Minerva Surgery最新文献

Introduction: Surgical repair of hiatal hernia (HH) is plagued by high recurrence rates. Hiatoplasty failure has been identified as a major determinant of recurrent symptoms and HH, but there is no consensus on the optimal surgical approach to minimize this complication and hiatal mesh reinforcement remains controversial. The use of the falciform ligament as an autologous rotational flap to support crural repair has been proposed as a potential solution. This review aims to evaluate the safety and efficacy of the falciform ligament flap (FLF) as an adjunct in HH repair.

Evidence acquisition: Searches were conducted on Google, Google Scholar, PubMed, Scopus, Web of Science, and Cochrane through May 2024. The primary study outcome was HH recurrence rate. Secondary outcomes included 30-day mortality rate, postoperative morbidity, and length of hospital stay. Descriptive statistics were used to analyze the data.

Evidence synthesis: Twelve studies comprising 469 patients undergoing FLF augmentation during primary or revisional HH repair were included. The majority (80.7%) of patients had HH types III-IV. Crural suture hiatoplasty was performed in all cases, and adjunctive mesh reinforcement was reported in two studies. Postoperative morbidity was 4.6%, and there was no mortality. The overall HH recurrence rate was 5.8% (range 0-15.4%).

Conclusions: Our study seems to suggest that FLF may reduce postoperative HH recurrence. Well designed and comparative studies with long-term follow-up are required to confirm these preliminary data.

Background: The association between bariatric surgery and esophagogastric cancer (EGC) is debated. This study aimed to assess EGC characteristics and surgery outcomes comparing bariatric and non-bariatric patients.

Methods: Single-center retrospective analysis of prospective EGC surgery database.

Results: EGC-surgery was performed in 269 patients, classified as bariatric (N.=10, 3.3%), and non-bariatric (N.=259, 96.6%) groups. Non-bariatric group was sub-classified into body mass index (BMI) <35 kg/m² (N.=244) and >35 kg/m² (N.=15). BMI was 35.3±5.6 vs. 25.7±16.1 and 37.8±8.7 kg/m2 in bariatric vs. non-bariatric-BMI <35 and >35, respectively (P<0.001). Bariatric patients were significantly younger (56.75±11 vs. 71±10 and 68.38±8.2 years; P<0.001). They tended to have lower rates of diabetes mellitus (30% vs. 43.9% and 73.3%; P=0.05) and significantly lower hypertension rates (50%, vs.86.5% and 93.3%, P<0.004). Bariatric procedures were performed 11.3 years (IQR 5.5-16.5) prior to EGC-surgery. Tumor characteristics were statistically comparable except a significantly higher number of positive LN in the bariatric group (6.9±13.6 vs. 2.7±4.9 and 1.9±4.8; P=0.006), and more bariatric patients received adjuvant treatment (P=0.035). Postoperative major complication rates (0% vs. 25.8%, and 33.3%; P=0.14) and length of hospital stay (14.1±15.3, vs. 23±28.5, and 21±18 days; P=0.59) were comparable. There was no significant difference in Disease- free survival (P=0.42) or overall survival (P=0.48) between patient-groups.

Conclusions: Bariatric patients were diagnosed with EGC at a younger age, and tended to have worse nodal involvement. Although outcomes were comparable, clinical and endoscopic surveillance seem important as EGC can occur 10 years or earlier than in non-bariatric patients.

Introduction: Esophageal inflammatory fibroid polyp (IFP) is a rare benign tumor of the gastrointestinal tract with limited available data on clinicopathologic features and treatment strategies.

Evidence acquisition: A systematic review of the literature in PubMed/Medline and Scopus databases was performed for articles concerning esophageal IFP in adult population.

Evidence synthesis: A total of 16 studies were identified, involving 16 patients with a Male-Female Ratio of 3:1 and mean age of 50.38 years. Clinical presentation of esophageal IFP included progressive dysphagia in 56.3% of cases, with additional symptoms such as epigastric and retrosternal pain, weight loss, vomiting, and melena. Diagnostic modalities involved endoscopy in all cases, with endoscopic ultrasound (EUS) employed in 50% of cases and tissue biopsy performed during endoscopy in 87.5% of the patients. Therapeutic approach of esophageal IFP consisted of surgical resection in 75% of the patients and endoscopic resection in the remaining 25%, with various surgical procedures employed based on tumor location. Follow-up data, available for 11 patients over a median duration of 15.5 months, indicated two instances of recurrence following endoscopic resection, while the other nine patients remained asymptomatic with no evidence of recurrence.

