World Journal of Surgery最新文献

Introduction: Rectus diastasis of parity is the separation of the abdominal muscles that can occur after childbearing. We hypothesized that a subpopulation of women with rectus diastasis also present with back pain and/or urinary incontinence, a condition referred to as symptomatic established rectus diastasis, and this results in impaired health-related quality of life. This study identified the prevalence of symptomatic established rectus diastasis in primiparous women and measured their health-related quality of life.

Methods: Gravid nulliparous women over 18 years old were consecutively recruited from December 2021 to August 2022 and followed prospectively. Inter-rectus distances were measured with ultrasound in early pregnancy, and 6-week, 6-month, and 12-month postpartum. Patient reported outcome measures included the Oswestry Disability Index (ODI) for back pain, International Consultation on Incontinence Questionnaires Urinary Incontinence Short Form (ICIQ-UI SF) for urinary incontinence, and the 36-item short form (SF-36) for health-related quality of life.

Results: Two-hundred and thirteen women were recruited, of which 192 underwent ultrasound measurement in early pregnancy, 130 at 6-week postpartum, 120 at 6-month, and 109 at 12-month. There was a significant increase in mean inter-rectus distance over the study period (p < 0.001). The proportion of women with rectus diastasis at 12-month postpartum (> 30 mm) was 30.3% and compared to those without they had worse back pain (p = 0.014) but no difference in urinary incontinence (p > 0.05). Women with symptomatic established rectus diastasis at 12-month postpartum (rectus diastasis and back pain (ODI > 0)), made up 25% of the cohort and had significantly worse health-related quality of life than those without (p < 0.05). Predictive factors for symptomatic established rectus diastasis included increased total fetal birthweight (OR 3), lower maternal BMI (OR 1.2), and gestational diabetes (OR 6.7).

Conclusion: This study of gravid nulliparous women from early pregnancy until 12-month postpartum identified rectus diastasis in 30.3% and symptomatic established rectus diastasis in 25%. Women with symptomatic established rectus diastasis had significantly worse health-related quality of life.

Background: ROME IV diagnostic criteria describe functional gallbladder disorder as biliary pain in the absence of gallstones, supported by a low ejection fraction on gallbladder scintigraphy. However, clinicians have noticed histopathological analysis of gallbladders to intermittently reveal cholelithiasis. Our study aims to quantify this and to reduce misdiagnosis rates of functional gallbladder disorders.

Methods: We performed a single-center retrospective cohort study at St John of God Midland Hospital in Western Australia, Perth on 484 consecutive patients undergoing hepatobiliary iminodiacetic acid (HIDA) scan between November 1, 2015 and April 1, 2024.

Results: 5.6% (27/484) of patients had functional gallbladder disorder (FGBD) diagnosed preoperatively by ROME IV underwent cholecystectomy at our center. Of this, 18.5% (5/27) were noted to have histopathological cholelithiasis despite preoperative imaging suggesting otherwise. Of the 22 patients with true gallbladder dysfunction, 70% (7/10) had resolution of symptoms after cholecystectomy, with remaining 30% (3/10) experiencing persisting symptoms and referred on for further medical workup. 5 had private follow-up and 7 did not attend follow-up appointments. Ultrasonography had a sensitivity at 64% and specificity of 88% for identifying cholelithiasis, with a negative predictive value of 81.48%.

Conclusion: Functional gallbladder disorders remain a rare but not insignificant contributor to patients with undifferentiated abdominal pain. In the setting of microlithiasis, 1 in 5 patients will have gallstones missed on preoperative imaging. These emphases the importance of considering functional aspects of biliary pain in the absence of structural pathologies and being aware of the limitations of imaging to reduce the morbidity false negatives can confer.

Introduction: Postoperative nutrition after pancreatoduodenectomy (PD) remains controversial. Although many centers routinely place a feeding jejunostomy tube (FJT) after PD, it is associated with morbidity. We conducted this study to compare the perioperative outcomes with and without FJT placement post-PD.

