Minerva Surgery最新文献

Introduction: The aim of this systematic review was to compare minimally invasive procedures versus excision and wound closure for the treatment of pilonidal disease (PD) in terms of perioperative outcomes.

Evidence acquisition: Search was performed in PubMed, Embase and Web of Science, founding 581 articles.

Evidence synthesis: Six articles published between 2018 and 2023, including 595 patients were included in the present systematic review. All of these studies presented endoscopic pilonidal sinus treatment (EPSIT) as the minimally invasive surgical technique for the treatment of pilonidal disease, while no articles meeting the inclusion and exclusion criteria addressed video-assisted ablation of pilonidal sinus. One hundred eighty-two patients (30.6%) underwent EPSIT (Group A), whereas 413 (69.4%) underwent excision and wound closure (Group B). Patients in Group A experienced shorter operative times (42.1±16 minutes) and hospital stay (0.5±0.3 days) in comparison to Groups B (59.3±19 minutes and 2.4±1 days, respectively). Group A had lower complication rate (12.5%) compared to Group B (35.2%) and recurrence rate (17.9% versus 14.8%). Wound dehiscence rate was 12.8% in Group B. Mean time to complete healing was longer in Group A than Group B (47.9±26.1 days and 39.1±22.3 days, respectively).

Conclusions: EPSIT requires approximately 9 additional days to fully heal, but it avoids the risk of wound dehiscence, and had fewer complications, along with a shorter hospital stay, compared to those treated with excision and wound closure. The choice of treatment should be personalized, considering the individual needs and specific risk factors for wound dehiscence.

Background: Elderly population has an increased risk of post-operative complications, therefore a precise and quick assessment of the expected risks allows a more aware decision on surgical indications. The American College of Surgeons NSQIP Surgical Risk Calculator (ACS-NSQIP SRC) is a practical tool that provides estimates of outcomes, however previous studies showed heterogeneous results. Our aim was to test its ability to correctly predict post-operative complications in a cohort of elderly patients who underwent major surgery in our Institution.

Methods: Data on consecutive elderly patients (≥75 years) that underwent major surgery (2022-2023) were retrospectively collected. The SRC was queried and the risk of post-operative complications, including geriatric outcomes, was obtained. Patients were divided into four groups based on CPT code. Observed and expected complication rates were compared.

Results: A total of 112 patients (50.9% female, median age 80 years, median BMI 28.8 kg/m²) were included and divided into groups (urgent 60 patients, colorectal 20, upper-GI resections 17 and benign upper-GI 15). In the urgent group, we observed a higher rate of serious complications (22 vs. 12.7, P=0.005), any complications (30 vs. 15.6, P<0.001) and superficial SSI (17 vs. 4.9, P<0.001) than the expected. Discharge to post-acute care facilities was over-estimated.

Conclusions: The ACS-NSQIP SRC demonstrated poor ability to predict post-operative complications and geriatric outcomes in our cohort of elderly patients. Our findings confirm other studies that temper the enthusiasm towards the NSQIP SRC as a practical tool to predict post-operative complications, especially in an urgent setting.

In the past, patients who underwent thoracic surgery were advised to rest, recover, and save energy, avoiding engaging in tiring physical activity. Postoperative rest-centered management of patients following anatomical resection can cause pulmonary and cardiovascular complications. Inability to cough, not deep breathing, dysfunctional diaphragm, pain and lying down cause lung atelectasis, pneumonia, and respiratory failure. Early postoperative mobilization's effects on mental or physical recovery and morbidity rate are unclear. Although advanced technological developments, thoracotomy is still the main incision for thoracic surgery. Lung resection and thoracotomy reduce the quality of patients' daily ambulatory activities. The exercise was shown to have anti-inflammatory effects. Anxiety, fear, and pain activate the same brain regions. Postoperative early mobilization could reduce anxiety and help to reduce the intensity of pain. Many different procedures that stop bed rest, start mobilization, and the walking distance or number of steps during postoperative the first mobilization are applied in the departments of thoracic surgery. How many meters the patient can walk and how many steps he/she needs to take are variable. Protocols to facilitate and enforce early mobilization would be beneficial. Early mobilization can reduce the rate of postoperative complications and length of hospital. Early mobilization as soon as possible within the first 24 h is supported as safe and acceptable in literature.

Introduction: Parastomal hernias (PSH) are a frequent complication following ostomy surgery, often requiring surgical intervention. Robotic surgery offers potential advantages in PSH repair, but evidence on its efficacy remains limited. This systematic review evaluates the outcomes of different robotic PSH repair techniques.

Evidence acquisition: A systematic search of PubMed, Embase, and Cochrane databases was conducted (2015-2024) to identify studies on robotic PSH repair. Fourteen studies (13 retrospective, two prospective) met the inclusion criteria after screening 324 articles.

Evidence synthesis: Data on patient demographics, surgical techniques, complications, recurrence rates, and follow-up duration were extracted. The analysis included 355 patients with a median follow-up of 12 months. Early studies focused on feasibility and safety, with subsequent research refining specific techniques like the Sugarbaker, Pauli, and keyhole repairs. Reported recurrence rates ranged from 0% to 9.5% across these techniques. However, 30-day complication rates varied significantly (0% to 50%), highlighting the need for standardized reporting and patient selection criteria. While some studies demonstrated low recurrence rates with acceptable complication profiles, others revealed higher complication rates, potentially related to specific techniques or patient factors. The emergence of variations within the Sugarbaker technique, such as the retromuscular approach with transversus abdominis release (TAR), demonstrates ongoing innovation in robotic PSH repair.

Conclusions: Robotic PSH repair shows promise, but further research is needed to confirm its long-term efficacy and cost-effectiveness.

Background: Point-of-care ultrasound (POCUS) is increasingly utilized in clinical medicine, yet its role in assessing normal postoperative bowel function remains underexplored, particularly after laparoscopic colorectal surgeries.

Methods: A prospective cohort study of 20 laparoscopic bowel resection patients was conducted, utilizing small bowel POCUS before surgery and daily from postoperative day (POD) 1 to POD 4. Small bowel width and a Small Bowel Motility Index (SBMI) were recorded in each examination. Statistical analyses involved repeated measures ANOVA to evaluate motility and width changes over study days.

Results: The small bowel motility index displayed statistically significant differences across the study days before surgery up to POD4 (P<0.001). Pairwise comparisons revealed significant differences between pre-surgery (10.58±1.31) and POD1 (8.20±2.30) with a mean difference of 2.38 (P=0.009). Subsequent days demonstrated significant differences between POD1 and POD3 (9.78±1.51) and POD4 (10.30±2.05) with mean differences of -1.58 (P=0.049) and -2.10 (P=0.029) respectively. In contrast, small bowel width did not exhibit statistical significance during this follow-up period (P=0.112).

Conclusions: Our findings underscore the dynamic nature of small bowel motility, highlighting its potential as a crucial parameter for postoperative assessment. Further larger studies with vareity of patients are warranted to explore the broader applications of small bowel POCUS in postoperative care.