Pub Date : 2025-02-12DOI: 10.1007/s00464-025-11559-x
A J Bartholomew, C Jing, K P Economopoulos, A Sizemore, J Lim, S Record, S Greene, J M Ladowski, T C Howell, A Gordee, M Kuchibhtala, J Yoo, K Jain-Spangler, A D Michaels, P A Fong, J A Greenberg, K A Seymour
Background: Titanium metal clips have classically been used to occlude the cystic artery and duct during laparoscopic cholecystectomy (LC). Non-absorbable, polymer clips are an alternative with a locking feature. There is limited research evaluating the adoption, safety, and cost of these clips during cholecystectomy.
Methods: A retrospective review was conducted on patients undergoing elective LC from 2017 to 2019. The cohort was divided based on the use of metal or polymer clips. The primary outcome was 30-day emergency department (ED) visit rate. Secondary outcomes included readmission and complications. Surgeon utilization and cost comparison were assessed. Chi square, Wilcoxon rank-sum, and multivariable logistic regression was performed.
Results: 1244 patients underwent LC by 38 surgeons, of which 934 (75.1%) utilized metal clips. Thirty-day ED presentation was 8.5%, with a higher rate for the polymer clip group (12.4% vs 7.2%, p = 0.005); 79% of presentations were related to the operation. On adjusted analysis, ED visits were associated with hospital facility and insurance payor. Thirty-day readmission rate was comparable for polymer and metal clips (4.9% vs 3.2%, p = 0.18, respectively). Most surgeons used metal clips (58%) and there was no impact based on fellowship training. Those who preferentially utilized polymer clips had more recently graduated from medical school (p = 0.02) and were more likely to perform intraoperative cholangiograms (p < 0.001). The device cost difference favored polymer clips by $75 per case.
Conclusion: Polymer clips are a safe alternative to metal clips, with a similarly low complication profile. Despite an increase in 30-day ED visit rate in the polymer group, adjusted analysis demonstrated an association with hospital facility and insurance type, and not clip type. Given LC is one of the most commonly performed operations worldwide, the benefit of locking polymer clips should be incorporated into intraoperative decision making.
{"title":"Impact of metal vs non-absorbable, polymer clips during laparoscopic cholecystectomy.","authors":"A J Bartholomew, C Jing, K P Economopoulos, A Sizemore, J Lim, S Record, S Greene, J M Ladowski, T C Howell, A Gordee, M Kuchibhtala, J Yoo, K Jain-Spangler, A D Michaels, P A Fong, J A Greenberg, K A Seymour","doi":"10.1007/s00464-025-11559-x","DOIUrl":"https://doi.org/10.1007/s00464-025-11559-x","url":null,"abstract":"<p><strong>Background: </strong>Titanium metal clips have classically been used to occlude the cystic artery and duct during laparoscopic cholecystectomy (LC). Non-absorbable, polymer clips are an alternative with a locking feature. There is limited research evaluating the adoption, safety, and cost of these clips during cholecystectomy.</p><p><strong>Methods: </strong>A retrospective review was conducted on patients undergoing elective LC from 2017 to 2019. The cohort was divided based on the use of metal or polymer clips. The primary outcome was 30-day emergency department (ED) visit rate. Secondary outcomes included readmission and complications. Surgeon utilization and cost comparison were assessed. Chi square, Wilcoxon rank-sum, and multivariable logistic regression was performed.</p><p><strong>Results: </strong>1244 patients underwent LC by 38 surgeons, of which 934 (75.1%) utilized metal clips. Thirty-day ED presentation was 8.5%, with a higher rate for the polymer clip group (12.4% vs 7.2%, p = 0.005); 79% of presentations were related to the operation. On adjusted analysis, ED visits were associated with hospital facility and insurance payor. Thirty-day readmission rate was comparable for polymer and metal clips (4.9% vs 3.2%, p = 0.18, respectively). Most surgeons used metal clips (58%) and there was no impact based on fellowship training. Those who preferentially utilized polymer clips had more recently graduated from medical school (p = 0.02) and were more likely to perform intraoperative cholangiograms (p < 0.001). The device cost difference favored polymer clips by $75 per case.</p><p><strong>Conclusion: </strong>Polymer clips are a safe alternative to metal clips, with a similarly low complication profile. Despite an increase in 30-day ED visit rate in the polymer group, adjusted analysis demonstrated an association with hospital facility and insurance type, and not clip type. Given LC is one of the most commonly performed operations worldwide, the benefit of locking polymer clips should be incorporated into intraoperative decision making.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143410661","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}
Pub Date : 2025-02-11DOI: 10.1007/s00464-025-11587-7
Lea Sander Berg, Hans Friis-Andersen, Nellie Bering Zinther, Mehmet Öztoprak, Kåre Andersson Gotschalck
Background: For treatment of common bile duct stones (CBDS), guidelines recommend a one-stage approach, including laparoscopic common bile duct exploration (LCBDE) or intraoperative endoscopic retrograde cholangiopancreatography (intraERCP). Studies show favourable outcomes with transcystic LCBDE (tLCBDE), but this technique is not widely adopted. The use of tLCBDE may be limited by several factors, but to what degree is unknown. The aim of this study is to examine the feasibility and, secondarily, outcomes of tLCBDE for patients undergoing removal of CBDS and laparoscopic cholecystectomy (LC) when tLCBDE is the first-line treatment.
