World Journal of Gastrointestinal Surgery最新文献

Background: Hepatolithiasis is a common disease whose key treatment modality is hepatectomy. However, postoperative complications are common and can adversely affect the therapeutic outcomes. The analysis of clinical data is essential to prevent a poor prognosis following hepatectomy.

Aim: To determine the prognostic value of the neutrophil-to-lymphocyte ratio (NLR), albumin/alkaline phosphatase ratio (ALB/ALP), and total bilirubin (TBIL) levels in hepatolithiasis hepatectomy.

Methods: We retrospectively studied 135 patients with hepatolithiasis who underwent hepatectomy between March 2021 and August 2023. The patients were stratified into good and poor prognosis groups. We compared the general data and peripheral blood levels of NLR, ALB/ALP, and TBIL. Multivariate logistic regression was used to identify factors influencing poor prognosis, and the predictive value of these biomarkers was assessed using receiver operating characteristic (ROC) curve analysis.

Results: Of 135 patients, 41 had poor prognosis. Comparative analysis revealed this group had significantly higher proportions of patients with an American Society of Anesthesiologists (ASA) score ≥ grade II, intraoperative blood transfusion, and a history of hepatobiliary surgery. These patients also had a lower anatomical hepatectomy rate and significantly greater intraoperative blood loss (P < 0.05). Biochemically, the poor prognosis group exhibited an elevated NLR and TBIL levels, along with a significantly reduced ALB/ALP (P < 0.05). Multivariate analysis confirmed ASA ≥ II, anatomical hepatectomy, blood loss, transfusion, and surgical history as independent factors for poor prognosis. Furthermore, ROC curve analysis established that NLR, ALB/ALP, and TBIL levels were valuable predictive biomarkers for post-hepatectomy prognosis in patients with hepatolithiasis, demonstrating high efficacy when combined.

Conclusion: The independent risk factors for poor post-hepatectomy prognosis were identified as ASA ≥ II, non-anatomical resection, high blood loss, transfusion, and prior surgery; NLR, ALB/ALP, and TBIL also held predictive value.

Background: Hepatitis A virus (HAV) infection remains a significant cause of acute viral hepatitis globally, and the endemicity pattern is intermediate in Mexico. Although most cases follow a benign and self-limited course, less than 5% of patients with HAV infection progress to acute liver failure, which carries mortality rates of 13%-33% depending on access to liver transplantation (LT). The identification of clinical and biochemical predictors of adverse outcomes is crucial to improve early risk stratification, optimize patient management, and guide timely referral to transplant centers.

Aim: To assess the utility of clinical and biochemical variables and prognostic scores in predicting mortality and the need for LT in patients with acute HAV infection.

Methods: We conducted a retrospective case series of all patients hospitalized at Medica Sur Clinic between 2018 and 2024 who were positive for immunoglobulin M antibodies for HAV. Clinical and laboratory data were collected from patients' electronic medical records. Continuous variables were summarized as the means ± SD or median and interquartile range and compared using Student's t-test or the Mann-Whitney U test, as appropriate. Categorical variables were expressed as frequencies and percentages and compared using the χ ² test or Fisher's exact test.

Results: A total of 69 patients with HAV infection (mean age, 38 ± 11 years; 65% male) were included. 14% of patients had a history of hepatic steatosis, 10% had type 2 diabetes, and 45% were smokers. Acute liver injury was observed in 47 patients (68%), acute liver failure was detected in five patients (7.2%), and mortality or LT occurred in three patients (4.3%; two deaths and one transplant). Patients who died or required orthotopic LT were older, and they had higher heart and respiratory rates at admission. These patients additionally exhibited greater liver dysfunction, including higher bilirubin and transaminase levels, prolonged coagulation times, lower sodium and albumin levels, and worse albumin-bilirubin scores. Severity scores [model for end-stage liver disease (MELD), MELD with sodium, MELD version 3.0] were significantly higher in patients with complications than in those without complications.

