World Journal of Surgery最新文献

The double-stapled technique is the most common method of colorectal anastomosis. Despite its widespread use, emerging data suggests that this technique may be a risk factor for anastomotic complications, as it is believed that crossing staple lines and resultant dog-ears are potentially weak points that are prone to ischemia and anastomotic leak. Herein, we describe technical variations of single-stapled colorectal anastomoses which surgeons can readily adopt and integrate into their armamentarium of anastomotic techniques.

Background: The aim of this study was to elucidate the clinical impact of the CALLY index in patients with gastric cancer (GC) undergoing gastrectomy.

Methods: Between January 2014 and December 2020, 617 patients who underwent gastrectomy for GC at the Osaka City General Hospital were enrolled in this study. The CALLY index was calculated using the following formula: [albumin (g/dL) × lymphocytes (/μl)]/[CRP (mg/dL) × 10⁴]. We compared the predictive value of four biomarkers [CALLY index, modified Glasgow prognostic score (mGPS), neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR)] for short- and long-term outcomes and focused on the CALLY index to elucidate its clinical value.

Results: Receiver operating characteristic analysis showed that the area under the curve for the CALLY index was the highest among the four biomarkers. The 5-year overall survival (OS) and cancer-specific survival (CSS) rates in the low and the high CALLY groups were statistically significant. Multivariate analysis identified the CALLY index as an independent factor for OS and CSS but not NLR or PLR. The mGPS was an independent factor for OS but not for CSS in multivariate analysis. Regarding complications, only the CALLY index was an independent predictor of major complications (≧ Clavien-Dindo grade 3) in multivariate analysis but not others.

Conclusions: The CALLY index may have a clinical value in predicting OS, CSS, and major complications in GC patients undergoing gastrectomy.

Background: Remote-access thyroidectomies have gained popularity, but track recurrence, which is the implantation of thyroid tissue or lesions along the surgical access route, has been reported in case studies. This systematic review aims to review cases of track recurrence following remote-access thyroidectomies.

Methods: A comprehensive literature search was conducted using PubMed, the Web of Science, the Cochrane Library, and Google Scholar to identify case reports on track recurrence after endoscopic or robotic thyroidectomy up to June 2024. Data included patient demographics, details of the initial surgery and diagnosis, methods and timing of recurrence detection, and management strategies.

Results: The search yielded 1578 articles, of which 17 case reports comprising 18 patients were included. The patients (16 females and two males) had a mean age of 34.6 ± 14.9 years. The mean size of initial tumors was 3.9 ± 1.2 cm, with diagnoses of eight cancers and 10 benign lesions. The initial surgeries included 12 endoscopic and six robotic procedures. Track recurrence was most often detected by palpable nodules followed by routine imaging and elevated serum Tg levels. The interval between initial surgery and recurrence ranged from 3 months to 8 years. Management varied from surgical resection and radioactive iodine therapy to close observation. There were no further recurrences in all but one case postoperatively.

Conclusion: Track recurrence after remote-access thyroidectomy is rare but significant. Proper surgical techniques, careful handling of thyroid tissue, and rigorous postoperative monitoring are essential to minimize this risk. Awareness and prompt management of track recurrence may lead to favorable outcomes.

Background: The Lichtenstein technique is the gold standard for adult open inguinal hernia repair with mesh. The Desarda technique emerged in 2001 as a novel, promising non-mesh technique that has demonstrated low recurrence and postoperative complications.

Methods: We searched MEDLINE, the Cochrane Central Register of Clinical Trials, and Embase for randomized controlled trials (RCT) published until April 2024. Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Heterogeneity was assessed using Cochran's Q test and I² statistics, with p-values <0.10 and I²>25% considered significant. Statistical analysis was performed using the R software, version 4.1.2.