Method: A retrospective cross-sectional study including patients with removal of CBDS and LC at Horsens Regional Hospital during June 2017-March 2022. We classified patients into three groups: tLCBDE, preoperative ERCP (preERCP), and other procedures. The reasons for not performing tLCBDE were registered from medical charts. In the tLCBDE and the preERCP group, we registered clearance rate, postoperative complications, and subsequent ERCP.
Results: In total, 229 patients received a procedure due to CBDS, of which 73% were emergency procedures. The groups were as follows: 179 (78%) tLCBDE, 25 (11%) preERCP, and 25 (11%) other procedures. preERCP was chosen due to the patient being unfit for emergency surgery, tLCBDE not being technically possible, and other reasons. Other procedures were chosen, because tLCBDE was not technically possible, lack of equipment or qualified surgeon, and other reasons. In the tLCBDE group, 94% of patients with CBDS were cleared, 5.6% had a complication of Clavien-Dindo grade ≥ 3, and 3.9% patients needed a subsequent ERCP.
Conclusion: tLCBDE is feasible, safe, and effective treatment which can be performed in the majority of patients with CBDS and should be considered an equivalent to ERCP or choledochotomy as first-line treatment of patients with CBDS. As some patients require ERCP or choledochotomy, tLCBDE should not be the sole treatment available.
{"title":"Feasibility and outcome of transcystic laparoscopic common bile duct exploration as first-line treatment for common bile duct stones: a retrospective cross-sectional study.","authors":"Lea Sander Berg, Hans Friis-Andersen, Nellie Bering Zinther, Mehmet Öztoprak, Kåre Andersson Gotschalck","doi":"10.1007/s00464-025-11587-7","DOIUrl":"https://doi.org/10.1007/s00464-025-11587-7","url":null,"abstract":"<p><strong>Background: </strong>For treatment of common bile duct stones (CBDS), guidelines recommend a one-stage approach, including laparoscopic common bile duct exploration (LCBDE) or intraoperative endoscopic retrograde cholangiopancreatography (intraERCP). Studies show favourable outcomes with transcystic LCBDE (tLCBDE), but this technique is not widely adopted. The use of tLCBDE may be limited by several factors, but to what degree is unknown. The aim of this study is to examine the feasibility and, secondarily, outcomes of tLCBDE for patients undergoing removal of CBDS and laparoscopic cholecystectomy (LC) when tLCBDE is the first-line treatment.</p><p><strong>Method: </strong>A retrospective cross-sectional study including patients with removal of CBDS and LC at Horsens Regional Hospital during June 2017-March 2022. We classified patients into three groups: tLCBDE, preoperative ERCP (preERCP), and other procedures. The reasons for not performing tLCBDE were registered from medical charts. In the tLCBDE and the preERCP group, we registered clearance rate, postoperative complications, and subsequent ERCP.</p><p><strong>Results: </strong>In total, 229 patients received a procedure due to CBDS, of which 73% were emergency procedures. The groups were as follows: 179 (78%) tLCBDE, 25 (11%) preERCP, and 25 (11%) other procedures. preERCP was chosen due to the patient being unfit for emergency surgery, tLCBDE not being technically possible, and other reasons. Other procedures were chosen, because tLCBDE was not technically possible, lack of equipment or qualified surgeon, and other reasons. In the tLCBDE group, 94% of patients with CBDS were cleared, 5.6% had a complication of Clavien-Dindo grade ≥ 3, and 3.9% patients needed a subsequent ERCP.</p><p><strong>Conclusion: </strong>tLCBDE is feasible, safe, and effective treatment which can be performed in the majority of patients with CBDS and should be considered an equivalent to ERCP or choledochotomy as first-line treatment of patients with CBDS. As some patients require ERCP or choledochotomy, tLCBDE should not be the sole treatment available.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399919","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}
Background: Accurate lymph node (LN) dissection is crucial in the surgical management of lung cancer. However, studies addressing the challenges of anatomically precise LN dissection are limited. This study aimed to evaluate the utility and safety of mixed reality (MR) holograms as an intraoperative support tool for hilar and mediastinal lymph node dissection (HMLND).