Conclusion: Advanced age, elevated severity, and higher albumin-bilirubin scores emerged as predictors of adverse outcomes in patients with HAV infection, and consideration of these factors could guide the need for more intensive monitoring strategies. These findings highlight the importance of incorporating prognostic scoring systems into routine clinical evaluation to improve outcomes in high-risk patients.

Background: Anorectal abscess and cryptoglandular anal fistula are common conditions with high recurrence rates, reflecting an incomplete understanding of their pathophysiology. A classic, yet unproven hypothesis proposes that high androgen levels increase infection risk by stimulating anal gland secretion, potentially explaining the male predominance. However, direct evidence regarding sex hormone levels in patients remains scarce. We hypothesized that active perianal infection is associated with significantly altered testosterone (T) levels.

Aim: To investigate the association between perianal diseases and sex hormone levels and to identify factors associated with T levels.

Methods: This cross-sectional study included 249 men: 64 with hemorrhoids, 64 with anorectal abscess, and 121 with anal fistula. Preoperative serum sex hormone levels were measured. Multivariate linear regression identified factors associated with T levels.

Results: There were no significant differences in age among the three groups at baseline. T levels differed significantly among the groups (P < 0.001). Multivariate regression analysis revealed that in the overall study population, anorectal abscess (B = -2.999, P < 0.001) and body mass index (BMI; B = -0.368, P < 0.001) negatively correlated with T levels. In the abscess group, white blood cell count (B = -0.565, P < 0.001) and BMI (B = -0.298, P = 0.011) negatively correlated with T levels. In the fistula group, BMI (B = -3.866 P < 0.001) and internal opening above the dentate line (B = -4.479, P = 0.048) were associated with lower T levels.

Conclusion: Patients with active perianal infections exhibited a significantly lower T level compared to those with hemorrhoids or fistulas, which is independently associated with systemic inflammation severity and obesity.

Background: Intestinal obstruction, characterized by the impaired transit of intestinal contents due to various etiologies, constitutes a prevalent surgical emergency. In certain cases, surgical intervention becomes imperative, wherein intraoperative intestinal decompression is frequently necessitated. Ensuring effective decompression while minimizing contamination of the operative field constitutes a pivotal step that exerts a direct influence on postoperative outcomes.

Aim: To assess the clinical efficacy of cannula-assisted decompression techniques employed during intraoperative intestinal decompression procedures.

Methods: A retrospective cohort analysis of 70 patients diagnosed with small bowel obstruction and treated at the Department of General Surgery, Anqing Municipal Hospital, between January 2023 and November 2024 was performed. Of these patients, 37 underwent cannula-assisted decompression, while 33 received conventional enterotomy decompression. The clinical utility of the cannula-assisted technique was evaluated by comparing intraoperative variables and postoperative recovery indicators between the two cohorts.

Results: The cannula-assisted group exhibited statistically significant advantages over the conventional decompression group in terms of reduced operative duration for intestinal decompression, increased volume of evacuated intraluminal contents, and diminished contamination of the surgical field (P < 0.05). Furthermore, this group demonstrated enhanced postoperative recovery, as indicated by a more rapid return of bowel function - reflected in shortened time to first flatus - and a lower rate of incisional infections relative to the conventional decompression group (P < 0.05).

Conclusion: The application of cannula-assisted decompression techniques effectively facilitates intraoperative decompression of the small intestine, reduces procedural duration, mitigates surgical field contamination, and expedites postoperative recovery.

Background: Acute appendicitis is a common surgical emergency, and appendectomy is essential to prevent complications such as perforation and peritonitis. Although the procedure is routine, outcomes may be affected by surgery timing, staffing, and hospital resources. Evidence on whether off-hour operations increase complications is conflicting. This study aimed to assess whether laparoscopic appendectomy performed during weekday in-hours, after-hours, or holiday periods influences postoperative outcomes.

Aim: To investigate clinical outcomes of laparoscopic appendectomy performed during weekday daytime, weekday evening, and weekends or holidays.

Methods: The data of 977 patients who underwent laparoscopic appendectomy in a high-volume tertiary hospital between January 1, 2024, and December 31, 2024, were recruited. Patients were divided into three groups including surgeries during regular weekday in-hours (group 1), during weekday after-hours (group 2) and during weekends or extended holiday periods (group 3). Demographic, peri-, and postoperative data were compared.

