Minerva Surgery最新文献

Introduction: Amyand's hernia (AH) is a relatively rare type of inguinal hernia, characterized by the presence of the appendix inside the hernia sac. The aim of this study is to examine the role of prosthetic mesh in AH repair compared to the traditional suture repair techniques regarding safety, efficacy and various postoperative complications.

Evidence acquisition: A systematic review of MEDLINE via PubMed, Scopus and Google Scholar was performed, aligned with the PRISMA guidelines. All studies in English language reporting AH repair using mesh or suture techniques in adults including more than 5 patients were included.

Evidence synthesis: Twelve studies reported a total of 123 patients with AH, 58 of which were repaired using prosthetic mesh and 71 with traditional suture techniques. The overall presence of an inflamed appendix was 58.5%. Appendicitis was present in 12.7% of the mesh repair group compared to a 95.5% of the suture repair group. Surgical site infections (SSIs) were 3.4% of all complications in the mesh group compared to 6.8% in the suture repair group. Extended hospital stay of more than 10 days was observed in 12.7 in the mesh group compared to 7.3% of the suture repair group.

Conclusions: The most technically challenging cases with septic conditions are appropriate for suture repair only, while mesh repair is usually performed in AH cases without appendix inflammation and is more commonly used in conjunction with appendix reduction into the abdominal cavity rather than appendicectomy.

Background: Portal hypertension (PH) is a critical condition often managed through surgical interventions such as transjugular intrahepatic portosystemic shunt (TIPS). Conventional portal pressure monitoring relies on invasive measurements, necessitating alternative approaches. Subharmonic-aided pressure estimation (SHAPE) technology offers a noninvasive method utilizing contrast-enhanced ultrasound, potentially reducing procedural risks. This study evaluated the clinical utility of SHAPE in assessing portal hypertension and monitoring hemodynamic changes pre- and post-TIPS placement.

Methods: A total of 23 patients with PH underwent direct portal vein pressure (PVP) measurement, and SHAPE was performed for noninvasive estimation. Six patients who underwent TIPS received SHAPE evaluations before and after the procedure. Agreement and correlation between SHAPE and PVP were analyzed.

Results: SHAPE demonstrated a strong correlation with PVP (P<0.001), with significant changes observed post-TIPS (P=0.011). These findings suggest SHAPE as a valuable tool for noninvasive monitoring of PH and evaluating TIPS efficacy.

Conclusions: SHAPE technology presents a promising noninvasive alternative for assessing portal hypertension in surgical settings. It offers a safer and efficient approach to monitoring hemodynamic changes, particularly in patients undergoing TIPS, potentially reducing reliance on invasive procedures.

Background: To achieve an equilibrium a balance between nociception and antinociception, a suitable depth of anesthesia is essential. The Surgical Pleth Index (SPI) and entropy measurements, which consist of response entropy (RE) and state entropy (SE), serve as tools to assess the level of pain perception during surgical procedures. Research has indicated that the SPI is a more dependable instrument than the RE-SE difference for evaluating pain perception under sevoflurane-remifentanil anesthesia. Nevertheless, the effectiveness of the SPI and RE-SE difference in gauging noxious stimuli under propofol-remifentanil anesthesia is still uncertain. The objective of this study is to compare the sensitivity and dependability of the SPI and RE-SE difference in evaluating noxious stimuli during general anesthesia maintained with propofol and remifentanil.

Methods: Thirty patients were administered incremental remifentanil effect-site concentrations (CeREMIs) of 0, 2, and 4 ng/mL under propofol-remifentanil anesthesia. A standardized noxious stimulus was applied for 30 seconds at each CeREMI level. Data regarding changes in the SPI, RE-SE difference difference, RE, SE, heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure were collected for each patient both before and during the stimulus. Receiver operating characteristic curves were analyzed to assess the predictive ability of these indicators for nociceptive stimuli.

Results: Under propofol-remifentanil anesthesia, the change in the SPI value gradually decreased in accordance with the CeREMI increase under the same intensity of nociceptive stimulation. Compared with the other indicators, the SPI demonstrated greater reliability in assessing noxious stimulation, exhibiting the highest combination of sensitivity and specificity.

Conclusions: In the context of this study, the SPI proved to be a superior indicator compared to the RE-SE difference for monitoring nociception during propofol-remifentanil anesthesia.

