World Journal of Surgery最新文献

Purpose: To investigate the incidence of the Sri Lankan pediatric population who seek emergency surgical services and who are subsequently at risk of impoverishment and catastrophic expenditure.

Methods: Prospective data collection at a tertiary pediatric Sri Lankan hospital of direct out-of-pocket (OOP) medical and nonmedical expenses related to pediatric surgical interventions. Catastrophic expenditure and risk of impoverishment were respectively described as expenses superior to 10% of household income and falling below the impoverishment line due to income drop. PPP = purchasing power parity: I$ 3.65, I$ 2.15, and national poverty line (NPL). Distribution of income were estimated using a gamma distribution.

Results: Two hundred and twenty pediatric patient surveys completed by carers were collected. Two hundred had complete data for analysis. Ninety-six patients required emergency procedures; the others underwent elective surgeries. The overall direct medical and nonmedical expenses (total direct = TD) mean per patient was I$116.6 and the overall indirect expenses mean per patient was I$94.9. 53.2% were affected by catastrophic expense. 85% (n = 170) of the study population was below the NPL. Receiving surgical care would impact up to 74.1% at the NPL threshold and up to 87.1% at the I$3.65 PPP/day limit.

Conclusions: If pediatric surgery care is required, 25.9% of the Sri Lankan population is at risk of impoverishment or catastrophic expenditure. There is need for financial aid.

Background: Postoperative delirium is a common complication after emergency surgery. Delirium is associated with increased morbidity and mortality. Clinical approach varies and pharmacological treatment is ineffective. We aimed to investigate if a structured non-pharmacological multidisciplinary intervention could reduce postoperative delirium.

Methods: An interventional study including all patients aged 65 years or older undergoing major abdominal emergency surgery in an 8 month period. The intervention consisted of improved screening, staff, patient, and family education, ward modifications and nurse-led daily motor and sensory stimulation. Data was obtained from medical records. Results were compared to an unmatched historic cohort. Primary outcome was occurrence of delirium, secondary outcomes were mortality, postoperative complications, and length of stay.

Results: 312 patients were included, 81 in the study group and 231 in the control group. Delirium occurred in 6.2% of the interventional group compared to 15.2% in the historic cohort (p = 0.038). In a multivariate regression analysis, the rate of delirium was significantly reduced in the interventional group; OR 0.185 95% CI (0.04-0.81), p = 0.026. The 90 day mortality was 14.8% in the interventional group and 8.7% in the historic cohort (p = 0.116). The rate of overall medical complications was significantly lower in the study group (37% vs. 63%, p < 0.001). Median length of stay was 6 days in both groups.

Conclusions: A structured cluster intervention may prevent the occurrence of postoperative delirium. The intervention did not reduce mortality or length of stay, but the need for supplementary nursing staff was eliminated.

Background: Percutaneous ultrasound-guided microwave ablation (MWA) for benign solid thyroid nodules is the newest modality for treatment. However, the differences in treatment outcomes between MWA and endoscopic thyroidectomy vestibular approach (TOETVA) for patients with benign euthyroid solitary nodules remain unknown. We are sharing initial results from our prospective study.

Methods: Prospective study between January 2022 and December 2023 was conducted and data were noted at 3 time points in patients planned for treatment (Preoperative, 1 week, and 12 months). Main outcome measures were clinical outcome and comparison of thyroid-related quality of life using the ThyPRO-39hin and swallowing-related quality of life using the SWAL-QoL.

Results: Of the 36 included patients, 20 patients underwent TOETVA and 16 underwent MWA. Both the groups were comparable in terms of demographic and clinicopathological profiles. The nodule volume reduction rate of patients at 12 months after MWA was 75.10% and 100% for TOETVA. The mean preoperative ThyPRO-39hin and SWAL-QoL scores were comparable in all domains between the two groups. Mean ThyPRO-39hin and SWAL-QoL scores on postoperative day 7 were significantly better in the MWA group in domains impaired social life (p < 0.0001) and impaired daily life (p = 0.0002). However, at the end of 12 months, mean ThyPRO-39hin and SWAL-QoL scores became significantly better in the TOETVA group as compared to the MWA group.

Conclusion: Our findings suggest that transoral endoscopic thyroidectomy results in significant superior clinical outcome, thyroid-related quality of life, and swallowing-related quality of life in the long term.

Background: The decision to perform segmental or extended colectomy in Lynch syndrome (LS) patients with colorectal cancer (CRC) is still controversial. Therefore, this systematic review and meta-analysis aims to provide updated evidence for segmental versus extended colectomy in LS carriers with CRC.

Methods: PubMed, Embase, and Cochrane Library were systematically searched for studies published until January 2024 comparing segmental and extended colectomies for CRC in patients with LS. Risk ratio (RR) was used to evaluate binary endpoints with 95% confidence intervals (CIs). Heterogeneity was assessed with the Cochran's Q test and I² statistics. Statistical analysis was performed using the R Software, version 4.2.3.

