World Journal of Surgery最新文献

We describe a novel "Sleeve Colonoscopy" technique, a pragmatic approach to preserving surgical sterility during cases where on-table colonoscopy or enteroscopy is required. The sleeve of a readily available surgical gown is used to create a barrier between the sterile surgical field and the endoscopy equipment path via a colotomy or enterotomy.

Background: VHR is one of the most performed operations in the United States. The influence of surgeon age and experience on postoperative outcomes following VHR remains unclear. Our study aims to evaluate the effect of surgeons' age and experience on complications following open, laparoscopic, and robotic-assisted ventral hernia repairs (VHR).

Methods: A retrospective analysis of the Abdominal Core Health Quality Collaborative (ACHQC) database identified patients undergoing open, laparoscopic, or robotic VHR. Surgeons were categorized by age (30-39, 40-49, 50-59 and ≥ 60 years old) and experience. Experience was defined using estimated lifetime case volume.

Results: In open repairs, increasing age was associated with significantly higher odds of recurrence but lower odds of SSO. Experienced surgeons had higher odds recurrence (OR 7.1, p < 0.001), but lower odds SSO (OR 0.5, p < 0.001) and reoperation (OR 0.8, p = 0.001). In robotic repairs, increasing age was associated with significantly higher odds of recurrence and reoperation but lower odds of SSO. Experience was protective for recurrence (OR 0.7), SSO (OR 0.07), and reoperation rates (OR 0.006) (all p < 0.001). In laparoscopic repairs, age was not associated with odds of recurrence, SSO, or reoperation. Experienced surgeons had higher odds of recurrence (OR 3.5, p < 0.001) but lower odds of reoperation (OR 0.2, p < 0.001).

Conclusions: In open repairs, both age and experience were associated with lower odds of SSO; however, experience was associated with higher recurrence. Older surgeons had higher odds of recurrence in robotic repairs, whereas experience was protective. These findings suggest that targeted training and credentialing strategies that account for both age and procedural familiarity may help optimize patient outcomes across all hernia repair techniques.

Background: Recent retrospective and prospective studies have demonstrated the safety of delayed surgery for acute appendicitis. However, evidence regarding delayed surgery in elderly patients is limited, and it is unclear whether it is safe to delay appendectomy in this patient population.

Methods: The outcomes of patients aged 65 years and older who underwent appendectomy for suspected appendicitis at a single institution were reviewed and analyzed. The outcomes investigated were perforation rate and complication rate. Multivariable logistic regression analysis was performed to adjust for risk factors and calculate adjusted odds ratios (aOR) for in-hospital delay.

Results: A total of 525 patients aged 65 years and older underwent appendectomy for suspected appendicitis. The perforation rate was 44.4% (233 of 525) and the complication rate was 25.1%. The multivariable analysis showed no association between a waiting time of more than 12 h compared to less than 12 h and perforation rate (aOR 0.96; 95% CI 0.55-1.70; p = 0.90) or complication rate (aOR 0.93; 95% CI 0.49-1.76; p = 0.83). A risk factor for perforation in the multivariable analysis was an elevated CRP level ≥ 50 mg/L and risk factors for complications were suspected perforation on preoperative imaging (p = 0.004), anticoagulant use (p = 0.04), and CRP levels ≥ 150 mg/L (p < 0.001).

Conclusion: This large retrospective analysis showed that it is safe to delay surgery by 12 h in patients aged 65 years and older. Delayed surgery was not associated with a higher rate of perforation or complications after adjusting for risk factors. These results open the possibility of optimizing coagulation or possible comorbidities in elderly patients before surgery or postponing surgery when more critical cases require more urgent treatment. In patients with suspected perforation on imaging, the decision to delay surgery should me made with caution, taking into account the patient's overall presentation, comorbidities, and vital signs.

Introduction: Sutureless laparoscopic appendectomy is performed using energy devices for dissection of the mesoappendix as well as sealing the base of the appendix without any use of clips, ligature, or knots. The study attempted to explore the feasibility and safety of a conventional bipolar Maryland forceps in completing laparoscopic sutureless appendectomy without using any other advanced energy device.

Methodology: It was a randomized controlled trial conducted on 180 patients. It included patients with uncomplicated acute appendicitis. The patients were randomly divided into two groups and underwent laparoscopic appendectomy using endoloop or conventional bipolar electrosurgery using Maryland forceps.

Result: The mean age group of the study population was 26.21 ± 7.98 years. Mean operating time in the endoloop group was 29.36 and 23.10 min in the bipolar Maryland group (p = 0.339). The mean diameter of the excised appendix specimen was 7.27 ± 0.95 mm in the former group, whereas 7.48 ± 0.96 mm in the latter group (p = 0.266). There were no significant postoperative complications in either group.

Conclusion: It appears that sealing the appendicular base using conventional bipolar electrosurgery (Maryland) is safe and feasible without any significant complications and can be used conveniently in sutureless laparoscopic appendectomy.

Trial registration: CTRI number: 069386; https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=OTMyNTU=&Enc=&userName=.

Objective: This meta-analysis aims to evaluate the efficacy of adjuvant therapy (ADJ) in patients with resected invasive IPMNs, compared with follow-up (FUP).

Methods: A random effects meta-analysis was performed. Meta-regression analysis was used to clarify heterogeneity. The trial sequential analysis was used to test Type I and Type II errors, defining the required information size (RIS). The primary endpoint was OS, and the secondary endpoint was DFS.

Results: The accrued sample size (AIS) was 2422 patients for OS and 493 patients for DFS. OS and DFS in the ADJ arm were similar to the FUP arm (HR 1.21; 95% CI 0.81-1.79, p = 0.349 and HR 0.98; 95% CI 0.64-1.51, p = 0.936). The RIS were 2422 for OS and 254 for DFS, allowing the exclusion of Type II errors. For the primary endpoint, heterogeneity was high (I² = 98%). Meta-regression analysis showed that, although considering two groups equal for confounding covariates, OS in the ADJ and FUP arms remains similar. A subgroup analysis showed that node-positive patients have improved OS after adjuvant therapy administration (HR 1.86; 95% CI 1.39; 2.47, p < 0.001).

Conclusion: Adjuvant therapy should not be administered indiscriminately to all patients. Node-positive invasive IPMN seems to have an improved OS.

Trial registration: PROSPERO 2024 CRD42024561326.