Methods: This was an open-label randomized controlled trial, in which the FJT was placed in one arm and the nasojejunal tube (NJT) in the other. All patients with periampullary neoplasm who underwent pylorus resecting PD were included in this study. The primary outcome assessed was clinically relevant delayed gastric emptying (CR-DGE), and the secondary outcomes were clinically relevant postoperative pancreatic fistula (CR-POPF), postoperative complications, and hospital stay.

Results: Forty patients were allocated to the FJT and NJT groups, and the two groups were comparable in baseline demographics, disease characteristics, and perioperative outcomes, including CR-POPF rates. The FJT group had a significantly higher CR-DGE rate (55% vs. 25%, p = 0.006), required increased use of prokinetic drugs (77.5% vs. 45%, p = 0.003), and had a longer median postoperative hospital stay (11 vs. 9 days, p = 0.007). Both groups had similar tube-related complications. In the NJT group, 22.5% of the patients with CR-DGE required parenteral nutrition. On multivariate analysis, the presence of FJT [adjusted odds ratio (aOR), 6.030 (1.431-25.402), p = 0.014] and intra-abdominal collection [aOR, 7.108 (1.026-49.224), p = 0.047] were independent risk factors for CR-DGE.

Conclusion: Post-PD placement of FJT was an independent risk factor for CR-DGE. Hence, the routine use of the FJT can be omitted after PD without compromising postoperative morbidity and nutrition.

Trial registration: The trial was registered with the Clinical Trial Register with CTRI number: CTRI/2021/02/030942 (https://ctri.nic.in/Clinicaltrials/advancesearchmain.php).

Background: Robotic adrenalectomy (RA) is increasingly adopted, but its clinical value compared with laparoscopic adrenalectomy (LA) remains unclear. We assessed perioperative outcomes and the learning curve of RA.

Methods: A bicentric retrospective study included 228 patients who underwent adrenalectomy between 2013 and 2023 (97 RA, 131 LA). Primary outcomes were intra- and postoperative complications (Clavien-Dindo, Comprehensive Complication Index, CCI). Secondary outcomes included operative time and length of stay (LOS). Subgroup analysis evaluated tumors ≥ 6 cm. RA learning curve was assessed with cumulative sum (CUSUM) analysis.

Results: Patients in the RA group had higher ASA scores, more prior abdominal surgery, and larger tumors. Overall complication rates were similar (RA 18.6% vs. LA 17.6%, p = 0.846). RA was independently associated with shorter LOS (OR 0.48; 95% CI 0.26-0.84; p = 0.012). In tumors ≥ 6 cm, RA reduced postoperative complications (5.3% vs. 35.3%, p = 0.037). CUSUM analysis showed earlier improvements in operative time (after 25 cases) and later reductions in morbidity (after ∼ 45 cases).

Conclusions: RA is a safe alternative to LA even in complex patients. It shortens LOS overall and improves outcomes in large adrenal tumors. CUSUM analysis highlights a progressive but safe learning curve, supporting the integration of RA into endocrine surgical practice.

Background: Bone mineral density (BMD) measurement at the lumbar spine, femoral neck, total hip, and distal 1/3 radius is recommended for patients with primary hyperparathyroidism (PHPT). Osteoporosis at any site justifies surgery. The distal 1/3 radius is often neglected. This study evaluated the prevalence of distal 1/3 radius measurement, the proportion of osteoporosis at this site alone, and BMD changes 1 year post-parathyroidectomy in patients with PHPT.

Methods: A total of 548 patients who underwent parathyroidectomy for PHPT between 2016 and 2024 in University Hospital Center of Nantes (France) were reviewed. Patients without pre-surgery BMD measurements at the lumbar spine or the femoral neck were excluded. BMD was assessed via dual x-ray absorptiometry before and 12-months after surgery.

Results: Four hundred patients (mean age 63.3 ± 12.3 years, 80.5% female, and 86.2% menopausal) were included. Mean baseline serum calcium was 2.76 ± 0.19 mmol/L; median PTH was 99.2 pg/mL [76.1; 138.7]. Osteoporosis was present in 47.0% of patients. Distal 1/3 radius BMD was measured in 46.2%, identifying 11.4% with forearm-only osteoporosis. They were younger (60.6 ± 13.9 vs. 67.1 ± 10.2 years, p = 0.048), less frequently menopausal (66.7% vs. 95.9%, p = 0.001) and had higher calcium levels (2.88 ± 0.18 vs. 2.73 ± 0.20 mmol/L, p = 0.002) than the other osteoporotic patients. After surgery, BMD increased significantly at the lumbar spine (+0.06 g/cm²) and the total hip (+0.03 g/cm²), in a similar way to other osteoporotic patients.

