Minerva Surgery最新文献

Introduction: At present, harvesting more lymph nodes is considered more conducive to the prognosis of colorectal cancer surgery. The recent development of enhanced surgical visualization has led to the wide employment of indocyanine green (ICG) to assist minimally invasive surgery. This systematic review aims to provide a wide and critical overview of the current state of the art of ICG lymphography during rectal surgery, by focusing on the most relevant literature on this topic.

Evidence acquisition: After validation and registration in the PROSPERO international prospective register of systematic reviews on the 5^th May 2024 (ID: CRD42024539426), 8 publications have been considered relevant for the research query and have been divided into two groups: lateral pelvic lymph node dissection (LPLND) and lateral pelvic sentinel lymph node biopsy (LPSLNB). A meta-analysis has not been performed due to the low statistical significance.

Evidence synthesis: ICG lymphography seems to improve the number of harvested lateral pelvic lymph nodes, to reduce intraoperative blood loss and hospital length of stay during LPLND. In LPSLNB the detection rate of lateral pelvic sentinel lymph nodes ranged from 91.3% to 92%.

Conclusions: ICG lymphography for fluorescence guidance for LLND is a feasible and safe technique, with promising application in terms of the number of harvested lymph nodes and post-operative outcomes improvement during rectal oncological surgery. As some of these benefits have been already suggested by the current literature, they need to be confirmed in larger and randomized clinical.

Introduction: Studies suggested that restrictive fluid therapy during major surgery could be associated with better post-operative outcomes. The albumin uses in the perioperative period has been the subject of numerous studies with a still controversial efficacy and safety profile. This study aimed to assess the efficacy and safety of perioperative albumin use during major non-cardiac surgery.

Evidence acquisition: This study was registered in PROSPERO (ID: CRD42022353278). We performed an electronic search of the relevant literature from 2000 until 2023. The primary endpoint was the incidence of moderate postoperative complications (defined by a Clavien-Dindo classification grade ≥2). Secondary endpoints were intraoperative fluid balance, intraoperative blood loss, postoperative wound infection and acute kidney injury (AKI).

Evidence synthesis: We identified four relevant studies involving 426 patients (213 patients in the albumin group versus 213 patients in the control group). The meta-analysis did not reveal any significant difference between both group regarding the incidence of postoperative moderate complications even after subgroup analyses based on intraoperative or postoperative albumin administration (OR=1.23, 95% CI 0.73, 2.08, P=0.44). No difference was found for intraoperative fluid balance (MD=-190.83, 95% CI -408.67, 27.02, P=0.09), intraoperative blood loss (MD=-27.54, 95% CI -225.55, 170.48, P=0.79) and postoperative wound infection (OR=1.91, 95% CI 0.98, 3.73, P=0.06). Moreover, albumin administration was not associated with a significant increase of AKI incidence (OR=2.02, 95% CI 0.90, 4.53, P=0.09).

Conclusions: Perioperative use of albumin during major non-cardiac surgery did not result in an increased incidence of moderate postoperative complications.

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.

Background: The aim of this supplement registry study was to evaluate the efficacy of Pycnogenol^® in controlling signs and symptoms of chronic venous insufficiency (CVI), diabetic microangiopathy and microcirculatory parameters - in diabetic patients with CVI and microangiopathy. These CVI patients are eligible for medical procedures as their incompetent superficial veins can be treated with repeated sclerotherapy and or local surgery according to needs.

Methods: During this registry study, only non-interventional managements were used. The effects of the use of elastic compression with standard management (SM) was compared to Pycnogenol^® intake (150 mg/day) and SM, without using elastic compression for 8 weeks.

Results: Fifty-eight diabetic patients with CVI completed the study with 28 subjects supplemented with Pycnogenol^® and 30 in the control group. The two groups completing 8 weeks were comparable at baseline. After 8 weeks, no side effects were observed; the compliance was optimal with >98.5% of the supplement capsules correctly used. The tolerability to stockings was lower (73% of stockings were not fully used for the whole day). There were no dropouts. Venous pressures were comparable in the two groups at baseline. Microcirculatory and clinical measurements of the patients were comparable at inclusion. After 8 weeks, the differences between Pycnogenol^® and elastic compression were statistically significant for skin resting flux (RF), rate of ankle swelling (RAS), transcutaneous PO2 and PCO2 indicating a significant improvement in microcirculatory perfusion with Pycnogenol^® in comparison with elastic compression. In parallel, clinical symptoms assessed by the Composite Symptom Score (CSS), the venous Clinical severity Score (VCSS) and the Venous Disability Score (VDS), were significantly lower in the Pycnogenol^® group than in the compression group, indicating a significant clinical effect of Pycnogenol^® compared to elastic compression (P<0.05). Pycnogenol^® showed important antioxidant properties and lowered oxidative stress as seen also in previous studies.

Conclusions: This registry study confirms the clinical and microcirculatory efficacy of Pycnogenol^® in CVI in diabetics. The study indicates the significant supplementary, clinical role of Pycnogenol^® in the management of this common clinical condition over a short period of time, possibly preventing ulcerations.

