Surgery Journal最新文献

Colonic obstruction is reported in 85% of emergency colorectal surgery for cancer. Colonic ischemia, however, is a rare entity and is found in 5% of these emergency cases. We herein present the case of a 72-year-old man presenting with signs and symptoms of obstruction and was found to have an obstructive sigmoid cancer. A first urgent laparotomy showed small bowel ischemia, for which small bowel resection and large bowel decompression were done without tumor resection. Postoperatively, the patient transiently improved, then deteriorated in few days, and a second urgent laparotomy showed a large bowel ischemia proximal to the mass. The treatment for patients with colon cancer with suspected colonic ischemia should be emergency laparotomy with long abdominal incision, carefully exploring the whole length of the small and large bowel. Despite large bowel decompression, a secondary colonic ischemic event should be suspected in case of deterioration.

Background  Globally, surgical care plays a vital role in health care. Unfortunately, complications arise in approximately 5 to 18% of surgical procedures. However, research has shown that following the surgical safety checklist provided by the World Health Organization (WHO) can significantly reduce these complications and surgery-related fatalities. The objective of this study was to assess the accuracy and completion of the WHO Surgical Safety Checklist. Materials and Method  From October 3, 2022 to February 28, 2023, a comprehensive observational study was conducted involving 300 patients who underwent elective and emergency surgeries. The completion rates for the different stages of surgery, namely sign-in, time-out, and sign-out, were determined using the SPSS 22.0 software. Result  In our research, we specifically examined the completion of the checklist for 300 patients who underwent important procedures within a span of 5 months. For each patient, we ensured that their identities, procedures, and consent were verified with a 100% success rate. Additionally, we thoroughly checked the anesthesia equipment and drugs for safety in every case. Furthermore, all essential images were consistently displayed for each patient, achieving a 100% adherence to this crucial aspect of the process. Conclusion  In general, the level of completeness of the checklist was satisfactory across the sign-in, time-out, and sign-out phases. While this study did not assess the specific outcomes, it is presumed that incomplete data may have exposed patients to potential perioperative complications.

Objective  To summarize patient characteristics and outcomes for the historical and current methods of long-segment tracheal replacement in humans. Materials and Methods  A single reviewer screened the abstracts and full texts using Covidence for file management. Studies published in English that reported human subjects with circumferential or near-circumferential (>270 degrees) cervical tracheal replacements were included. Articles with subjects treated with primary anastomosis alone, retracted articles, abstracts, expert opinion articles, and conference presentations were excluded. Results  A total of 32 articles were included in the review reporting 156 cases of long-segment tracheal replacement including synthetic (alive at 1-8 years n  = 6/64), regenerative medicine (dead at 15 days-55 months n  = 4, not reported n  = 6), cadaveric tracheal allograft (alive at 5 months-10 years n  = 32/38), aortic allograft (alive at 6-85 months n  = 12/16), free tissue transfer (alive at 6-108 months n  = 13/21), allotransplantation (alive at 6-24 months n  = 5/8), and vascular composite allograft (VCA) (alive at 20 months n  = 1/1). Conclusion  Silicone and Marlex prostheses have poor long-term outcomes. The cadaveric tracheal allograft can only replace near-circumferential tracheal defects and is therefore limited to benign tracheal pathology. Inadequate structural support plagues the aortic allograft and often requires numerous invasive procedures and maintenance of an intraluminal stent. A lack of mucociliary clearance exists in all methods of tracheal replacement except cadaveric tracheal allograft and VCA and can cause fatal mucous plugging and chronic pulmonary infections. VCA and allotransplantation require long-term immunomodulation therapy.

Background  Pediatric obesity is a common comorbid condition that may complicate pediatric surgeries, such as appendectomy. Prior research on the consequences of obesity on pediatric appendectomy outcomes have been limited by small-sample sizes and pooled analyses that do not distinguish the effects of surgical approach. Associations between surgical approach, pediatric obesity, and postoperative appendectomy outcomes thus remain unclear. Objective  To analyze postoperative appendectomy outcomes by accounting for pediatric obesity, appendectomy approach, and their interaction. This is a retrospective cohort population analysis. Nationwide data of pediatric inpatients from the United States were obtained. All pediatric patients who had an appendectomy were selected from the 2019 Kids' Inpatient Database. Materials and Methods  Outcomes variables were the length of stay and postoperative complication rate. The primary exposure variables were pediatric obesity, surgical approach (laparoscopic [LA] vs. open appendectomy [OA]), and an interaction term between the two. Control variables were patient demographics, clinical complexity, and geographic location. Multiple regression was used to determine relationships between the outcome, exposure, and control variables. Results  A total of 49,037 pediatric patients had an appendectomy, with the number of OA and LA being 4,517 and 44,420, respectively. LA patients had 5.8% ( p  < 0.001) shorter length of stay than OA patients. For obese patients, length of stay was 31.8% ( p  < 0.001) longer than for nonobese patients, but LA (compared with OA) reduced it by 19% ( p  < 0.007). Obesity had no effect on the number of postoperative complications. Conclusion  Obese patients had significantly longer length of stay than nonobese counterparts following OA (31.8%), but this difference was minimized for LA patients (15.81%). There was no association between complication rate, obesity, and surgical approach. Our findings will enable more accurate estimations of pediatric patients' postoperative courses and efficient allocation of limited hospital resources. Further research may wish to study the effects of other common pediatric comorbidities on other procedures.

