Minerva Surgery最新文献

Background: To assess the efficacy of the stapled transanal rectal resection (STARR) procedure in treating obstructed defecation syndrome (ODS) in patients with rectocele and rectoanal intussusception grade II-III, focusing on symptom resolution, functional improvement, and pain reduction.

Methods: This prospective study included patients undergoing STARR for ODS. Preoperative parameters such as anal pain, smearing, itching, bleeding, and obstructed defecation symptoms were assessed using standardized questionnaires (Wexner and Altomare). Functional outcomes, including constipation, incontinence, and obstruction, were evaluated at baseline and at 1, 3, and 6 months postoperatively. Pain levels were categorized into mild (0-3), moderate (4-7), and severe (8-10). Primary endpoints included functional improvement, pain reduction, and resolution of anal symptoms. Secondary endpoints included complication rates, hospital stay duration, and patient satisfaction. Statistical analysis included paired t-tests and one-way repeated measures ANOVA.

Results: Significant improvements were observed postoperatively. Anal smearing (35%) resolved by 3 months, while anal itching (42.5%) and bleeding (75%) significantly declined, stabilizing by 6 months. Severe pain (17.5%) was noted during hospitalization but fully resolved within 1 month, with 97.5% reporting only mild pain at 6 months. Patient satisfaction was 85%. Complication rates were low (7.5% Clavien-Dindo grade I/IIIa), and no reoperations were required.

Conclusions: STARR effectively improves functional outcomes and alleviates ODS symptoms, including pain, smearing, itching, and bleeding. Low complication rates and high patient satisfaction support its use as a viable surgical option, though long-term follow-up is warranted.

Acute pancreatitis (AP) is a potentially life-threatening inflammatory condition characterized by localized pancreatic damage and the activation of the inflammatory cascade, leading to systemic inflammatory response syndrome (SIRS). This complex disease often presents with a variable and unpredictable course. The primary causes of AP include the migration of gallstones and alcohol consumption. The Revised Atlanta Classification 2012 (RAC) is the most widely utilized classification system for AP, distinguishing between interstitial edematous pancreatitis and necrotizing pancreatitis, three severity levels and an early and a late phase. Severe AP carries a high risk of mortality. Currently, there is no definitive prognostic score for accurately predicting severe cases of AP. Initial management focuses on supportive care, applicable to both mild and severe forms of the disease, while later management addresses complications associated with severe AP. Although there is no consensus on the optimal type or regimen of fluids for resuscitation, goal-directed fluid therapy, particularly with Ringer's lactate, has been linked to improved outcomes. Prophylactic antibiotics have not proven effective in preventing infectious complications associated with AP. Patients experiencing mild acute gallstone pancreatitis should be advised to undergo laparoscopic cholecystectomy during their initial admission, whereas those with severe gallstone pancreatitis and signs of cholangitis or choledocholithiasis may benefit from early endoscopic retrograde cholangiopancreatography (ERCP). The management of severe AP complications has evolved from an early surgical approach to a minimally invasive step-up strategy, which is now considered the standard intervention.

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.