Conclusions: Esophageal IFP is a rare benign tumor of the gastrointestinal tract presenting with dysphagia, regurgitation, and heartburn. Resection, either endoscopic or surgical, is the primary treatment approach. Prognosis for esophageal IFP is favorable, with low recurrence rates. Further research is required to investigate potential risk factors and etiology for this lesion, and to explore novel therapeutic approaches that may improve patient outcomes.

Background: Chronic pancreatitis (CP) is characterized by longstanding inflammation of the pancreas. Several authors have reported minimally invasive treatment of this CP (pancreaticoduodenectomy, lateral pancreaticojejunostomy, Frey procedure) with promising short-term outcomes.

Methods: This is a case series of 6 patients diagnosed with CP and treated using the laparoscopic modified Frey procedure at Hue Central Hospital, Vietnam.

Results: Six patients (5 males and 1 female) with CP and operated on using modified Frey's procedure. The median age was 45 years old. The mean of Body Mass Index was 16.3 kg/m². The median preoperative duration of symptoms was 3.3 years. All patients were presented with a dilated main pancreatic duct (mean diameter of 7.8 mm). The median time to first bowel movement was 1.5 (1-2) days. The median postoperative hospital stay was 7 (5-11) days. No reoperation or mortality was recorded.

Conclusions: The laparoscopic modified Frey procedure is feasible and safe with good short-term and mid-term outcomes for chronic pancreatitis.

Background: The aim of this study was to analyze short-term outcomes focusing on readmissions after laparoscopic bariatric metabolic surgery (BMS) in an Italian academic Bariatric Center of Excellence IFSO-European Chapter (EC).

Methods: This is a retrospective study based on the analysis of a prospectively maintained institutional database. Patients aged between 18 and 65 years who underwent primary BMS and/or revisional BMS (RBMS) between 2012 and 2021 were included. Primary endpoint was to analyze the readmission rate at 30 postoperative days. The secondary endpoint involved assessing the causes of readmission within 30 days of discharge, the rates, and types of reoperations and/or additional procedures related to the first surgery, and the outcomes of readmitted patients.

Results: A total of 2297 patients were included in the study. Among them, 2143 underwent primary surgery and 154 patients underwent RBMS. Eighty-two percent of the Enhanced Recovery after Surgery (ERAS) protocol items were applied starting from 2016. Within 30 days after discharge, 48 patients (2.09%) were readmitted. Overall readmission rate following primary and revisional BMS was 2.15%, respectively 1.30%. Ten readmitted patients (20.8%) had complications graded IIIb or more (Clavien-Dindo classification) and needed additional procedures. Mortality rate was 4.17% among readmitted patients.

Conclusions: Only 2.09% of patients undergoing laparoscopic bariatric surgery were readmitted. Of these, 20.8% required additional procedures. Standardization of surgical techniques and perioperative protocols in a bariatric center of excellence resulted in a low readmission rate even in RBMS.

Background: Routine splenic flexure mobilization (SFM) during left hemicolectomy and high anterior rectal resection guarantees a well perfused and tension-free anastomosis, respecting current oncological criteria. According to the recent literature, only 70% of laparoscopic colorectal surgeons considered routine SFM mandatory. Because of its difficulty, SFM increases morbidity including surrounding organs injuries. The goal of the study is to report our experience in avoiding routine SFM during colorectal resection compared to the current surgical state of art.

Methods: Data were collected retrospectively on elective left hemicolectomy without routine SFM performed in our unit between January 2015 to April 2020. Patients were recruited according to diagnosis, histopathology, operative time, ASA score, post-operative morbidity and mortality.

Results: Seventy-five oncological patients, underwent to surgery without SFM. The other 13 patients underwent to SFM due to technical issues. The mean operative time was 160.2±44.7 mins, significantly shorter than in patients whose SFM occurred (210.3 min). The morbidity rate was 1%, reintervention occurred in one patient. Eighteen-month median follow-up morbidity was 11% while mortality was 3%. Recurrence rate was of about 5%.

Conclusions: As results from study data analysis, left colectomy can be conducted safely in both laparoscopic and laparotomic approach without SFM in selected cases. As reported in a recent meta-analysis, benefits of avoiding SFM concern reduced operative time without compromising postoperative outcome and respecting oncological criteria, as emerged by our results. Colorectal resection without SFM when is feasible, improves surgical approach reducing technical difficulties and avoiding splenic injuries.