Methods: Polygonal (stereolithographic) files of the thoracic cavity were created from SYNAPSE VINCENT images and uploaded into Holoeyes MD virtual reality software. The three-dimensional (3D) holograms generated from these images were displayed on head-mounted displays (HoloLens2) worn by the surgeons and their assistants during HMLND. Intraoperative hologram support (IHS) safety was assessed in 10 patients who underwent HMLND with anatomical lung resection. Additionally, the utility of the intraoperative hologram was evaluated through a questionnaire completed by four thoracic surgeons experienced in hologram manipulation.
Results: IHS was used for a median duration of 5 min (interquartile range: 4-6). No 90-day postoperative complications were observed. Surgeons unanimously agreed that the holograms accurately represented the vascular and bronchial structures of the hilar and mediastinal regions. Additionally, none of the surgeons disagreed that the holograms provided greater benefit intraoperatively compared to preoperatively. In particular, IHS was found effective for the dissection of non-adjacent interlobar LNs post-segmentectomy and LN #4L.
Conclusions: IHS improved the surgical understanding of thoracic anatomy during HMLND, potentially leading to more precise and reliable LN dissection.
{"title":"Intraoperative support using mixed reality holograms for hilar and mediastinal lymph node dissection.","authors":"Naofumi Miyahara, Masafumi Hiratsuka, Yusuke Okamoto, Takashi Teishikata, Keiji Kamohara","doi":"10.1007/s00464-025-11593-9","DOIUrl":"https://doi.org/10.1007/s00464-025-11593-9","url":null,"abstract":"<p><strong>Background: </strong>Accurate lymph node (LN) dissection is crucial in the surgical management of lung cancer. However, studies addressing the challenges of anatomically precise LN dissection are limited. This study aimed to evaluate the utility and safety of mixed reality (MR) holograms as an intraoperative support tool for hilar and mediastinal lymph node dissection (HMLND).</p><p><strong>Methods: </strong>Polygonal (stereolithographic) files of the thoracic cavity were created from SYNAPSE VINCENT images and uploaded into Holoeyes MD virtual reality software. The three-dimensional (3D) holograms generated from these images were displayed on head-mounted displays (HoloLens2) worn by the surgeons and their assistants during HMLND. Intraoperative hologram support (IHS) safety was assessed in 10 patients who underwent HMLND with anatomical lung resection. Additionally, the utility of the intraoperative hologram was evaluated through a questionnaire completed by four thoracic surgeons experienced in hologram manipulation.</p><p><strong>Results: </strong>IHS was used for a median duration of 5 min (interquartile range: 4-6). No 90-day postoperative complications were observed. Surgeons unanimously agreed that the holograms accurately represented the vascular and bronchial structures of the hilar and mediastinal regions. Additionally, none of the surgeons disagreed that the holograms provided greater benefit intraoperatively compared to preoperatively. In particular, IHS was found effective for the dissection of non-adjacent interlobar LNs post-segmentectomy and LN #4L.</p><p><strong>Conclusions: </strong>IHS improved the surgical understanding of thoracic anatomy during HMLND, potentially leading to more precise and reliable LN dissection.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399925","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}
Pub Date : 2025-02-11DOI: 10.1007/s00464-025-11601-y
Wen Xu, Meiping Ouyang, Guili Xia, Ying Zhu
Objectives: To explore the postoperative complications and efficacy of endoscopic resection of hypertrophic anal papillae combined with internal hemorrhoid ligation.
Methods: A retrospective study was conducted on 47 patients from our center who underwent endoscopic resection of hypertrophic anal papillae, with or without internal hemorrhoids ligation. The patients were divided into two groups based on the surgical procedure: the anal papillae resection group and the anal papillae resection + internal hemorrhoid ligation group. The analysis included patient age, gender, anal papillae diameter, postoperative pain intensity and duration, postoperative bleeding severity, presence of anal edema, and follow-up outcomes at 3 months postoperatively.
Results: There were no statistically significant differences in age, gender, or anal papillae diameter among the two patient groups. The postoperative pain intensity was higher in the group undergoing anal papillae resection combined with internal hemorrhoid ligation, with a median Visual Analog Scale (VAS) score of 1 (0, 2), and the duration of pain was longer, with a median of 1 (0, 2) day. Both the pain intensity and duration showed statistically significant differences (P < 0.05). However, there were no statistically significant differences in the incidence of postoperative bleeding or anal edema. At the 3-month follow-up, the effective rates were 90.9% and 80.0%, respectively, and there were no statistically significant differences among the groups.
