%)。转为 RYGB 后,8 个月时的体重减轻率达到峰值 18.8%,之后趋于平稳,为 13.5%。预测转为 RYGB 后体重减轻幅度更大的因素包括接受 SG 时体重指数(BMI)较高(每增加 5 公斤/平方米,体重减轻率就增加 0.8%[95% CI 0.5-1%,p] ):从 SG 转为 RYGB 可以有效地进一步减轻体重。起始体重指数(BMI)较高、EWL%≥ 40% 或 SG 后体重反弹≤ 20% 的患者在转换后的减肥效果最佳。
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引用次数: 0
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Surgical Endoscopy And Other Interventional Techniques
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