Minerva Surgery最新文献

Background: There is a scarcity of literature describing outcomes of reoperative Crohn's disease. An in-depth knowledge of these outcomes is critical for managing patient expectations and optimal perioperative planning. We sought to examine outcomes in patients undergoing reoperative surgeries for Crohn's disease compared to index operations.

Methods: A retrospective chart review of surgeries performed from 2018-2023 at a single tertiary care academic institution was performed. A subgroup analysis of index vs. reoperative ileocolic resections was performed to minimize confounding due to the heterogeneity of operations between the index and reoperative groups.

Results: Out of 119 patients, 70 (59%) underwent index operations, and 49 (41%) were reoperations. Overall complication rates (24.28% vs. 34.69%, P=0.224), EBL (189.5 vs. 193.4 mL, P=0.94), operative time (209 vs. 236 min, P=0.091), length of stay (mean: 7.24 vs. 10.08 days, P=0.0142), utilization of laparoscopy (92.85% vs. 65.3%, P=0.0002) and conversion to open technique (4.61% vs. 9.37%, P=0.392) favored index cases. The laparoscopic approach narrowed the gap in length of stay between the index and reoperative groups from 2.83 to 0.6 days. Subgroup analysis of ileocolic resections (Index: 50, reoperations: 26) also favored the index operations.

Conclusions: The current study provides valuable insight into managing patient expectations and optimal perioperative planning for reoperative Crohn's disease. Reoperations were associated with longer stays, lower utilization of laparoscopic platforms, and a trend toward higher overall complication rates. Laparoscopy reduces the gap in length of stay between index and reoperations; however, it is associated with a higher reoperation conversion rate.

Background: The aim of this supplement registry study was to evaluate the efficacy of Pycnogenol^® in controlling signs and symptoms of chronic venous insufficiency (CVI), diabetic microangiopathy and microcirculatory parameters - in diabetic patients with CVI and microangiopathy. These CVI patients are eligible for medical procedures as their incompetent superficial veins can be treated with repeated sclerotherapy and or local surgery according to needs.

Methods: During this registry study, only non-interventional managements were used. The effects of the use of elastic compression with standard management (SM) was compared to Pycnogenol^® intake (150 mg/day) and SM, without using elastic compression for 8 weeks.

Results: Fifty-eight diabetic patients with CVI completed the study with 28 subjects supplemented with Pycnogenol^® and 30 in the control group. The two groups completing 8 weeks were comparable at baseline. After 8 weeks, no side effects were observed; the compliance was optimal with >98.5% of the supplement capsules correctly used. The tolerability to stockings was lower (73% of stockings were not fully used for the whole day). There were no dropouts. Venous pressures were comparable in the two groups at baseline. Microcirculatory and clinical measurements of the patients were comparable at inclusion. After 8 weeks, the differences between Pycnogenol^® and elastic compression were statistically significant for skin resting flux (RF), rate of ankle swelling (RAS), transcutaneous PO2 and PCO2 indicating a significant improvement in microcirculatory perfusion with Pycnogenol^® in comparison with elastic compression. In parallel, clinical symptoms assessed by the Composite Symptom Score (CSS), the venous Clinical severity Score (VCSS) and the Venous Disability Score (VDS), were significantly lower in the Pycnogenol^® group than in the compression group, indicating a significant clinical effect of Pycnogenol^® compared to elastic compression (P<0.05). Pycnogenol^® showed important antioxidant properties and lowered oxidative stress as seen also in previous studies.

Conclusions: This registry study confirms the clinical and microcirculatory efficacy of Pycnogenol^® in CVI in diabetics. The study indicates the significant supplementary, clinical role of Pycnogenol^® in the management of this common clinical condition over a short period of time, possibly preventing ulcerations.

Diastasis recti abdominis (DRA) is an acquired condition defined by a widening of the linea alba exceeding 2 cm and the subsequent separation between the two medial margins of the rectus muscles, accompanied by a laxity of the ventral abdominal muscles, and often by ventral midline hernias. It is a quite common problem in women after pregnancy. In addition to the aesthetic implications resulting from the swelling of the anterior abdominal wall in the case of increased pressure within the abdominal cavity, DRA leads to several physical functional disorders, including muscle weakness, prolapses of the pelvic organs, urinary and fecal incontinence, low back and pelvic pain and sexual dysfunction. The management of diastasis recti can be conservative, with physiotherapy and specific physical exercises, but, especially in case of concomitant hernia, surgery can be considered as the first choice of treatment in order to restore the midline and repair the hernia. Through recent years, a large amount of mini-invasive surgical techniques has been proposed, approaching the abdominal differently, and to date there is still lack of evidence on the optimal choice for surgeons and patients. So, the present review aims to give the reader an overview on the different techniques proposed, focusing on the three main categories of approaches (pre-aponeurotic, retro-muscular and pre-peritoneal), their specific features and results, with a view on the newly proposed robotic approaches that can theoretically reproduce each single technique.

Introduction: Postoperative pancreatic fistula (POPF) is the most severe complication after pancreaticoduodenectomy (PD), and this study investigates the effects of single-layer and double-layer pancreaticojejunostomy (PJ) on POPF.