Conclusion: The complication rate of endoscopic resection of hypertrophic anal papillae combined with internal hemorrhoids ligation is low, and the therapeutic effect is good.
{"title":"Clinical effects of endoscopic resection of hypertrophied anal papillae combined with internal hemorrhoid ligation therapy: a retrospective study.","authors":"Wen Xu, Meiping Ouyang, Guili Xia, Ying Zhu","doi":"10.1007/s00464-025-11601-y","DOIUrl":"https://doi.org/10.1007/s00464-025-11601-y","url":null,"abstract":"<p><strong>Objectives: </strong>To explore the postoperative complications and efficacy of endoscopic resection of hypertrophic anal papillae combined with internal hemorrhoid ligation.</p><p><strong>Methods: </strong>A retrospective study was conducted on 47 patients from our center who underwent endoscopic resection of hypertrophic anal papillae, with or without internal hemorrhoids ligation. The patients were divided into two groups based on the surgical procedure: the anal papillae resection group and the anal papillae resection + internal hemorrhoid ligation group. The analysis included patient age, gender, anal papillae diameter, postoperative pain intensity and duration, postoperative bleeding severity, presence of anal edema, and follow-up outcomes at 3 months postoperatively.</p><p><strong>Results: </strong>There were no statistically significant differences in age, gender, or anal papillae diameter among the two patient groups. The postoperative pain intensity was higher in the group undergoing anal papillae resection combined with internal hemorrhoid ligation, with a median Visual Analog Scale (VAS) score of 1 (0, 2), and the duration of pain was longer, with a median of 1 (0, 2) day. Both the pain intensity and duration showed statistically significant differences (P < 0.05). However, there were no statistically significant differences in the incidence of postoperative bleeding or anal edema. At the 3-month follow-up, the effective rates were 90.9% and 80.0%, respectively, and there were no statistically significant differences among the groups.</p><p><strong>Conclusion: </strong>The complication rate of endoscopic resection of hypertrophic anal papillae combined with internal hemorrhoids ligation is low, and the therapeutic effect is good.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399916","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}
Pub Date : 2025-02-10DOI: 10.1007/s00464-025-11535-5
Mohammad Kermansaravi, Masoumeh Shahsavan, Karl Hage, Halit Eren Taskin, Shahab ShahabiShahmiri, Tigran Poghosyan, Amir Hossein Davarpanah Jazi, Clement Baratte, Rohollah Valizadeh, Jean-Marc Chevallier, Omar M Ghanem
Background: One anastomosis gastric bypass (OAGB) currently stands as the third most common metabolic and bariatric surgical procedure with increasing popularity worldwide. Iron deficiency anemia (IDA) is the most prevalent anemia observed after gastric bypass procedures.
Methods: This systematic review and meta-analysis aimed to assess the overall incidence of IDA and identify the effect of biliopancreatic limb (BPL) length on the incidence of IDA in patients undergoing OAGB by a systematic literature search in PubMed, Web of Sciences, and Scopus.
Results: Twenty-six studies including 11,015 patients were finally included for review. The mean age and mean BPL lengths were 40.1 ± 7.2 years and 190.4 ± 29.2 cm respectively. The IDA prevalence after OAGB was 16% and BPL length was shown to predict IDA rates after OAGB (p = 0.042). Specifically, 8% of patients with a BPL length of 150-179 cm, 12% of patients with a BPL length of 180-199 cm, and 9% of patients with a BPL length of ≥ 200 cm experienced IDA.
Conclusion: Despite the promising trends of performed OAGB worldwide, further studies are required to ascertain the risks related to this procedure and refine the surgical techniques.
