Minerva Surgery最新文献

Stoma surgery is frequently used to treat conditions such as colorectal cancer and inflammatory diseases. While it can extend patients' lives, it often introduces challenges that negatively affect quality of life. Convex skin barriers are commonly recommended for managing flat or retracted stomas and addressing irregular peristomal surfaces, such as creases or folds. Despite the variety of convex products available, there is limited evidence guiding their proper selection and use. This study explores the application of Esteem Body^™ with Leak Defence^™ Soft Convexity by Convatec, focusing on achieving stoma protrusion and peristomal skin flattening to protect against leakage in patients with an ostomy. Eighteen Italian stomacare nurses participated in three expert panel meetings. These sessions reviewed the latest literature on the five main characteristics of convexity, assessed abdominal planes and stoma profiles, and discussed the device's safety, efficacy, usability, and potential impact on patient outcomes. The expert panel developed an algorithm to guide the selection of appropriate convexity based on stoma and abdominal profiles. The proper use of Esteem Body^™ with Leak Defence^™ Soft Convexity can significantly improve clinical outcomes by optimizing leakage prevention, enhancing stomacare nurses' decision-making, and improving patients' quality of life.

Background: Centellicum^®, a standardized Centella Asiatica extract, has been used orally for fibrosis and scar prevention. The main aim of this 2-month registry pilot study was the reduction of visible, significant scars and keloids after suturing traumatic wounds with irregular edges (lacerations), using Centellicum^®.

Methods: The effects of oral Centellicum^® (450 mg/day; 2 capsules) and a standard management (SM) on wound healing were compared with the effects of a control group that used only the standard management.

Results: Forty-eight otherwise healthy male subjects with lacerations requiring suturing were included in the study. 25 took Centellicum^® in addition to the standard management and 24 followed the standard management only. No side effects were observed with the supplement. Centellicum^® supplementation showed very good tolerability and compliance with 98% of the capsules correctly used. The two groups of otherwise healthy male subjects with lacerations were considered comparable at inclusion and there were no dropouts. No infections were observed. At 60 days, the scar dimensions were significantly smaller in the supplemented group (P<0.05). The elevation of the scar above the surrounding, non-affected skin, was also significantly reduced in the Centellicum^® group compared to controls (P<0.05). Local pain levels were significantly lower (P<0.05) in the supplement group at 60 days. Additionally, the scar redness score was significantly lower in the supplement group compared to controls (P<0.05) by the end of the study. The incidence of initial keloid formation was significantly lower in the supplemented subjects at 60 days, as determined by finger-point pressure palpation and high-resolution ultrasound (P<0.05). Skin flux, as measured by laser Doppler flowmetry (indicating hypervascularization due to local inflammation) was lower (P<0.05) with Centellicum^® at the end of the study. Inflammation, assessed via thermography (hot spots on the healing skin) was less visible and reduced in most areas in the supplement group (P<0.05) in comparison with the control group. Plasma oxidative stress was significantly lower in the Centellicum^® group at the end of the study (P<0.05).

Conclusions: Oral Centellicum^® intake over 2 months improved healing of lacerations and reduced scarring, fibrosis and keloids at the level of the lesions. A larger study setup with more patients and with a prolonged study duration is needed to confirm these initial results.

Thyroidectomy is a common procedure in endocrine surgery, frequently performed to treat benign and malignant thyroid conditions. Recurrent laryngeal nerve (RLN) injury, a major complication, underscores the necessity for meticulous nerve dissection during surgery. Intraoperative neuromonitoring (IONM) has emerged as a valuable adjunct to visual identification in RLN preservation. This review synthesizes current literature on IONM in thyroid surgery, emphasizing its role in enhancing RLN integrity assessment and reducing surgical complications such as vocal cord paralysis. IONM techniques include intermittent and continuous monitoring, each offering distinct benefits in nerve function evaluation. While debate persists regarding IONM's efficacy in mitigating unilateral RLN injuries, protocols integrating IONM data have significantly reduced the incidence of bilateral RLN injury, exemplifying advancements in surgical safety. Challenges remain, including variability in study outcomes and the optimal timing of IONM application.

Background: There is a scarcity of literature describing outcomes of reoperative Crohn's disease. An in-depth knowledge of these outcomes is critical for managing patient expectations and optimal perioperative planning. We sought to examine outcomes in patients undergoing reoperative surgeries for Crohn's disease compared to index operations.

Methods: A retrospective chart review of surgeries performed from 2018-2023 at a single tertiary care academic institution was performed. A subgroup analysis of index vs. reoperative ileocolic resections was performed to minimize confounding due to the heterogeneity of operations between the index and reoperative groups.

Results: Out of 119 patients, 70 (59%) underwent index operations, and 49 (41%) were reoperations. Overall complication rates (24.28% vs. 34.69%, P=0.224), EBL (189.5 vs. 193.4 mL, P=0.94), operative time (209 vs. 236 min, P=0.091), length of stay (mean: 7.24 vs. 10.08 days, P=0.0142), utilization of laparoscopy (92.85% vs. 65.3%, P=0.0002) and conversion to open technique (4.61% vs. 9.37%, P=0.392) favored index cases. The laparoscopic approach narrowed the gap in length of stay between the index and reoperative groups from 2.83 to 0.6 days. Subgroup analysis of ileocolic resections (Index: 50, reoperations: 26) also favored the index operations.

Conclusions: The current study provides valuable insight into managing patient expectations and optimal perioperative planning for reoperative Crohn's disease. Reoperations were associated with longer stays, lower utilization of laparoscopic platforms, and a trend toward higher overall complication rates. Laparoscopy reduces the gap in length of stay between index and reoperations; however, it is associated with a higher reoperation conversion rate.