Diastasis recti abdominis (DRA) is an acquired condition defined by a widening of the linea alba exceeding 2 cm and the subsequent separation between the two medial margins of the rectus muscles, accompanied by a laxity of the ventral abdominal muscles, and often by ventral midline hernias. It is a quite common problem in women after pregnancy. In addition to the aesthetic implications resulting from the swelling of the anterior abdominal wall in the case of increased pressure within the abdominal cavity, DRA leads to several physical functional disorders, including muscle weakness, prolapses of the pelvic organs, urinary and fecal incontinence, low back and pelvic pain and sexual dysfunction. The management of diastasis recti can be conservative, with physiotherapy and specific physical exercises, but, especially in case of concomitant hernia, surgery can be considered as the first choice of treatment in order to restore the midline and repair the hernia. Through recent years, a large amount of mini-invasive surgical techniques has been proposed, approaching the abdominal differently, and to date there is still lack of evidence on the optimal choice for surgeons and patients. So, the present review aims to give the reader an overview on the different techniques proposed, focusing on the three main categories of approaches (pre-aponeurotic, retro-muscular and pre-peritoneal), their specific features and results, with a view on the newly proposed robotic approaches that can theoretically reproduce each single technique.

Introduction: Postoperative pancreatic fistula (POPF) is the most severe complication after pancreaticoduodenectomy (PD), and this study investigates the effects of single-layer and double-layer pancreaticojejunostomy (PJ) on POPF.

Evidence acquisition: Four electronic databases were systematically searched until March 2024: PubMed, Web of Science, Embase, and Cochrane Library. Statistical analysis was performed using Review Manager (RevMan) software. Mean difference (MD) or odds ratios (OR) with 95% confidence intervals (CI) were used to indicate continuous or dichotomous variables, respectively. Ten studies were included, comprising 1811 patients.

Evidence synthesis: Compared to the double-layer PJ group, the single-layer PJ group had a similar POPF rate (OR=0.73; P=0.28) and grade C POPF rate (OR=0.55; P=0.12), but a lower grade B POPF rate (OR=0.50; 95% CI: 0.31-0.81; P=0.005). The clinically relevant POPF (CR-POPF) rate was lower in the single-layer PJ group (OR=0.47; 95% CI: 0.31-0.73; P<0.001), especially in the 2017 International Study Group of Pancreatic Surgery (ISGPS) criteria subgroup (OR=0.44; 95% CI: 0.27-0.73; P=0.001), the China subgroup (OR=0.41; 95% CI: 0.26-0.64; P<0.001), and the minimally invasive subgroup (OR=0.40; 95% CI: 0.22-0.74; P=0.003).

Conclusions: Compared with double-layer PJ, single-layer PJ after PD might reduce the incidence of CR-POPF.

Background: This work summarizes the technical and scientific advancements in wound repair and regeneration, building on concepts from the authors' previous publications. The application of the anti-inflammatory and regenerative medicine (AIMED) method is analyzed, introducing a new therapeutic approach for patients using a medical device, Lecoxen^® cream.

Methods: A diagnostic and therapeutic pathway for patients with acute, chronic, and recalcitrant skin lesions was implemented at two Italian medical centers. The AIMED method, focusing on reducing inflammation and promoting regeneration, was used. In the retrospective observational study, patients were randomized into two groups with a 1:1 ratio, with Group A receiving Lecoxen^® cream to assess its efficacy.

Results: Wound healing progress was assessed at 12 and 24 weeks, with patients stratified based on the cause of the lesion. Included patients had vascular lesions, pressure ulcers, diabetic foot ulcers, rare-origin lesions, acute or traumatic wounds, surgical complications, and burns. At 24 weeks, a significantly higher complete recovery was observed in patients with vascular lesions treated with Lecoxen compared to the control group. Additionally, pain reduction measured using the VAS Scale showed a 100% reduction in pain after 4 weeks of treatment in the Lecoxen group compared to the control.

Conclusions: This retrospective study has validated a multidisciplinary approach to chronic wound treatment, centered on the use of Lecoxen^®. The device's functionalities were integrated into the therapeutic approach; by correlating clinical data with biochemical and cellular parameters, the study demonstrated the device's role in tissue repair and regeneration, providing a foundation for future research.

Background: The purpose of this study was to determine whether the application of the Endo GIA^™ Stapler (Medtronic, Dublin, Ireland) could be helpful in the dissection of adrenal tumors in complicated cases.

Methods: We retrospectively reviewed the records of patients who underwent laparoscopic adrenalectomy between 2012 and 2022 at the College of Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea (Seoul, Republic of Korea). We adopted the Endo GIA^™ Stapler (Medtronic) to seal vessels around adrenal gland and separate adrenal gland completely when it was difficult to perform meticulous dissection and isolation with laparoscopic instruments. Thirteen patients who underwent laparoscopic adrenalectomy with Endo GIA^™ staplers were reviewed and compared with 45 other patients who underwent laparoscopic adrenalectomy without Endo GIA^™ staplers.

Results: There were no statistical differences between the two groups in demographic, tumor-related, and diagnostic variables. Surgical outcomes such as margin involvement, bleeding, operation duration, rate of conversion to open surgery, blood transfusion, complications, and recurrence were not different between the two groups.

Conclusions: In our experience, applying of the Endo GIA^™ Stapler (Medtronic) in laparoscopic adrenalectomy is a feasible and acceptable approach.