{"title":"Iron deficiency anemia after one anastomosis gastric bypass: A systematic review and meta-analysis.","authors":"Mohammad Kermansaravi, Masoumeh Shahsavan, Karl Hage, Halit Eren Taskin, Shahab ShahabiShahmiri, Tigran Poghosyan, Amir Hossein Davarpanah Jazi, Clement Baratte, Rohollah Valizadeh, Jean-Marc Chevallier, Omar M Ghanem","doi":"10.1007/s00464-025-11535-5","DOIUrl":"https://doi.org/10.1007/s00464-025-11535-5","url":null,"abstract":"<p><strong>Background: </strong>One anastomosis gastric bypass (OAGB) currently stands as the third most common metabolic and bariatric surgical procedure with increasing popularity worldwide. Iron deficiency anemia (IDA) is the most prevalent anemia observed after gastric bypass procedures.</p><p><strong>Methods: </strong>This systematic review and meta-analysis aimed to assess the overall incidence of IDA and identify the effect of biliopancreatic limb (BPL) length on the incidence of IDA in patients undergoing OAGB by a systematic literature search in PubMed, Web of Sciences, and Scopus.</p><p><strong>Results: </strong>Twenty-six studies including 11,015 patients were finally included for review. The mean age and mean BPL lengths were 40.1 ± 7.2 years and 190.4 ± 29.2 cm respectively. The IDA prevalence after OAGB was 16% and BPL length was shown to predict IDA rates after OAGB (p = 0.042). Specifically, 8% of patients with a BPL length of 150-179 cm, 12% of patients with a BPL length of 180-199 cm, and 9% of patients with a BPL length of ≥ 200 cm experienced IDA.</p><p><strong>Conclusion: </strong>Despite the promising trends of performed OAGB worldwide, further studies are required to ascertain the risks related to this procedure and refine the surgical techniques.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143390466","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}
Pub Date : 2025-02-10DOI: 10.1007/s00464-025-11540-8
Cezanne D Kooij, Eleni Boptsi, Bas L A M Weusten, D R de Vries, Jelle P Ruurda, Richard van Hillegersberg
Background: Boerhaave syndrome is a rare, life-threatening condition, characterized by spontaneous esophageal rupture. This study aims to share our 13-year experience in managing Boerhaave syndrome.
Methods: A retrospective, observational study was conducted of consecutive patients with Boerhaave syndrome who presented at our tertiary referral center, between 2011 and 2023. Patients were categorized by time to diagnosis, to assess the impact of diagnostic delay.
Results: Among 21 patients, 13 (62%) were diagnosed early (< 24 h) and 8 (38%) late (> 24 h). In the early-diagnosed group (n = 13), 6 patients (46%) received primary intervention with stent placement in combination with surgical drainage (5 with mediastinal and pleural drainage and 1 with only pleural drainage), while 5 patients (38%) were initially treated with only a stent. One patient (8%) underwent surgical pleural drainage alone and one (8%) underwent an esophagectomy. Among the 8 late-diagnosed patients, 4 (50%) were primarily treated with both stent placement and surgical drainage (2 with mediastinal drainage, 1 with pleural drainage and 1 with both), 3 (38%) with only stent placement, and one (13%) was managed conservatively. Additional interventions were required in 14 patients (67%). Additional surgical drainage was performed in 5 of 8 patients who had initially been treated with stent only (63%) and in 2 of 10 patients who had initially received both stent and surgical drainage (20%). Stent complications occurred in 7 patients (37%), including leakage (16%), migration (16%), and bleeding (5%). The median hospital stay was 32 days (IQR 15-37) and the overall 90-day mortality was 14%. Mortality was significantly higher in late-diagnosed patients (n = 3, 38%) compared to those early diagnosed (n = 0, 0%) (p = 0.042), with all 3 deceased patients either refusing or being unfit for treatment.
Conclusion: Based on this study, we recommend prioritizing closure of the defect combined with drainage, while considering individual patient factors, including advanced age.
{"title":"Treatment of Boerhaave syndrome: experience from a tertiary center.","authors":"Cezanne D Kooij, Eleni Boptsi, Bas L A M Weusten, D R de Vries, Jelle P Ruurda, Richard van Hillegersberg","doi":"10.1007/s00464-025-11540-8","DOIUrl":"https://doi.org/10.1007/s00464-025-11540-8","url":null,"abstract":"<p><strong>Background: </strong>Boerhaave syndrome is a rare, life-threatening condition, characterized by spontaneous esophageal rupture. This study aims to share our 13-year experience in managing Boerhaave syndrome.</p><p><strong>Methods: </strong>A retrospective, observational study was conducted of consecutive patients with Boerhaave syndrome who presented at our tertiary referral center, between 2011 and 2023. Patients were categorized by time to diagnosis, to assess the impact of diagnostic delay.</p><p><strong>Results: </strong>Among 21 patients, 13 (62%) were diagnosed early (< 24 h) and 8 (38%) late (> 24 h). In the early-diagnosed group (n = 13), 6 patients (46%) received primary intervention with stent placement in combination with surgical drainage (5 with mediastinal and pleural drainage and 1 with only pleural drainage), while 5 patients (38%) were initially treated with only a stent. One patient (8%) underwent surgical pleural drainage alone and one (8%) underwent an esophagectomy. Among the 8 late-diagnosed patients, 4 (50%) were primarily treated with both stent placement and surgical drainage (2 with mediastinal drainage, 1 with pleural drainage and 1 with both), 3 (38%) with only stent placement, and one (13%) was managed conservatively. Additional interventions were required in 14 patients (67%). Additional surgical drainage was performed in 5 of 8 patients who had initially been treated with stent only (63%) and in 2 of 10 patients who had initially received both stent and surgical drainage (20%). Stent complications occurred in 7 patients (37%), including leakage (16%), migration (16%), and bleeding (5%). The median hospital stay was 32 days (IQR 15-37) and the overall 90-day mortality was 14%. Mortality was significantly higher in late-diagnosed patients (n = 3, 38%) compared to those early diagnosed (n = 0, 0%) (p = 0.042), with all 3 deceased patients either refusing or being unfit for treatment.</p><p><strong>Conclusion: </strong>Based on this study, we recommend prioritizing closure of the defect combined with drainage, while considering individual patient factors, including advanced age.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391758","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}
Background: There is no consensus on managing patients with endoscopic suspicion of early esophageal squamous cell carcinoma (ESCC) but biopsy-confirmed low-grade intraepithelial neoplasia (LGIN). The aim of this study is to evaluate the utility of an endoscopic ultrasound (EUS)-based radiomics nomogram for predicting esophageal LGIN pathological progression before diagnostic endoscopic submucosal dissection (ESD).
