Minerva Surgery最新文献

Background: Peristomal skin complications represent one of the main clinical concerns in people with an ostomy. Existing assessment tools do not include preventive approaches and active participation of the patient. S.A.C.S. Evolution was created to fill this gap, introducing the concept of healthy peristomal skin (L0) as a primary clinical reference and developing a dual interface dedicated to the healthcare professional and the patient.

Methods: A prospective multicenter observational study validated the psychometric properties of S.A.C.S. Evolution: Phase one tested face validity, phase two tested content validity and phase three evaluated criterion and predictive validity with the longitudinal application on patients with intestinal or urinary ostomy, followed at 1, 3, and 6 months.

Results: Face validity reached unanimous consensus among both healthcare professionals and patients. Content validity showed a Content Validity Index > 0.96 among professionals and 1.00 among patients. Criterion validity showed a 95.5% agreement between S.A.C.S. Evolution and S.A.C.S. 2.0 assessments, and a high overlap between patient and stoma nurse evaluations. Longitudinal analysis showed a significant reduction in lesion severity over time, with an increase in the marginal probability of maintaining a healthy skin state (L0) above 90% at six months. Age was confirmed as a predictive factor of greater severity.

Conclusions: S.A.C.S. Evolution proved valid, reliable, and clinically sensitive in the assessment of peristomal skin condition and consequent prevention of peristomal alterations. Its dual interface, clear terminology, and focus on healthy peristomal skin support early prevention, patient empowerment, and standardization of stoma care pathways. Digital integration could further enhance its impact.

Background: Short-stay and ambulatory pathways for laparoscopic appendectomy (LA) have gained increasing acceptance, yet conventional hospitalization remains common practice for acute appendicitis (AA). This study aimed to evaluate the safety and feasibility of a structured one-day LA protocol (discharge within 24 hours) and to refine patient selection criteria.

Methods: A two-phase observational study was conducted, including a retrospective analysis followed by prospective validation of predefined eligibility criteria for one-day discharge.

Results: Among 812 LA patients, early discharge was achieved safely without increased complications or readmissions. In the prospective phase, 132 patients met criteria and 90 were discharged within 24 hours. Logistic regression confirmed operator-dependent factors - especially drainage and longer operative time - as primary barriers to protocol adherence.

Conclusions: A structured one-day LA protocol is safe, feasible, and effective in selected patients. The one-day pathway is now standard of care for uncomplicated AA at our institution.

Introduction: Despite advancements in colorectal surgery, anastomotic complications such as leakage and stricture remain significant challenges. The influence of circular stapler size on these outcomes is controversial. This meta-analysis evaluates the impact of stapler diameter on anastomotic morbidity following low colorectal anastomosis.

Evidence acquisition: A systematic search of PubMed, Google Scholar, and the Cochrane Central Register was conducted in accordance with PRISMA guidelines. Comparative studies that reported outcomes based on circular stapler size were included. Primary endpoints were anastomotic leak, stricture, bleeding, and overall anastomotic morbidity. Secondary outcomes included overall morbidity, major complications, reoperation, readmission, and operative time. Odds ratios (ORs) and standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated. The ROBINS-I and GRADE tools were used to assess the risk of bias and quality of evidence.

Evidence synthesis: Seven studies comprising 2214 patients (small stapler size (<30 mm): N.=859, large stapler size (≥30 mm): N.=1355) were included. Use of larger staplers was associated with a significantly lower incidence of anastomotic stricture (OR=2.31, 95% CI: 1.48-3.60, P=0.0002), with low heterogeneity (I²=5%). No significant differences were observed in anastomotic leak, bleeding, or overall anastomotic morbidity. Secondary outcomes, including overall and major morbidity, readmission, reoperation, and operative duration, also showed no significant differences between stapler sizes.

Conclusions: Larger circular staplers are associated with a reduced risk of anastomotic stricture following low colorectal anastomosis, without increasing other postoperative complications. These findings support the consideration of larger stapler diameters when anatomically feasible. Further high-quality prospective studies are warranted to validate these results and guide surgical decision-making.

Cervical spine fractures are a critical concern in emergency medicine, often resulting in significant morbidity and mortality. Early recognition and management are essential to prevent secondary spinal cord injuries and optimize patient outcomes. This review examines current assessment and treatment strategies for cervical spine fractures in the emergency department. Clinical decision rules such as the Canadian C-Spine Rule and the National Emergency X-Radiography Utilization Study (NEXUS) aid in determining the need for imaging, while computed tomography remains the gold standard for diagnosis. Traditional immobilization techniques, including manual inline spinal immobilization and cervical collars, are widely used, though recent evidence challenges their effectiveness in reducing neurological deterioration. Management approaches vary depending on the severity and stability of the fracture, with stable injuries often treated conservatively and unstable fractures requiring surgical intervention. New evidence suggests that a more individualized approach to immobilization and management may be beneficial, balancing patient comfort and clinical outcomes. Adherence to established trauma protocols remains critical in ensuring timely intervention and reducing complications. Further research is necessary to refine immobilization practices and develop more targeted treatment strategies to improve long-term outcomes for patients with cervical spine fractures.

Respiratory disorders can be broadly classified into two primary categories: those triggered by infectious agents and those stemming from noninfectious factors. The infectious group comprises a wide array of pathogens, including bacteria, viruses, and fungi. In contrast, the noninfectious category encompasses conditions such as immune system dysfunctions, as well as both malignant and benign tumors. Given the intricate and diverse nature of these diseases, accurate diagnosis often requires more than just routine clinical assessments and conventional imaging techniques. To address this complexity, the medical community has increasingly turned to minimally invasive diagnostic methods, which provide enhanced precision in managing complex cases. This comprehensive review delves into the utilization of these cutting-edge minimally invasive technologies within the field of respiratory medicine. It meticulously outlines their current applications, highlights their benefits and limitations, and also explores potential directions for future research endeavors, aiming to shed light on the evolving landscape of respiratory disease diagnosis and management.