Results: There were no significant differences in operative time, conversion to open surgery, or complication rates between all groups. However, patients in the weekend/holiday group had significantly shorter time to surgery (median: 584 minutes vs 589 minutes vs 535 minutes, P = 0.002), and patients in the weekday in-hours group had significantly longer hospital stays than the other groups (median: 2 days vs 1 day vs 1 day, P < 0.001). No mortality occurred in any group.

Conclusion: In a well-staffed center, laparoscopic appendectomy during weekends or holidays is safe and may offer faster surgical access. Delay to surgery, not the working hour, is the main factor affecting outcomes.

Background: Perianal abscesses (PAs) are associated with significant complications, such as recurrent infections, pain, anal fistulas, rectovaginal fistulas, rectourethral fistulas, and rectovesical fistulas. However, established primary and secondary prevention strategies for PAs are lacking.

Aim: To explore the relationships between obesity and lipid metabolites, including perianal abscess onset.

Methods: We conducted two independent studies under a unified research question. Case-control analysis was conducted at a single hospital between May 2023 and November 2023. Inpatients diagnosed with a perianal abscess and matched healthy controls were included. Body dimensions and serum metabolites were measured. Genome-wide association study data regarding genetic variants of PAs, obesity, and serum metabolites were obtained for the Mendelian randomization (MR) analysis. The study outcomes were perianal abscess onset and the number and location of PAs.

Results: In the case-control study, higher body mass index (BMI), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), blood glucose levels, uric acid (UA) levels, total cholesterol levels, triglyceride levels, and low-density lipoprotein (LDL) levels were associated with increased risk of PAs. Higher high-density lipoprotein levels were associated with reduced risk of PAs. The BMI, WHR, WHtR, UA level, triglyceride level, and LDL level were associated with the number and severity of PAs. In MR analysis, the BMI, WHR, body fat percentage, whole body fat mass, limb fat percentage, limb fat mass, and various lipid profiles were significantly associated with the risk of PAs.

Conclusion: A hospital-based case-control study and an independent MR analysis consistently support obesity and lipid metabolism profiles are associated with an increased risk of perianal abscess. These findings provide a basis for developing primary and secondary prevention strategies for perianal abscess.

Background: Traditional laparoscopic total mesorectal excision (LaTME) presents challenges in patients with low rectal cancer, including difficult surgical exposure and positive margin risks.

Aim: To compare the short-term outcomes of laparoscopic-assisted transanal total mesorectal excision (TaTME) and LaTME for mid-to-low rectal cancer.

Methods: A retrospective analysis of 138 patients with rectal cancer was conducted, and they were divided into the TaTME group (n = 66) and the LaTME group (n = 72). Surgical indicators, pathological outcomes, recovery parameters, inflammatory markers, and anal function were compared.

Results: The two groups showed comparable baseline characteristics (P > 0.05). The TaTME group demonstrated superior intraoperative performance with significantly less blood loss (78.4 ± 28.6 mL vs 118.7 ± 35.2 mL, P < 0.001), reduced hemoglobin decrease (18.3 ± 8.7 g/L vs 26.8 ± 12.4 g/L, P = 0.002), and lower vasoactive drug requirement (6.1% vs 15.3%, P = 0.044). Pathologically, TaTME achieved better oncological outcomes including lower circumferential resection margin-positive rate (4.5% vs 13.9%, P = 0.032), higher lymph node harvest (17.8 ± 4.6 vs 15.2 ± 4.1, P = 0.001), and improved complete total mesorectal excision rate (89.4% vs 77.8%, P = 0.048). The TaTME group exhibited accelerated gastrointestinal recovery with shorter times to first flatus (2.1 ± 0.8 days vs 2.8 ± 1.2 days, P = 0.001) and reduced hospital stay (7.8 ± 2.1 days vs 9.4 ± 2.8 days, P = 0.001). Inflammatory markers were significantly lower, including postoperative day 2 interleukin (IL)-6 (42.6 ± 12.8 pg/mL vs 56.3 ± 15.7 pg/mL, P < 0.001) and C-reactive protein peaks (68.4 ± 18.2 mg/L vs 89.7 ± 24.6 mg/L, P < 0.001). Multivariate analysis revealed TaTME as an independent protective factor for good anal function (odds ratio = 0.234, P = 0.003), while tumor distance ≤ 2 cm, elevated IL-6, and neoadjuvant therapy were risk factors. These findings demonstrate TaTME's advantages in surgical safety, oncological quality, postoperative recovery, and functional preservation.