Obesity is an emerging worldwide health care issue. It has a direct and indirect bearing on health-related outcomes. Rates of overweight and obesity have grown manifold in the past few decades globally. Once considered a problem of the affluent societies only, obesity is now dramatically on the rise in low- and middle-income countries also. Single anastomosis gastric bypass (SAGB) is one of the combined bariatric procedures adopted for weight loss in patients failing maximal medical therapy. Internal hernia (IH) after SAGB is a less recognized clinical entity. We hereby report our experience with four such cases under light of current available literature. Bariatric procedures are associated with some short- and long-term limitations. IHs are among one of the dreaded complications associated with some bariatric procedures with rates reaching up to 16% after classic Roux-en-Y gastric bypass. The incidence of IH post-SAGB is comparatively rare and is very less frequently reported. Symptoms of IH post-SAGB are quite nonspecific and depend on the time and extent of herniation. The symptoms can vary from benign intermittent colicky pain to severe intra-abdominal pain presenting as a surgical emergency. Routine physical examination and biochemical investigations are nonspecific and unreliable in evaluating those patients. Computed tomography (CT) with intravenous and oral contrast is the most common imaging modality used for preoperative evaluation of those symptoms. The CT findings can be unremarkable in patients having intermittent symptoms/herniation. Diagnostic laparoscopy is the cornerstone for diagnosis and management of patients having high suspicion of IH.

Purpose  Postoperative nausea and vomiting (PONV) is a major problem after surgery. This study aimed to demonstrate the incidence of PONV and the potential associated factors in female patients undergoing laparoscopic gastrointestinal surgery against the background of double prophylactic therapy. Methods  Our retrospective study recruited 109 female patients undergoing laparoscopic gastrointestinal surgery with double prophylactic therapy, combining palonosetron with dexamethasone, from October 2020 to March 2021, at the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. Patient characteristics and perioperative management factors were included in univariate and multivariate analyses to identify factors influencing PONV. Results  Four patients lacked complete records, and of the 105 patients included in the final analysis, 53 (50.5%) patients developed PONV. Two influencing factors for PONV were identified: a history of chemotherapy (odds ratio [OR] 0.325, 95% confidence interval [CI] 0.123-0.856; p  = 0.023) and dosage of hydromorphone ≥ 0.02 mg/kg (OR 2.857, 95% CI 1.247-6.550; p  = 0.013). The performance of the multivariate logistic regression was evaluated by analyzing receiver operating characteristic curves, resulting in an area under the curve value of 0.673. Conclusion  The incidence of PONV remains high in female patients undergoing laparoscopic gastrointestinal surgery, even with double prophylactic therapy. A dosage of hydromorphone ≥ 0.02 mg/kg may increase risk of PONV, whereas a history of chemotherapy might be a protective factor.

Introduction  Central pancreatectomy (CP) represents an organ-preserving type of pancreatic resection. The procedure has been associated with improved long-term functional results, but increased postoperative morbidity rates, compared with the more radical resection types. The purpose of the present study was to present the outcomes of three consecutive CPs performed in our department. Materials and Methods  Between January 2021 and January 2022, three patients (A, B, and C) were submitted to a CP in our department. Relevant patient data including data of the detailed preoperative assessment, operations notes, and recovery charts were prospectively collected and reviewed for all subjects. A scheduled follow-up, at the outpatient clinic, was conducted to assess the long-term functional results. Results  The postoperative course of patient A, a 56-year-old male, was complicated by a grade C postoperative pancreatic fistula that required a reoperation. Patient B, a 66-year-old female, developed a biochemical leak that resolved spontaneously while patient C, a 64-year-old male, had a completely uneventful recovery. The length of hospital stay for the three patients was 24, 12, and 8 days, respectively. Regarding the long-term results, patient B was lost to follow-up while both patient A and C were followed up, as outpatients, 21 and 10 months after the operation. During follow-up, in patient A, we did not record the presence of symptoms consistent with pancreatic exocrine insufficiency, the hemoglobin A1C (HbA1C) levels were 7.1% while no additional medications were needed to be prescribed to maintain the glycemic control following surgery. In patient C, a significant weight loss was recorded (body mass index reduction of 11 kg/m ² ) without however the presence of malabsorption-specific symptoms. The HbA1C levels were 7.7% and optimal glycemic control was achieved with oral antiglycemic agents alone. Conclusion  CP should be regarded as a type of pancreatic resection with certain and very limited oncological indications. An approach of balancing the advantages out of the superior postoperative functional results with the drawbacks of the increased procedure-associated morbidity could highlight the patient group that could potentially experience benefits out of this limited type of resection.