Results: Eighteen RCTs comprising 1756 patients were included, of whom 861 (49%) were submitted to Desarda and 895 (51%) were submitted to Lichtenstein. Desarda was associated with lower seroma rates (OR 0.55; 95% CI 0.35-0.89; and p = 0.014), less operative time (MD -8.6 min; 95% CI -14.5 to -2.8; and p < 0.01), lower postoperative pain on day one (MD -1.3 VAS score; 95% CI -2.3 to -0.3; p < 0.01) or chronic pain (OR 0.32; 95% CI 0.12-0.88; and p = 0.028), and faster return-to-work activities (MD -2.1 days; 95% CI -3.7 to -0.6; and p < 0.01). The recurrence rate was 1.4% for Desarda versus 2.1% for Lichtenstein, with no statistical difference between techniques.

Conclusion: In this meta-analysis, Desarda significantly decreases seroma operative time, postoperative pain on day 1, chronic pain, and return-to-work activities.

Background: Comprehensive studies on priority areas for improving geriatric surgery outcomes, inclusive of geriatric-pertinent data, are limited.

Methods: The ACS NSQIP geriatric database (2014-2018) was used to abstract older adults (≥65 years) undergoing inpatient general surgery procedures. Thirty-day complication, functional decline, and mortality rates were analyzed, with a focus on two geriatric-pertinent complications: delirium and new/worsening pressure ulcers.

Results: There were 9062 patients; 41.9% were ≥75 years. Mean age was 73.9 years. The majority of patients were female (54.0%), White (77.7%), and had independent functional status before surgery (94.0%). Overall 30-day complication, functional decline, and mortality rates were 33.6%, 34.5%, and 3.5%, respectively; failure to the rescue rate was 9.7%. Including geriatric-pertinent complications increased the overall complication rate by 20.4%. Delirium emerged as the leading complication (11.9%), followed by bleeding (11.1%), and wound-related complications (10.1%); these three accounted for 53.7% of complications. Delirium and pressure ulcers were associated with a >50% rate of postoperative functional decline (52.0% and 71.4%, respectively); pressure ulcers were also notable for a 25.5% failure to the rescue rate. Both were also among complications most likely to occur following the 3 most common procedures (colorectal surgery, pancreatic resections, and exploratory laparotomy), which overall accounted for approximately 79.6% of complications, 73.4% of patients experiencing functional decline, and 82.3% of mortality.

Conclusions: Delirium is the leading complication among older adults undergoing inpatient surgery. Overall, a small number of complications and procedure groups account for most surgical morbidity and mortality among older adults and thus constitute priority areas for outcomes improvement.

Background: Surgeons are sometimes reluctant to manage uncomplicated appendicitis non-operatively. Reasons cited include the risk of recurrent appendicitis and the risk of missed appendiceal malignancy. The aim of this study was to address these uncertainties and determine the long-term efficacy of antibiotic versus operative management of appendicitis.

Method: One-year follow-up of patients enrolled in the multicentre, COVID:HAREM cohort study during March-June 2020 was performed. Initial operative or non-operative management was determined on a case-by-case basis by the responsible surgeon. Outcomes were appendicectomy rate at 1-year, histology of removed appendix and predictors of unsuccessful antibiotic treatment.

Results: A total of 625 patients who had non-operative management were included. Emergency appendicectomy had been performed by 1-year in 24% (149/625), with a median time to appendicectomy of 12 days [IQR 1-77] from presentation. Thirty-one patients had elective appendicectomy. Normal histology was reported in 6% of emergency procedures and 58% of elective ones. There were 7 malignancies and 3 neuroendocrine tumors identified at histology. All patients with malignant histology had ≥1 risk factors for malignancy at initial presentation. Faecolithiasis (hazard ratios (HR) 2.3, 95% confidence intervals (CI) 1.51-3.49) and a high Adult Appendicitis Score (AAS >16; HR 2.44, 95% CI 1.52-3.92) were independent risk factors for unsuccessful non-operative management.

Conclusion: At 1 year, 71% of patients managed non-operatively did not undergo an appendicectomy. Recurrence of appendicitis was associated with faecolithiasis and a high AAS. Patients at higher risk for appendiceal malignancy should have targeted follow-up. These factors should be considered when counseling patients on non-operative management.