Minerva Surgery最新文献

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.

Background: Tube ileostomy can prevent anastomotic leakage (AL) on the patients underwent lower anterior resection. However, it has one major disadvantage: the inability to control fecal diversion efficacy (FDE). In this single-center, prospective randomized controlled trial (RCT), we evaluated a novel technique, pressure-controlled tube ileostomy (PCTI), which uses cuff-pressure adjustment to maintain reliable FDE, and assessed its safety and effectiveness.

Methods: This study was conducted as a single-center prospective RCT. Patients were randomly allocated (1:1) to PCTI or LI (Ll) using a computer-generated sequence with allocation concealment via sealed opaque envelopes; blinding of surgeons/patients was not feasible.

Results: Baseline characteristics were comparable between groups. The anastomotic leakage rates were 9.2% (23/250) in the PCTI group and 9.7% (24/248) in the LI group received the initial surgery (P=0.85). The rates of stoma-related complications including infections, irritant dermatitis, herniation and so on, were 8.8% in PCTI group and 16.2% in LI group (P=0.0133), respectively. Fifteen patients received LI retained their stoma, compared with 2 in the PCTI group (P=0.0013). In PCTI group, the time of cannula extubation and stoma closure after cannula extubation were 20.5±4.6 and 7.2±4.4 days, respectively.

Conclusions: The PCTI can effectively inhibit the occurrence of grade C anastomotic leakage and reduce the occurrence of serious complications caused by anastomotic leakage through the FDE control by adjusting the cuff pressure and can avoid secondary reversal surgery. We consider that the improved PCTI is a safe and practical-surgical technique in protecting the anastomosis.

Background: Palliative surgical management of advanced gastric cancer with gastric outlet obstruction remains controversial. While both palliative gastrectomy (PG) and gastrojejunostomy (PGJ) offer symptom relief, their impact on survival and postoperative outcomes is debated.

Methods: We conducted a retrospective cohort study of 70 patients with advanced gastric cancer and symptomatic gastric outlet obstruction, treated at a single tertiary center between 2017 and 2024. Patients underwent either PG or PGJ after being deemed unsuitable for endoscopic intervention. Clinical and surgical parameters, complications, nutritional support, and survival outcomes were analyzed.

Results: Of the 70 patients, 46 underwent PG and 24 underwent PGJ. Median survival was significantly longer in the PG group (344 vs. 117 days, P<0.001), and PG was an independent predictor of improved survival (HR 0.083, P<0.001). PG was associated with higher rates of anastomotic leaks and ICU admissions, while PGJ showed higher rates of delayed gastric emptying and need for post-discharge nutritional support (33.3% vs. 6.7%, P=0.009). Return to oral intake was more common after PG (95.7% vs. 79.2%, P=0.042). Postoperative chemotherapy significantly improved survival (HR=0.152, P=0.003).

Conclusions: PG offers a significant survival benefit over PGJ in selected patients with advanced gastric cancer, but at the cost of increased surgical morbidity. Careful patient selection based on disease extent, performance status, and likelihood of postoperative recovery is essential for optimizing outcomes.

Background: Acute cholecystitis (AC) is a common general surgical emergency. Older age is associated with higher incidence of gallstones and increasing severity of AC. Data on outcomes for older adults with AC remain sparse however.

Methods: All patients with AC presenting to public hospitals in Ireland between January 2017 and July 2023 were identified using the National Quality Assurance and Improvement System (NQAIS). Data were collected on patient demographics, comorbidities, length of stay, clinical management, in-patient mortality, and readmissions. Patients were grouped into cohorts by age range.

Results: Overall, 20,886 admission episodes were identified, with a median age of 59 years (IQR 43-73) and 11,747 (56%) female patients; 3745 patients were in the 65-74 year group, 3239 in the 75-84 year, and 1478 in the over 85 year group. Older adults had more co-morbidities (Charlson Co-morbidity Index >3 in 440 (30%) of the over 85s, 689 (21%) of 75-84 years, 429 (11%) 65-74 years, and 421 (3%) under 65s (P<0.0001). In the over 85 years group, patients had the highest in-patient mortality rate (96 [6.5%]; P<0.0001), lowest rate of cholecystectomy (49 [3%]; P<0.0001), highest rate of percutaneous cholecystostomy use (140 [9%]; P<0.0001), and lowest rates of discharge to home (947 [64%]). Patients in the 65-74 year and 75-84 year groups also experienced poorer outcomes than those in the under 65 year group.

Conclusions: Increasing age is associated with worsening outcomes for patients with AC. For the oldest adults, AC is associated with significant risks of morbidity and potential loss of independence.

Background: Allogenic blood transfusion (ABT) is associated with postoperative complications and possibly early recurrence (ER). after oncologic surgery. We sought to investigate predictors and impact of ABT in cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC).

Methods: All patients who underwent CRS±HIPEC from June 2020 to January 2022 at a high-volume center were included. Patients were classified according to whether they had received a perioperative ABT during the entire hospitalization period. ER was defined as the time from complete resection to the first recurrence (local or distant) or death, whichever occurred first, within 2 years after surgery. Multivariate logistic regression and Cox analysis identified risk factors for ABT and ER, respectively.

Results: Of 168 patients, 56 (33.3%) required ABT (mean 2.4 [2.2] red blood cell units). Multivariate logistic analysis showed that hemoglobin levels 24-h before surgery (odds ratio [OR] 0.5; 95% confidence interval [CI]: 0.4 to 0.7), intraoperative fluid balance (OR 1.01; 95% CI: 1.01 to 1.02) and time of surgery (OR 1.1; 95% CI: 1.1 to 1.1) were independently associated with ABT. Multivariate Cox regression identified time of surgery (hazard ratio [HR] 1.01, 95% CI: 1.01 to 1.02) and previous systemic chemotherapy (HR 2.5, 95% CI: 1.3 to 4.8) as risk factors for ER, while ABT was not (P=0.078).

Conclusions: Lower preoperative hemoglobin levels, higher intraoperative fluid balance, and longer surgery time are risk factors for ABT. Longer operative time and previous systemic chemotherapy are associated with early recurrence.