Introduction: Emergency resuscitative thoracotomy (ERT) is a potentially life-saving procedure for selected trauma patients presenting in extremis with pending or already witnessed cardiopulmonary collapse. Outcome mostly in blunt trauma is believed to be poor. Our aim was to identify all studies reported over the past fourteen years and compare reported outcomes for blunt trauma.

Evidence acquisition: We performed a systematic literature search according to PRISMA guidelines (from January 1^st, 2010 to May 31^st, 2024). Qualitative comparison of studies and outcomes was done.

Evidence synthesis: A total of 22 articles were included for an overall number of 6315 ERT for blunt trauma. Male-to-female distribution was 3:1. The collectively reported overall survival was 4.5%. Mean age varied from lowest at 32.4 years to highest at 53 years. Neurological outcome was reported in 6 of 21 studies; among this six publications, just one reported neurological outcome using the Glasgow Outcome Scale (GOS). Heterogeneity in the studies prevented outcome analyses by formal quantitative meta-analysis.

Conclusions: The reported outcome after ERT for blunt trauma is not favorable, with an extremely low survival rate highlighted in most studies. Multicenter, prospective, observational data are needed to validate the modern role of ERT in blunt trauma.

Background: This study was to evaluate the application of ERAS in pediatric patients undergoing tonsillectomy and adenoidectomy.

Methods: Sixty patients were randomly divided into ERAS and control group. Patient outcomes, including hospital stay, operation time, bleeding volume, total cost, complications, m-YPAS, FLACC, and RSAS were observed.

Results: The length of hospital stay, total cost, and the incidence of postoperative nausea and vomiting in the ERAS group were significantly lower than those in the control group. The RSAS score, m-YPAS and FLACC score of the ERAS group were lower than those of the control group.

Conclusions: Our study shows that the application of ERAS can reduce hospital charges and postoperative pain from tonsillectomy and adenoidectomy in children.

Introduction: Pancreatic operations can be regarded as the most complex and high-risk procedures, with robotic approaches offering improved outcomes. This systematic review aimed to evaluate the impact of Body Mass Index (BMI) on perioperative outcomes in robotic pancreaticoduodenectomy (RPD) and robotic distal pancreatectomy (RDP).

Evidence acquisition: Articles published from 2000 to 2024 were sourced from PubMed and Google Scholar using relevant keywords, with inclusion criteria focusing on robotic procedures involving at least 30 patients and BMI classification. Studies using non-robotic approaches were excluded unless used for comparison. Of 17,187 articles identified, 11 met the inclusion criteria. The risk of bias was minimized through dual independent reviewers, adhering to the PRISMA checklist.

Evidence synthesis: Overall, 4645 patients (1501 RPD and 3144 RDP cases) were analyzed and highlighted some BMI-associated challenges, including longer operative times and increased postoperative complications in obese patients. However, robotic techniques were found to mitigate some of these issues, demonstrating reduced blood loss, lower conversion rates, and faster recovery compared to open or laparoscopic methods.

Conclusions: Results showed that robotic approaches improved surgical safety and efficacy, even in patients with BMI >25 kg/m², supporting their use in high-risk populations. Despite limited available studies, findings highlight the need for further research on BMI's influence in robotic pancreatic operations to optimize patient outcomes and refine clinical practices.

Background: Pancreatoduodenectomy (PD) is one of the most challenging surgical procedures among abdominal surgeries. The most common complication after PD is postoperative pancreatic fistula (POPF), which can be severe and entail other complications, such as post-pancreatectomy hemorrhage (PPH), which can be fatal. Several surgical techniques have been proposed to reduce the incidence of POPF and PPH.

Methods: In this study, we describe inframesocolic pancreatic anastomosis, which involves segregating the pancreatic anastomosis into the inframesocolic area by mobilizing the pancreatic remnant and creating a small window into the transverse mesocolon.

Results: This surgical technique was performed in 17 patients, with promising results in terms of delayed PPH prevention. In particular, we had only one case of PPH that was successfully treated by placing a stent into the SMA. No other bleeding events were reported, even in cases of anastomotic leakage.

Conclusions: In the context of mitigation strategies, this technique might be efficient in reducing the incidence of delayed PPH due to leakage of pancreatic juice into the supramesocolic area and consequent vascular erosion.