Updates in Surgery最新文献

Background: Hypoparathyroidism is the most common complication of thyroid surgery. The best way to assume normal parathyroid gland (PTG) function is to preserve them in situ, undamaged. Near-infrared autofluorescence (NIRAF)-imaging has been introduced as a potentially useful adjunct in thyroid surgery.

Objective: To assess the surgical outcomes of NIRAF-imaging utility in thyroid surgery.

Methods: The clinical records of patients who underwent surgery for papillary thyroid carcinoma (PTC) in a 7-month period were retrospectively reviewed. The primary endpoint was to assess NIRAF's impact on postoperative hypoparathyroidism. Secondary endpoints included its impact in preventing inadvertent PTG resection, time to resolution of postoperative hypoparathyroidism, and additional benefits in therapeutic central compartment neck dissection (tCCND).

Results: Fifty consecutive patients underwent surgery for PTC. Total thyroidectomy was performed in 42 patients. Whereas concomitant tCCND was performed in 8 patients. PTG-detection rate was 93% for NIRAF versus 87% for the surgeon (p = 0.04). NIRAF prevented inadvertent resection of 16 PTGs (p < 0.001). In tCCND, the detection rate of NIRAF was 100% versus 81% for the surgeon (p < 0.01). The rate of transient hypoparathyroidism applying NIRAF was 12% versus 15% (historical cohort) (p = 0.6). However, a significantly prompter resolution of hypoparathyroidism was demonstrated using NIRAF (average time of 2.7 weeks vs. 12.3 weeks; p < 0.0001).

Conclusion: Although NIRAF did not significantly minimize the overall risk of postoperative transient hypoparathyroidism, it demonstrated a trend toward improvement. It also led to prompter resolution of hypoparathyroidism and lowered the risk for inadvertent PTG resection. Therefore, NIRAF seems to be a promising surgical adjunct.

Crohn's disease (CD) is a chronic immune-mediated disorder affecting the gastrointestinal tract. While medical therapies have advanced, approximately 80% of CD patients will require surgery due to disease recurrence. A significant debate exists regarding the primary site of post-operative recurrence. This discrepancy in recurrence patterns underscores the complexity of CD management and the ongoing need for tailored surgical approaches. It has been recently demonstrated that the Kono-S anastomosis is safe and efficient in reducing endoscopic and surgical recurrence. Newer versions of the Kono-S anastomosis using staplers have been reported to further simplify the procedure and decrease operative time. The aim of this paper was to describe a distinct version of a totally stapled Kono-S anastomosis and provide preliminary results from our center. The technical procedure of a totally stapled Kono-S anastomosis is illustrated. A consecutive series of patients undergoing ileal or ileo-colic resection followed by totally stapled Kono-S anastomosis was identified from a prospectively collated database. Data included patient demographics and baseline characteristics, intraoperative details, short- and long-term post-operative outcomes. Between January and November 2023, 41 patients (mean age 36.4 years, 61% males) underwent ileal or ileo-colic resection followed by totally stapled Kono-S anastomosis for Crohn's disease. Mean operative time was 150.76 ± 43.22 min, and mean time of anastomotic construction was 19.71 ± 4.24. Time to flatus and stool were 2.73 ± 0.70 and 3.51 ± 1.16 days, respectively, and the length of post-operative stay was 6.80 ± 2.13 days. Only two patients (4.8%) presented complications following surgery, namely anastomotic bleeding. At a mean follow-up of 17.0 ± 2.1 months, no patient needed re-do surgery for disease recurrence at anastomotic site. The endoscopic recurrence rate was 14.4% (4/28). Our fully stapled version of the Kono-S anastomosis is safe and feasible, and short construction time and low technical complexity may help its diffusion among colorectal surgeons. Long-term outcomes on disease recurrence are still to be defined.

This study aims to explore the significant role of collaborative teaching between ultrasonographers and vascular surgeons in the training of vascular surgery residents in China. By comparing and analyzing the learning outcomes, clinical practice abilities, and patient feedback data of vascular surgery residents under traditional teaching methods versus collaborative teaching methods, combined with questionnaire surveys and statistical analysis, it was found that collaborative teaching significantly improved the training effect of vascular surgery residents. The results of this study provide new insights for medical education training, emphasizing the importance of interdisciplinary collaborative teaching in the training of vascular surgery residents.

With the rapid development of minimally invasive surgical techniques, there remains considerable controversy regarding the choice of surgical approach and anastomosis method for patients with right-sded colon cancer (RSCC). This meta-analysis compared the short-term outcomes of open right colectomies (ORC), laparoscopic right colectomies with intracorporeal and extracorporeal anastomosis (LRC-IA and LRC-EA), as well as robot right colectomies with intracorporeal and extracorporeal anastomosis (RRC-IA and RRC-EA). A systematic search was conducted across PubMed (n = 549), Web of Science (n = 821), Embase (n = 591), and the Cochrane Central Register (n = 86) from January 2000 to August 2024. Studies comparing at least two of the surgical techniques for RSCC were included. The primary outcomes evaluated were overall complications, wound infection, ileus, and reoperation rates. Secondary outcomes included operative time, blood loss, hospital stay, time to resume diet, and conversion rates. A Bayesian network meta-analysis was performed. A total of 39 studies comprising 6098 patients were included. The results indicated that LRC-IA had the lowest overall complication rate (OR 0.65; 95% CI [0.41, 1.07]), while ORC had the highest. RRC-IA was most effective in reducing wound infection (OR 0.77; 95% CI [0.39, 1.35]), blood loss (MD 18.01; 95% CI [4.62, 40.87]), and hospital stay (MD 0.93; 95% CI [0.67, 1.31]), while also demonstrating advantages in preventing postoperative ileus (OR 0.47; 95% CI [0.05, 1.31]) and ensuring faster bowel function recovery (OR 0.80; 95% CI [0.44, 1.53]). The analysis demonstrates that for patients with RSCC, RRC shows better short-term outcomes compared to LRC and ORC, while IA also surpasses EA.