Methods: In the development phase, EUS images of 535 patients who had biopsy-confirmed LGIN and were undergoing ESD were retrospectively included. Concurrently, 251 patients were prospectively included for independent model validation. A radiomics signature (RS) was constructed using Pearson test and the least absolute shrinkage and selection operator (LASSO) algorithm. A radiomics nomogram was then developed with multivariate logistic regression to predict pathologic upgrade before ESD. Model performance was assessed with receiver operating characteristic (ROC) analysis, calibration curves, and decision curve analysis (DCA).
Results: Following stepwise multivariate logistic regression analysis, statistically significant clinical features were incorporated into the clinical predictive model. From EUS images, 105 radiomic features were extracted, with 11 key features selected for RS development. The RS showed strong predictive performance in identifying pathologic upgrade (AUC = 0.786). Moreover, when integrated with the clinical model (AUC = 0.648), the RS performance remarkably improved (AUC = 0.818). These results were subsequently validated in the prospective test cohort (RS: AUC = 0.792; Clinical model: AUC = 0.669; Combined model: AUC = 0.821). The combined model presented as a nomogram also excelled in calibration tests and DCA, underlining its potential for clinical application.
Conclusion: The EUS-based radiomics nomogram showed potential for predicting pathologic upgrade in esophageal LGIN, which helps to distinguish high-risk from low-risk cases and assists clinicians in assessing the necessity of diagnostic ESD.
{"title":"Endoscopic ultrasound-based radiomics for predicting pathologic upgrade in esophageal low-grade intraepithelial neoplasia.","authors":"Yajing Chen, Shuhan Sun, Shumei Miao, Han Chen, Xiaoying Zhou, Feihong Yu","doi":"10.1007/s00464-025-11573-z","DOIUrl":"https://doi.org/10.1007/s00464-025-11573-z","url":null,"abstract":"<p><strong>Background: </strong>There is no consensus on managing patients with endoscopic suspicion of early esophageal squamous cell carcinoma (ESCC) but biopsy-confirmed low-grade intraepithelial neoplasia (LGIN). The aim of this study is to evaluate the utility of an endoscopic ultrasound (EUS)-based radiomics nomogram for predicting esophageal LGIN pathological progression before diagnostic endoscopic submucosal dissection (ESD).</p><p><strong>Methods: </strong>In the development phase, EUS images of 535 patients who had biopsy-confirmed LGIN and were undergoing ESD were retrospectively included. Concurrently, 251 patients were prospectively included for independent model validation. A radiomics signature (RS) was constructed using Pearson test and the least absolute shrinkage and selection operator (LASSO) algorithm. A radiomics nomogram was then developed with multivariate logistic regression to predict pathologic upgrade before ESD. Model performance was assessed with receiver operating characteristic (ROC) analysis, calibration curves, and decision curve analysis (DCA).</p><p><strong>Results: </strong>Following stepwise multivariate logistic regression analysis, statistically significant clinical features were incorporated into the clinical predictive model. From EUS images, 105 radiomic features were extracted, with 11 key features selected for RS development. The RS showed strong predictive performance in identifying pathologic upgrade (AUC = 0.786). Moreover, when integrated with the clinical model (AUC = 0.648), the RS performance remarkably improved (AUC = 0.818). These results were subsequently validated in the prospective test cohort (RS: AUC = 0.792; Clinical model: AUC = 0.669; Combined model: AUC = 0.821). The combined model presented as a nomogram also excelled in calibration tests and DCA, underlining its potential for clinical application.</p><p><strong>Conclusion: </strong>The EUS-based radiomics nomogram showed potential for predicting pathologic upgrade in esophageal LGIN, which helps to distinguish high-risk from low-risk cases and assists clinicians in assessing the necessity of diagnostic ESD.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143390463","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}
Pub Date : 2025-02-10DOI: 10.1007/s00464-025-11607-6
Veronika Günther, Frauke Nees, Nicolai Maass, Sören von Otte, Zino Ruchay, Julian Pape, Johannes Ackermann, Ibrahim Alkatout
{"title":"Correction: How effective and sustainable is proctoring in robotic surgery? A retrospective analysis based on interviews with surgeons.","authors":"Veronika Günther, Frauke Nees, Nicolai Maass, Sören von Otte, Zino Ruchay, Julian Pape, Johannes Ackermann, Ibrahim Alkatout","doi":"10.1007/s00464-025-11607-6","DOIUrl":"10.1007/s00464-025-11607-6","url":null,"abstract":"","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383332","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}
