Journal of Visceral Surgery最新文献

Aim of the study: Acute abdominal surgery, constituting a substantial portion of hospital services, is associated with high morbidity and mortality rates. This study aimed to compare two cohorts of emergency laparotomy surgeries: before (Cohort 1) and after (Cohort 2) the establishment of a regular daytime emergency operating theatre at Haukeland University Hospital, Norway.

Patients and methods: Data were collected from the hospital's operation planning and registration system and then merged with data from the hospital's electronic patient record system. The British National Emergency Laparotomy Audit (NELA) inclusion and exclusion criteria were used.

Results: The study found an increase from Cohort 1 to Cohort 2 in the number of surgeries, and in the proportion of urgent surgeries, both requested and started, within 6h. Results also showed a higher proportion of daytime surgeries in the latter cohort. More elderly patients were operated in Cohort 2, but the low 30-day mortality rate remained unchanged. Other key outcomes, such as length of hospital stay and reoperations within seven days, were also unchanged. The number of cancellations of scheduled surgery was significantly lower after a regular daytime emergency surgery room was available.

Conclusion: While improvements were found, the study acknowledges potential challenges and costs associated with the increasing availability of surgical theatres. The findings contribute to ongoing discussions on optimizing acute abdominal surgery pathways.

The objective of this study was to report on the results of cholecystectomy in patients with sickle cell disease in two hospitals in Niger.

Patients and methods: This was a retrospective study conducted over a six-year period in the general referral hospital and the national hospital of Niamey (Niger).

Results: We collected data concerning 56 cases of cholecystectomy in patients with sickle cell disease, representing of 10.3% of all cholecystectomies (gall bladder removals) performed. A majority of the patients were female (55.4%), with a mean age of 20.2 years, standard deviation of 8.8, and extreme values at 6 and 47 years. Homozygous SS forms of sickle cell disease predominated (92.9%). Nearly two-thirds of the patients (64.3%) were referred from the national sickle cell disease referral center. The main operative indication (69.6%) was symptomatic gall bladder (vesicular) lithiasis. All of the patients were anemic, with severe anemia in nearly half (44.6%). Exchange transfusion was carried out in 42.9% of the patients, and perioperative blood transfusion in 57.1%. The laparoscopic route was followed in almost all of the patients (94.6%). Mean postoperative stay in an intensive care unit was 23.5±7.2 (12-48) 48hours. The rate of postoperative complications was 23.2%, and the rate of mortality was 1.8%. As regards disease progress at one year, no vaso-occlusive crises were observed in seven eight (87.5) of the patients.

Conclusion: Cholecystectomy in sickle cell patients calls for a multidisciplinary strategy, and laparoscopy appears to be the ideal approach, especially insofar as it provides satisfactory postoperative comfort.

Aim: To evaluate oncologic and postoperative outcomes of pancreatic resections in a French low-volume peripheral center and compare them with national benchmarks from high-volume institutions. The objective was to determine whether a non-centralized center with an experienced hepatobiliary-pancreatic (HPB) team could achieve results comparable to national standards for pancreatic ductal adenocarcinoma (PDAC).

Methods: We conducted a retrospective study of 181 consecutive pancreatic resections performed between 2019 and 2024. Eighty-five patients had PDAC. Outcomes for this subgroup were benchmarked against national data reported by Marchese et al. on 17,183 PDAC pancreatectomies. Perioperative management and outcome definitions followed international guidelines.

Results: Despite a high-risk PDAC population (52.8% aged ≥70 years; 85.8% with Charlson Age-Comorbidity Index ≥4), 90-day and 1-year mortality were 3.5% and 10.6%, respectively, both lower than national averages for high-volume centers (4.6% and 18.6%). Clinically relevant postoperative pancreatic fistula occurred in 7.8% of PDAC patients, and 10.5% required reoperation. On multivariable analysis, soft pancreatic texture was the only independent predictor of fistula, while reoperation was strongly associated with early mortality.

Conclusions: Favorable outcomes in pancreatic cancer surgery can be achieved outside high-volume institutions when care is provided by HBP-experienced teams within structured, multidisciplinary pathways. These results support the concept that surgical performance reflects a combination of expertise, organization, and governance rather than volume alone. Adoption of performance-based indicators, alongside volume metrics, may better capture quality and ensure equitable, high-standard care across diverse healthcare settings.

Parastomal hernias (PSH) are a common complication of intestinal or urinary stomas, occurring with a prevalence greater than 30%. There is no repair technique that has proven to be feasible, safe, and associated with a limited risk of recurrence. The technique described herein is a modification of the SMART technique using a slowly resorbable prosthetic mesh (Phasix™) that offers several advantages: feasibility, safety, elective surgery, without stomal transposition, and a reduced risk of stomal injury and long-term complications.