Results: A total of 14 studies comprising 2303 LS carriers with CRC, of whom 1724 (74.9%) patients underwent segmental colectomy and 579 (25.1%) patients underwent extended colectomy. Segmental colectomy significantly increased metachronous CRC (mCRC) (RR 2.87; 95% CI 2.03-4.07; and p < 0.01). There were no significant differences between groups for 5-year overall survival (OS) (RR 0.92; 95% CI 0.82-1.03; and p = 0.14), 10-year OS (RR 0.99; 95% CI 0.96-1.04; and p = 0.80), and mortality (RR 1.63; 95% CI 0.90-2.97; and p = 0.11). There were no significant linear associations between the outcome of mCRC and age at the time of primary CRC, sex, primary CRC location, and pathogenic LS variant.

Conclusion: In this meta-analysis, segmental colectomy significantly increased mCRC compared with extended colectomy after the first surgery for CRC in patients with LS. However, there were no significant differences between groups for 5- and 10-year OS and mortality.

Background: The aim of this study was to validate in 20-year follow-up (FU) the outcomes reported in World J Surg 2010; 34(6):1232-8 on recurrent nodular goiter in the contralateral thyroid lobe among patients after thyroid lobectomy (TL) for multinodular goiter (MNG) receiving versus not receiving postoperative prophylactic levothyroxine (LT4) treatment.

Methods: Some 150 consenting patients underwent TL for MNG in 2000-2003. They were randomized to two groups, 75 patients each: (a) receiving prophylactic LT4 treatment postoperatively (dose range 75-125 microg/day to maintain thyroid-stimulating hormone values within 0.27-1.0 mU/L), and (b) not receiving LT4. Sixty-month FU was extended to 240 months for all the consenting patients. The primary outcome was prevalence of recurrent goiter. The secondary outcome was re-intervention rate for recurrent goiter. The outcomes were stratified according to individual iodine metabolism status assessed by urinary iodine excretion.

Results: During the 5-year FU (5 patients were lost) recurrent goiter was found in patients receiving versus not receiving LT4 in 1.4% versus 16.7% (p = 0.001) whereas during 20-year FU (29 patients were lost) it was 3.3% versus 30.0% of patients, respectively (p = 0.031). During 20-year FU 4.9% versus 30.0%, respectively, of patients receiving versus not receiving LT4 required contralateral thyroid lobe treatment/surgery (p = 0.028). LT4 decreased recurrence rate among iodine-deficient patients (10.0% vs. 70.0%, respectively; p = 0.037) but not among iodine-sufficient patients (0.0% vs. 10.0%, respectively; p = 0.056).

Conclusions: Twenty-year FU data confirmed that prophylactic LT4 treatment significantly decreased the recurrence of nodular goiter and the need for completion intervention/surgery, mostly among patients with iodine deficiency.

Background: Neuropsychiatric disorders frequently manifest in primary hyperparathyroidism (PHPT), yet evidence of parathyroidectomy's benefit remains mixed. We sought to compare the incidence of neuropsychiatric disorders among patients treated with parathyroidectomy versus nonoperative management.

Methods: We retrospectively reviewed our institutional administrative database for patients with PHPT. Patients with secondary hyperparathyroidism were excluded. The date of biochemical diagnosis of PHPT was designated as day 0 and new-onset neuropsychiatric disorders were defined as conditions diagnosed after this date. The risk of new-onset neuropsychiatric disorders in propensity score-matched surgical and nonsurgical patients was compared using the Cox regression over a median follow-up of 4.2 years.

Results: Our cohort included 3728 patients, predominantly female (78%) and white (63.9%), with a mean (± Standard deviation) age of 62 ± 14 years. Of these, 1704 (45.7%) underwent parathyroidectomy. After propensity score matching and adjusting for clinical characteristics, patients who had parathyroidectomy showed a reduced hazard ratio (HR) for new-onset cognitive impairment (HR: 0.65, 95% CI: 0.47-0.91), somnolence (HR: 0.45, 95% CI: 0.23-0.9) and schizophrenia (HR: 0.08, 95% CI: 0.01-0.6), but not for anxiety (HR: 1.07, 95% CI: 0.83-1.37), depression (HR: 1.02, 95% CI: 0.77-1.36) or suicidal ideation (HR: 0.31, 95% CI: 0.04-2.71). Additionally, surgical patients were less likely to require inpatient care (0.3% vs. 1.8%, p < 0.001) for neuropsychiatric disorders.

Conclusions: Parathyroidectomy is associated with lower risks of new-onset cognitive impairment, schizophrenia, or somnolence, indicating potential benefit of operative management in improving neuropsychiatric symptoms in patients with PHPT.