Conclusion: TaTME demonstrates superior short-term outcomes in surgical safety, oncological quality, and functional recovery to LaTME, warranting clinical promotion.

Background: Hepatic epithelioid angiomyolipoma (HEAML) is rare subtype of perivascular epithelioid cell tumor that is typically benign but has malignant potential. Misdiagnosis is common due to imaging similarities with other hypervascular hepatic neoplasms, such as hepatic hemangioma and hepatocellular carcinoma. An early biopsy should be considered when radiological findings raise suspicion of HEAML. A definitive diagnosis requires a histopathological assessment and immunohistochemical profile that confirm positivity for human melanoma black and smooth muscle actin and negativity for S-100.

Case summary: This article presents a case of multifocal HEAML in a 37-year-old woman. Five years prior, abdominal ultrasound incidentally detected two hyperechoic lesions in the liver, which were initially diagnosed as hemangiomas and managed with routine imaging surveillance. At a recent follow-up, the progressive enlargement of both lesions was noted, and contrast-enhanced computed tomography raised the possibility of AML. The patient had a laparoscopic procedure to remove the tumor in the left liver lobe after the lesion progressed. Postoperative histopathological analysis confirmed the diagnosis of HEAML. Transarterial embolization was chosen as an alternative to surgical resection because of the high operative risk associated with the proximity of the right lobe lesion to the hepatic hilum. The patient had an uneventful recovery, and no recurrence was detected at follow-up.

Conclusion: Surgical resection combined with interventional embolization has proven effective for managing multifocal HEAML, a rare tumor with a high risk of misdiagnosis.

In the case of acute perforated cholecystitis, rapid control of the infection site is important for patient outcomes. For free perforation with generalized peritonitis, emergency laparoscopic cholecystectomy remains the gold standard therapy. Percutaneous transhepatic cholecystostomy (PTC) is an alternative damage-control option, particularly for frail, septic, or profoundly comorbid patients, either as a bridge to (early or interval) cholecystectomy or, in truly inoperable patients, as definitive palliation. Gallbladder perforations are categorized on the basis of the Niemeier classification. The therapeutic modality depends on the type of perforation. In this editorial, we present the actual guidelines and the findings from trials related to this issue. Moreover, we propose a pragmatic pathway that is based on clinical evidence. The following research gaps are identified: Randomized controlled trials aiming to compare emergency laparoscopic cholecystectomy with PTC as a bridge in cases of Niemeier I and Niemeier II disease are lacking; there are no standardized criteria for the use of PTC as a definitive therapy, such as frailty, sarcopenia or other markers; and there are no comparative studies of endoscopic ultrasound-guided gallbladder drainage vs PTC in cases of perforation.

The study conducted by Martli et al, on the preoperative risk stratification of malignant potential in pancreatic cystic neoplasms (PCNs), identifies age and red cell distribution width (RDW) as independent predictors. This study offers a simple and cost-effective clinical tool for preoperative assessments. The significance lies in its integration of routine laboratory parameters with clinical features, effectively addressing the limitations associated with the accessibility and operator dependency of imaging and invasive diagnostic methods. However, factors such as the retrospective design, single-center setting, small sample size, and selection bias because of the inclusion of only surgical cases limit the generalizability of the findings. Future studies should emphasize multi-center prospective validation to further clarify the biological role of RDW in the malignant transformation of PCNs and to explore integrated models that combine RDW with imaging characteristics and molecular biomarkers, ultimately enhancing precision in individualized clinical decision-making.