Conclusion: After measuring distal 1/3 radius BMD, performed in < 50% of PHPT patients, it was identified that 11.4% patients had forearm-only osteoporosis, who could have a bone benefit from surgery. These findings emphasize the importance of systematic measurement during PHPT evaluation.

Trial registration: NCT05469087.

Background: Iliopsoas abscess (IPA), a purulent collection in the iliopsoas compartment, is an infrequent disease that is insidious, easily overlooked, life-threatening, and rarely diagnosed early due to nonspecific symptoms and signs. The classic triad of fever, flank pain, and hip movement limitation is present in only 30% of patients. Delays in treatment are followed by increased morbidity and mortality. The microbial etiology of IPA is variable and depends on the geographical area. IPA can be primary or secondary due to the origin of the infectious focus. This review aims to outline the current stage of knowledge of IPA, to emphasize its precocious recognition, and to provide a precise diagnosis using modern imaging according to the hospital patients are seen at, in an effort to reduce the delay in the diagnosis and treatment of IPA.

Methods: A comprehensive literature search was made from 1980 to December 2024 related to IPA published in English. Key words utilized were "iliopsoas abscess," "retroperitoneal infection," "psoas muscle disorder," "pyogenic psoas abscess," and "psoas abscess." A total of 247 papers were reviewed: 120 case reports, 33 short retrospective series of less than 15 patients, 20 large series with more than 50 patients, and 7 reviews. Additionally, 72 observational studies, 2 systematic reviews, and 2 prospective studies were reviewed. The inclusion criteria encompassed original and review articles published in English.

Conclusion: Since the description of IPA with isolated cases, then small series, and recently large retrospective reviews from major hospitals worldwide, the diagnosis and treatment of IPA have improved. With modern imaging techniques (US, CAT scan, and MRI), the diagnosis of IPA has increased, but sequential use of the aforementioned methods is not standardized; besides, there is no uniform treatment for IPA so far. Current management of IPA entails broad-spectrum antibiotics plus percutaneous or surgical drainage.

Introduction: Perioperative infection prevention and control (IPC) standards are known to reduce surgical site infections (SSI), but compliance is challenging. Clean Cut is a multimodal checklist-based quality improvement initiative to improve compliance with IPC standards. This study evaluates the impact of Clean Cut training workshops to improve IPC compliance when delivered as part of a bundled intervention.

Methods: From September 2021 to January 2023, nine Ethiopian hospitals received a bundled intervention that included educational workshops on the WHO Surgical Safety Checklist (SSC) and sterile reprocessing practices. Simultaneously, teams undertook a process mapping exercise of IPC standards to identify process gaps. We performed a time-series analysis to assess changes in compliance with the SSC, instrument, and linen reprocessing in the 4 months before and after the intervention. We calculated incidence rate ratios (IRR) of compliance and predicted the change in average weekly compliance.

Results: We observed 5821 operations, 2876 (49.4%) pre-intervention and 2946 (50.6%) post-intervention. Trends in SSC, instrument, and linen reprocessing compliance improved after the intervention. Average weekly SSC compliance improved 9.1% (RR: 1.09; 95% CI: 1.002-1.188; p = 0.044) while compliance with instrument reprocessing improved 12.1% (IRR: 1.12; 95% CI: 1.074-1.173; p < 0.001) and linen reprocessing 8.0% (IRR: 1.08, 95% CI: 1.017-1.147; p = 0.013).

Discussion: Workshop delivery coupled with process mapping of infection prevention standards was effective in improving compliance with the SSC and sterile reprocessing as part of a bundled intervention to reduce SSI. Observed improvements that temporally follow this work provide evidence of the value of this intervention.