Adult left lobe living donor liver transplantation has long been practiced nearly exclusively in Japan. To overcome the potential risks of small-for-size syndrome and hepatic venous outflow obstruction associated with the use of left lobe grafts, center-specific countermeasures such as splenectomy, meticulous hepatic venous reconstruction, and inclusion of the caudate lobe have been implemented, resulting in short- and long-term results comparable with those of right lobe graft in high-volume centers. A recent systematic review and meta-analysis confirmed these observations; however, the indications and techniques of adult left lobe living donor liver transplantation have yet to be standardized. Recently, there is a growing momentum in the Western countries toward adult left lobe living donor liver transplantation to expand the donor pool in an era of severe organ scarcity and decrease waitlist mortality rates. The introduction of minimally invasive living-donor hepatectomy is expected to further facilitate the use of left lobe grafts.

Groove pancreatitis (GP) is a chronic segmental pancreatitis which leads to altered pancreatic secretions and pancreatitis. The exact pathogenesis of GP has not been clearly identified to date but heavy smoking and chronic alcohol consumption seem to be the main factors involved. The resulting chronic pancreatitis (CP) is a debilitating disease causing abdominal pain often refractory to medical therapy, so much that the main indication for surgical treatment is intractable abdominal pain. A growing number of increasingly complex and diverse surgical operations for the treatment of this disease were reported. Operative procedures for CP are currently grouped into decompression procedures and pancreatic resections. No consensus about which one leads to the best outcomes, but every case should be tailored to specific clinical scenarios and single individuals. We report the case of a 44-year-old man with intractable abdominal pain due to GP underwent to Partington-Rochelle modified procedure. A Wirsung-jejunal side-to-side anastomosis as described by Partington-Rochelle was performed but with two variations: the first was the length of the anastomosis which was < 50 mm (short anastomosis), while the second was the placement of two removable Bracci stent tube 6 Fr to drain respectively the distal and the proximal-medium part of Wirsung duct. The post-operative course was uneventful with good pain control. During follow-up no evidence of any radiologic signs of infection or fluid collections or pancreatic fistula nor recrudescent of abdominal pain. Nowadays a uniform approach to this pathology still is lacking. Although surgery can be carried out with satisfactory results in specialized centers, the specifical operation type should be tailored to every single cases.

Background: Primary hyperparathyroidism (PHPT) due to a parathyroid adenoma stands as one of the most prevalent endocrinological disorders, with focused parathyroidectomy being the established therapeutic strategy.

Aim: This study aims to investigate whether the volume of the pathological gland influences perioperative outcomes and postoperative morbidity.

Methods: A retrospective analysis was conducted on data from 141 patients who underwent focused parathyroidectomy for PHPT at the University Hospital of Basel between 2007 and 2022.

Results: A total of 141 patients underwent surgery, with a mean age of 57.2 years and prevalence of women (64.5%).The volume of the lesion was divided into three groups (low < 1 ml, middle 1-1.99 ml, large > 2 ml) based on pathological specimen analysis. Preoperative calcium and parathyroid hormone (PTH) values were significantly higher in the large volume group compared to the low volume group (p < 0.05), while phosphate and vitamin D values were significantly lower (p < 0.05). A comparison of adenoma volume in symptomatic patients with asymptomatic patients revealed no statistically significant difference (p = 0.845) and the volume of the gland of any group did not influence the length of the operation (p = 0.173) and the perioperative morbidity (p = 0.108).

Conclusion: Compared to a volume of less than 1 ml, a parathyroid gland volume greater than 2 ml was associated with higher preoperative PTH and calcium levels and lower phosphate and vitamin D levels. The volume of the parathyroid gland does not seem to impact the clinical manifestations, or the incidence of perioperative complications.

The presence of an aberrant right hepatic artery (a-RHA) could influence the oncological and postoperative outcomes after pancreaticoduodenectomy (PD). A comparative study was conducted, including patients who underwent PD with a-RHA or with normal RHA anatomy. The primary endpoints were R1 resection in all margins (pancreatic, anterior, posterior, superior mesenteric artery, and portal groove), overall survival (OS), and disease-free survival (DFS). The secondary endpoints were morbidity, mortality, biliary leak (BL), postoperative pancreatic fistula (POPF), delayed gastric emptying (DGE), post pancreatectomy hemorrhage (PPH), length of stay (LOS), and operative time (OT). The selection bias was measured using the d-value and limited using entropy balancing analysis. Patients with arterial variants were 84 (37.5%), 39 (17.4%) of whom had a-RHA from SMA. The patients with a-RHA were more frequently symptomatic (d = 0.652), often affected by PDAC (d = 0.369), and judged borderline resectable (d = 0.588). Neoadjuvant therapy was more frequently proposed for patients with a-RHA (d = 0.465). The patients with a-RHA often had the Wirsung dilated compared to those without a-RHA (d = 0.336). After bias correction, the R1 resection rate on the superior mesenteric artery (SMA) margin was higher in the a-RHA group than in patients with normal RHA anatomy (OR 2.3; 1.1-5.2; P = 0.045). OS, DFS, morbidity, mortality, biliary leak (BL), postoperative pancreatic fistula (POPF), delayed gastric emptying (DGE), post pancreatectomy hemorrhage (PPH), length of stay (LOS), and operative time (OT) were similar in unmatched and matched population. The presence of a-RHA seems to increase the risk of R1 resection in the SMA margin.