World Journal of Surgery最新文献

Background: SPIO is increasingly popular in sentinel lymph node biopsy (SLNBx) because of its non-radioactive nature and logistical advantage. Previous studies have demonstrated non-inferiority of SPIO compared to conventional dual tracer technique in SLNBx for early breast cancers. Brown stain from SPIO raises esthetic concerns in breast conservative treatment (BCT). The aim of this study is to compare the staining outcomes of SPIO to conventional blue dye.

Method: This is a prospective study reporting the predefined secondary analysis of our previously conducted randomized controlled trial (Trial registration number NCT05288686). SPIO arm patients were given subareolar SPIO injections before operation, and control arm patients received blue dye and radioisotope injections. Patients receiving BCT were selected and assessed at follow-ups for skin stains up to 18-month postoperatively.

Results: One hundred and twelve patients and 113 SLNBx were included. Skin stains in both groups gradually decreased with time. SPIO group (61 SLNBx), as compared to control group (52 SLNBx), demonstrated larger incidence and size of skin stains throughout the study period (p < 0.001). The number of sentinel nodes (p = 0.03) and volume of lumpectomies (p = 0.034) were significantly correlated with skin stains at 18-month, that is, patients with more sentinel nodes harvested and larger volume of breast tissue resected have smaller stains by 18-month.

Conclusion: SPIO gives rise to higher incidence and larger skin stains compared to blue dye. Considerations should be given to cosmetic outcomes and shared decision-making be adopted whilst determining the optimal tracers in sentinel lymph node mapping.

Trial registration: The original randomized controlled trial was registered on ClinicalTrials.gov (NCT05288686).

Background: Anal sphincteroplasty (AS) was considered standard treatment for fecal incontinence (FI) associated with sphincter injury; however, long-term outcomes have been disappointing. Sacral neuromodulation (SNM) has proven effective for FI secondary to anal sphincter defects. This review aimed to assess outcomes of SNM in FI associated with anal sphincter defects and to compare outcomes to AS.

Methods: A PRISMA-compliant systematic review inquired PubMed and Scopus through January 2025 for studies that assessed SNM in FI secondary to anal sphincter defects. The primary outcome was continence improvement and change in baseline incontinence scores; overall complications were the secondary outcome. Random-effect meta-analyses were used to calculate pooled outcomes and odds of continence improvement after SNM compared to AS.

Results: Ten studies incorporating 779 patients (93.9% female; median age 54.5 years) were included. SNM was performed in 503 (64.5%) and AS in 265 (34%) patients. The weighted mean reduction in incontinence scores after SNM was 8.53 points (95% CI: 6.11, 10.96, p < 0.001) and the pooled rate of continence improvement was 66.7% (95% CI: 52.2%-81.1%). Previous sphincteroplasty, external sphincter defects > 120°, and low resting anal pressure were significantly associated with less continence improvement. Pooled complication and device removal rates were 18.5% (95% CI: 8.7%-28.2%) and 9.1% (95% CI: 3.4%-14.7%), respectively. SNM was associated with better continence improvement than AS (OR: 1.68, p = 0.006) with similar odds of complications (OR: 0.73, p = 0.763).

Conclusions: SNM was associated with a good improvement in FI associated with anal sphincter defects. However, a longer follow-up is required to ascertain these mid-term outcomes. There are not enough data to date to draw solid conclusions regarding the comparison between SNM and sphincteroplasty in patients with sphincter lesions.

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.

Background: The effect of topical intraoperative corticosteroid application on voice quality in thyroid surgery with preserved RLN remains unclear. This randomized controlled trial aimed to evaluate the efficacy and safety of this intervention.

Methods: Between January 2023 and June 2024, 134 patients scheduled for thyroid surgery were screened for eligibility. Patients who developed loss of signal (LOS) during surgery or who had postoperative impaired vocal cord motility on laryngoscopy were not included in the final analysis. Fourteen patients were excluded (six for previous thyroid/parathyroid surgery, four for preoperative vocal cord paralysis, and four for corticosteroid allergy), leaving 120 patients who were randomized equally to receive either topical intraoperative corticosteroids (n = 60) or standard treatment (n = 60). Baseline demographic and clinical data were comparable between the groups. Dynamic function of the larynx was monitored intraoperatively using electromyography (EMG), and vocal outcomes were assessed 1 week postoperatively using the Voice Handicap Index (VHI) and voice-related quality of life (V-RQOL). Laryngeal findings and adverse events were also recorded.

Results: No EMG signal was recognized in any patient. The EMG amplitudes and latencies of the vagus nerve (V1 and V2) did not differ significantly between the groups. EMG signal changes between V1 and V2 were observed in 16% of RLNs in the control group and in 18% in the corticosteroid group, but these were not associated with clinically significant decreases in amplitude or increases in latency. Postoperatively, the corticosteroid group had significantly lower (better) mean VHI scores (12.4 ± 3.2 vs. 19.6 ± 4.7; p < 0.01) and higher V-RQOL scores (88.3 ± 6.1 vs. 77.5 ± 8.8; p = 0.02) than the control group. The subgroup analysis of patients with EMG changes showed similar trends. Vocal fold edema occurred in 2 patients in the corticosteroid group and 5 in the control group, with complete resolution of stroboscopic abnormalities in all patients after 4 weeks. No local or systemic complications related to the use of corticosteroids were observed, and the postoperative courses were uneventful in both groups.

Conclusions: Topical intraoperative use of corticosteroids in thyroid surgery with preserved RLN is safe and associated with improved early postoperative voice outcomes. No significant adverse events were observed, and RLN function was preserved in all cases. Further studies are needed to assess the long-term clinical relevance of these results.

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=.