Minerva Surgery最新文献

Background: Totally implantable venous access devices (TIVADs) are widely used for long-term therapies, including chemotherapy. Given the potential for serious complications, it is crucial to determine the safest implantation technique with the lowest risk profile. This bicentric, retrospective study aims to compare the surgical vein cut-down approach with ultrasound-guided percutaneous vein puncture in terms of procedural success, complication rates, and operative efficiency.

Methods: A retrospective analysis was conducted on 3373 patients who underwent TIVAD implantation at two centers. Patients were divided into two groups: group A (N.=1846) underwent TIVAD placement via cephalic or external jugular vein cut-down, while group B (N.=1527) underwent ultrasound-guided puncture of the internal jugular or subclavian vein. The two techniques were compared based on operative time, success rate, need for conversion, and complication incidence.

Results: In Group A, the cephalic vein was used in 1733 cases, while the external jugular vein was used in 133 cases. No conversions to percutaneous access or contralateral approaches were required. In group B, TIVADs were implanted via the subclavian vein in 1490 patients and the internal jugular vein in 172 patients. The mean operative time was comparable between the two groups (32.6±11.3 minutes in group A vs. 34.2±12.5 minutes in group B; P not significant). However, the 30-day complication rate was significantly lower in group A (3.8%) compared to group B (5.7%; P<0.05).

Conclusions: This bicentric retrospective study suggests that the surgical cut-down approach for TIVAD implantation via peripheral veins is associated with a high success rate and a lower short-term complication rate compared to percutaneous techniques. However, given the retrospective design and potential center-specific factors, further prospective, multicentric studies are needed to confirm these findings and determine the optimal approach in different clinical settings.

Background: Elderly population has an increased risk of post-operative complications, therefore a precise and quick assessment of the expected risks allows a more aware decision on surgical indications. The American College of Surgeons NSQIP Surgical Risk Calculator (ACS-NSQIP SRC) is a practical tool that provides estimates of outcomes, however previous studies showed heterogeneous results. Our aim was to test its ability to correctly predict post-operative complications in a cohort of elderly patients who underwent major surgery in our Institution.

Methods: Data on consecutive elderly patients (≥75 years) that underwent major surgery (2022-2023) were retrospectively collected. The SRC was queried and the risk of post-operative complications, including geriatric outcomes, was obtained. Patients were divided into four groups based on CPT code. Observed and expected complication rates were compared.

Results: A total of 112 patients (50.9% female, median age 80 years, median BMI 28.8 kg/m²) were included and divided into groups (urgent 60 patients, colorectal 20, upper-GI resections 17 and benign upper-GI 15). In the urgent group, we observed a higher rate of serious complications (22 vs. 12.7, P=0.005), any complications (30 vs. 15.6, P<0.001) and superficial SSI (17 vs. 4.9, P<0.001) than the expected. Discharge to post-acute care facilities was over-estimated.

Conclusions: The ACS-NSQIP SRC demonstrated poor ability to predict post-operative complications and geriatric outcomes in our cohort of elderly patients. Our findings confirm other studies that temper the enthusiasm towards the NSQIP SRC as a practical tool to predict post-operative complications, especially in an urgent setting.

Introduction: Parastomal hernias (PSH) are a frequent complication following ostomy surgery, often requiring surgical intervention. Robotic surgery offers potential advantages in PSH repair, but evidence on its efficacy remains limited. This systematic review evaluates the outcomes of different robotic PSH repair techniques.

Evidence acquisition: A systematic search of PubMed, Embase, and Cochrane databases was conducted (2015-2024) to identify studies on robotic PSH repair. Fourteen studies (13 retrospective, two prospective) met the inclusion criteria after screening 324 articles.

Evidence synthesis: Data on patient demographics, surgical techniques, complications, recurrence rates, and follow-up duration were extracted. The analysis included 355 patients with a median follow-up of 12 months. Early studies focused on feasibility and safety, with subsequent research refining specific techniques like the Sugarbaker, Pauli, and keyhole repairs. Reported recurrence rates ranged from 0% to 9.5% across these techniques. However, 30-day complication rates varied significantly (0% to 50%), highlighting the need for standardized reporting and patient selection criteria. While some studies demonstrated low recurrence rates with acceptable complication profiles, others revealed higher complication rates, potentially related to specific techniques or patient factors. The emergence of variations within the Sugarbaker technique, such as the retromuscular approach with transversus abdominis release (TAR), demonstrates ongoing innovation in robotic PSH repair.

Conclusions: Robotic PSH repair shows promise, but further research is needed to confirm its long-term efficacy and cost-effectiveness.

Background: This retrospective study aims to compare the clinical efficacy and impact on the quality of life of laparoscopic cholecystectomy with medication dissolution of gallstones.

Methods: Clinical data of 86 cholelithiasis patients admitted to our hospital from January 2021 to December 2022 were retrospectively analyzed. The patients were divided into a conservative group of 40 cases and a surgical group of 46 cases based on different treatment methods. The conservative group received ursodeoxycholic acid combined with compound cholecystokinetic granules for gallstone dissolution, while the surgical group underwent laparoscopic cholecystectomy. The clinical efficacy, recovery indicators, complications, pre- and post-treatment Short-Form 36 Health Survey (SF-36) scores, and recurrence rates were observed.

Results: In the surgical group, the total effective rate was higher, the time to symptom relief and length of hospital stay were shorter, but the hospitalization costs were higher than conservative group. The incidences of complications and the recurrence rate were lower in the surgical group than in the conservative group. However, the SF-36 scores for post-treatment physiological function, physical role function, bodily pain, vitality, and general health were higher in the surgical group than in the conservative group.

Conclusions: Compared to medication dissolution, laparoscopic cholecystectomy demonstrates superior efficacy in the treatment of cholelithiasis, promoting symptom relief, reducing hospitalization duration, decreasing the incidence of complications, improving quality of life, lowering recurrence rates, and therefore deserves wider clinical application.

Introduction: Anorectal conditions such as hemorrhoidal disease and anal fissure are frequently painful and debilitating. Pain after hemorrhoidectomy is also common and distressing. These conditions are at least initially managed conservatively. An ointment formulation containing the calcium channel blocker nifedipine and the local anesthetic lidocaine has an established role in the treatment of rectal conditions, particularly conditions associated with anal sphincter hypertonia such as hemorrhoidal disease and anal fissure. This review aimed to compile the evidence for the use of nifedipine 0.3% and lidocaine 1.5% ointment in treating these common but bothersome anorectal diseases.

Evidence acquisition: A comprehensive literature search was conducted, updated to 07 August 2024, using PubMed and MEDLINE databases to identify studies of lidocaine and nifedipine, alone or in combination, for the topical treatment of anal fissure or hemorrhoidal disease. Articles identified in the literature search were supplemented by ad hoc searches and supplemented by relevant literature known to the authors.

Evidence synthesis: Nifedipine 0.3% and lidocaine 1.5% ointment is effective in relieving pain and aiding the resolution of thrombosed hemorrhoids, reducing resting anal pressure and healing chronic anal fissures, and controlling pain after hemorrhoidectomy. The ointment was significantly better than controls consisting of topical lidocaine 1.5% alone or in combination with hydrocortisone acetate 1%.

Conclusions: Although the available literature on the topical application of nifedipine and lidocaine in anorectal diseases is limited, nifedipine 0.3% and lidocaine 1.5% ointment should be considered a valid treatment option for clinicians treating anorectal diseases. Further studies are warranted to confirm and extend the results reported.