Pub Date : 2025-02-10DOI: 10.1007/s00464-025-11529-3
Hussein Abdallah, Joseph Derienne, Rodi Courie, Cosmin Sebastian Voican, Gabriel Perlemuter, Gianfranco Donatelli, Ibrahim Dagher, Hadrien Tranchart
Background: Left hypochondrium (LHC) approach has been routinely used in our department for performing single-port sleeve gastrectomy (SPSG). Starting from 2019, a transumbilical approach (TU) has been adopted in selected patients. The aim of this study was to report and compare our results of both approaches (LHC and TU) with special focus on incisional hernia (IH).
Methods: The data of patients who underwent sleeve gastrectomy via both approaches between 2019 and 2022 were retrospectively analyzed. An assessment of IH rate was carried out by reviewing abdominal computed tomography scans performed one year after surgery.
Results: During the study period, 449 patients who underwent SPSG were included in the final analyze. Patients in the TU group (n = 136, 30%) were more frequently female with a lower BMI and fewer comorbidities. An umbilical hernia was observed in 60% of patients in the TU group. Operative duration was longer in the LHC group (80 min vs. 64 min, P < 0.0001). Early complications rates did not differ between the groups (1.9% LHC vs. 0.7% TU, P = 0.353). During follow-up, 65 patients (14%) developed an IH: 9.9% and 25% in the LHC and TU groups, respectively (P < 0.0001). Weight loss and comorbidities resolution at 1 year were globally similar between the two groups.
Conclusion: We have demonstrated the feasibility, safety, and efficacy of SPSG via both LHC and TU approaches. The advantage of the LHC approach is its routine applicability. The TU approach offers an esthetic advantage and a shorter operative time but is associated with a much higher IH rate.
{"title":"Single-port sleeve gastrectomy: a comparison between transumbilical and left hypochondrium approaches.","authors":"Hussein Abdallah, Joseph Derienne, Rodi Courie, Cosmin Sebastian Voican, Gabriel Perlemuter, Gianfranco Donatelli, Ibrahim Dagher, Hadrien Tranchart","doi":"10.1007/s00464-025-11529-3","DOIUrl":"https://doi.org/10.1007/s00464-025-11529-3","url":null,"abstract":"<p><strong>Background: </strong>Left hypochondrium (LHC) approach has been routinely used in our department for performing single-port sleeve gastrectomy (SPSG). Starting from 2019, a transumbilical approach (TU) has been adopted in selected patients. The aim of this study was to report and compare our results of both approaches (LHC and TU) with special focus on incisional hernia (IH).</p><p><strong>Methods: </strong>The data of patients who underwent sleeve gastrectomy via both approaches between 2019 and 2022 were retrospectively analyzed. An assessment of IH rate was carried out by reviewing abdominal computed tomography scans performed one year after surgery.</p><p><strong>Results: </strong>During the study period, 449 patients who underwent SPSG were included in the final analyze. Patients in the TU group (n = 136, 30%) were more frequently female with a lower BMI and fewer comorbidities. An umbilical hernia was observed in 60% of patients in the TU group. Operative duration was longer in the LHC group (80 min vs. 64 min, P < 0.0001). Early complications rates did not differ between the groups (1.9% LHC vs. 0.7% TU, P = 0.353). During follow-up, 65 patients (14%) developed an IH: 9.9% and 25% in the LHC and TU groups, respectively (P < 0.0001). Weight loss and comorbidities resolution at 1 year were globally similar between the two groups.</p><p><strong>Conclusion: </strong>We have demonstrated the feasibility, safety, and efficacy of SPSG via both LHC and TU approaches. The advantage of the LHC approach is its routine applicability. The TU approach offers an esthetic advantage and a shorter operative time but is associated with a much higher IH rate.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391756","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}
Pub Date : 2025-02-10DOI: 10.1007/s00464-025-11583-x
Maher El Chaar, Allincia Michaud, Scott Allen Farabaugh, Dustin Manchester, Meredith Harrison, Luis Alvarado
Introduction: Hiatal Hernia (HH) repairs are commonly performed using a laparoscopic (L) approach. Recently, the robotic-assisted (RA) approach was introduced. The objective of the study is to describe our experience and analyze patient-centered clinical outcomes of RA-HH repairs with and without MSA (Magnetic Sphincter Augmentation).