Evidence acquisition: Four electronic databases were systematically searched until March 2024: PubMed, Web of Science, Embase, and Cochrane Library. Statistical analysis was performed using Review Manager (RevMan) software. Mean difference (MD) or odds ratios (OR) with 95% confidence intervals (CI) were used to indicate continuous or dichotomous variables, respectively. Ten studies were included, comprising 1811 patients.

Evidence synthesis: Compared to the double-layer PJ group, the single-layer PJ group had a similar POPF rate (OR=0.73; P=0.28) and grade C POPF rate (OR=0.55; P=0.12), but a lower grade B POPF rate (OR=0.50; 95% CI: 0.31-0.81; P=0.005). The clinically relevant POPF (CR-POPF) rate was lower in the single-layer PJ group (OR=0.47; 95% CI: 0.31-0.73; P<0.001), especially in the 2017 International Study Group of Pancreatic Surgery (ISGPS) criteria subgroup (OR=0.44; 95% CI: 0.27-0.73; P=0.001), the China subgroup (OR=0.41; 95% CI: 0.26-0.64; P<0.001), and the minimally invasive subgroup (OR=0.40; 95% CI: 0.22-0.74; P=0.003).

Conclusions: Compared with double-layer PJ, single-layer PJ after PD might reduce the incidence of CR-POPF.

Background: This work summarizes the technical and scientific advancements in wound repair and regeneration, building on concepts from the authors' previous publications. The application of the anti-inflammatory and regenerative medicine (AIMED) method is analyzed, introducing a new therapeutic approach for patients using a medical device, Lecoxen^® cream.

Methods: A diagnostic and therapeutic pathway for patients with acute, chronic, and recalcitrant skin lesions was implemented at two Italian medical centers. The AIMED method, focusing on reducing inflammation and promoting regeneration, was used. In the retrospective observational study, patients were randomized into two groups with a 1:1 ratio, with Group A receiving Lecoxen^® cream to assess its efficacy.

Results: Wound healing progress was assessed at 12 and 24 weeks, with patients stratified based on the cause of the lesion. Included patients had vascular lesions, pressure ulcers, diabetic foot ulcers, rare-origin lesions, acute or traumatic wounds, surgical complications, and burns. At 24 weeks, a significantly higher complete recovery was observed in patients with vascular lesions treated with Lecoxen compared to the control group. Additionally, pain reduction measured using the VAS Scale showed a 100% reduction in pain after 4 weeks of treatment in the Lecoxen group compared to the control.

Conclusions: This retrospective study has validated a multidisciplinary approach to chronic wound treatment, centered on the use of Lecoxen^®. The device's functionalities were integrated into the therapeutic approach; by correlating clinical data with biochemical and cellular parameters, the study demonstrated the device's role in tissue repair and regeneration, providing a foundation for future research.

Background: The purpose of this study was to determine whether the application of the Endo GIA^™ Stapler (Medtronic, Dublin, Ireland) could be helpful in the dissection of adrenal tumors in complicated cases.

Methods: We retrospectively reviewed the records of patients who underwent laparoscopic adrenalectomy between 2012 and 2022 at the College of Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea (Seoul, Republic of Korea). We adopted the Endo GIA^™ Stapler (Medtronic) to seal vessels around adrenal gland and separate adrenal gland completely when it was difficult to perform meticulous dissection and isolation with laparoscopic instruments. Thirteen patients who underwent laparoscopic adrenalectomy with Endo GIA^™ staplers were reviewed and compared with 45 other patients who underwent laparoscopic adrenalectomy without Endo GIA^™ staplers.

Results: There were no statistical differences between the two groups in demographic, tumor-related, and diagnostic variables. Surgical outcomes such as margin involvement, bleeding, operation duration, rate of conversion to open surgery, blood transfusion, complications, and recurrence were not different between the two groups.

Conclusions: In our experience, applying of the Endo GIA^™ Stapler (Medtronic) in laparoscopic adrenalectomy is a feasible and acceptable approach.

Background: Complete mesocolic excision (CME) has been introduced from open surgery, to compare right colon cancer surgery to total mesorectal excision for rectal cancer and it is currently being applied by robotic approach. CME concept is based on the complete removal of right mesocolon and the dissection deep at the level of the central feeding vessels. Aside the CME, intracorporeal anastomosis completes a total minimally invasive approach to the treatment of right colon cancer. This study retrospectively analyzed the feasibility and efficacy of robotic CME and intracorporeal anastomosis in a cohort of consecutive patients affected with right colon cancer.

Methods: The data of 110 patients undergone a robotic CME with IA anastomosis for right colon cancer from 2018 to 2023 were prospectively collected and retrospectively analyzed. Intraoperative, postoperative, and short-middle term outcomes were considered for analysis, as well as pathologic and oncologic outcomes. A time-to-event analysis was performed using the Kaplan-Meier method for OS and DFS.

Results: All patients underwent a robotic right colectomy. Median operative time was 184 min, blood loss was negligible, no intraoperative complications occurred. Three conversions (2.7%) were experienced due to bulky lymph nodes and severe local advanced tumor. Mean postoperative stay was 6 days. Six postoperative complications occurred, 4 postoperative ileus, 1 late dehiscence of the colonic stump and an iatrogenic colonic perforation. The latter needed reintervention.

Conclusions: Robotic CME with central vessels ligation seems feasible and safe, with acceptable morbidity and adequate short-middle term outcomes.