Methods: Patients who underwent RA-HH repair with or without MSA between April 2018 and February 2023 were included. The data were summarized using mean and standard deviation for all continuous variables. Frequency and percent were used for categorical data. Postoperative endoscopy and/or barium swallow were done on all patients. Postoperative clinical follow-up occurred at 2 weeks, 3,6,12, and 24 months. At 6 months, the Gastroesophageal Reflux Disease Health-Related Quality-of-Life (GERD-HRQL) scale was used to assess quality of life and symptom severity. The data were analyzed for both MSA and non-MSA patients and reported at 2 years. All data management and analysis were conducted using Stata V.18.
Results: Overall, the study included 295 patients. 30-day readmission and ED visit rates were 7.51% and 14.92%, respectively. In-hospital postoperative complication rate was 10.85%. We had no 30-day mortality. Conversion to open was 0.34%. Hospital length of stay was 0-1 day in 82.03% of cases. GERD-HRQL score decreased from 8.78 preoperatively to 1.34 at 6 months with 86.1% of patients reporting a score of 0. Our follow-up rate at year 2 from the index procedure was 74% ( 217 patients out of 295). Hernia recurrence rate at 24 months was 3.93%. PPI use at 2 years was 38.71%. MSA group had more post-op globus at 24 months (5.13% vs 1.12%) but similar rates of post-op heartburn and PPI use.
Conclusion: RA-HH at our center appears to be safe and feasible with low recurrence rates at 24 months. MSA had similar rates of PPI use but more post-op globus compared to the non-MSA group at 2 years.
{"title":"Robotic-assisted hiatal hernia repairs with and without magnetic sphincter augmentation (MSA): short- and long-term patient-centered outcomes in a single academic center.","authors":"Maher El Chaar, Allincia Michaud, Scott Allen Farabaugh, Dustin Manchester, Meredith Harrison, Luis Alvarado","doi":"10.1007/s00464-025-11583-x","DOIUrl":"https://doi.org/10.1007/s00464-025-11583-x","url":null,"abstract":"<p><strong>Introduction: </strong>Hiatal Hernia (HH) repairs are commonly performed using a laparoscopic (L) approach. Recently, the robotic-assisted (RA) approach was introduced. The objective of the study is to describe our experience and analyze patient-centered clinical outcomes of RA-HH repairs with and without MSA (Magnetic Sphincter Augmentation).</p><p><strong>Methods: </strong>Patients who underwent RA-HH repair with or without MSA between April 2018 and February 2023 were included. The data were summarized using mean and standard deviation for all continuous variables. Frequency and percent were used for categorical data. Postoperative endoscopy and/or barium swallow were done on all patients. Postoperative clinical follow-up occurred at 2 weeks, 3,6,12, and 24 months. At 6 months, the Gastroesophageal Reflux Disease Health-Related Quality-of-Life (GERD-HRQL) scale was used to assess quality of life and symptom severity. The data were analyzed for both MSA and non-MSA patients and reported at 2 years. All data management and analysis were conducted using Stata V.18.</p><p><strong>Results: </strong>Overall, the study included 295 patients. 30-day readmission and ED visit rates were 7.51% and 14.92%, respectively. In-hospital postoperative complication rate was 10.85%. We had no 30-day mortality. Conversion to open was 0.34%. Hospital length of stay was 0-1 day in 82.03% of cases. GERD-HRQL score decreased from 8.78 preoperatively to 1.34 at 6 months with 86.1% of patients reporting a score of 0. Our follow-up rate at year 2 from the index procedure was 74% ( 217 patients out of 295). Hernia recurrence rate at 24 months was 3.93%. PPI use at 2 years was 38.71%. MSA group had more post-op globus at 24 months (5.13% vs 1.12%) but similar rates of post-op heartburn and PPI use.</p><p><strong>Conclusion: </strong>RA-HH at our center appears to be safe and feasible with low recurrence rates at 24 months. MSA had similar rates of PPI use but more post-op globus compared to the non-MSA group at 2 years.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143390421","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}