Journal of Visceral Surgery最新文献

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.

Introduction: Three-dimensional (3D) reconstruction transforms cross-sectional medical images into interactive anatomical models, interpretable on an LCD screen, in augmented reality or via 3D printing. Although certain benefits have been established in liver surgery, its use in pancreatic surgery remains limited. This update outlines the applications of 3D visualization in pancreatic surgery, ranging from surgical planning to teaching.

Method: A systematic search for English-language articles reporting 3D pancreatic reconstructions in adult patients was conducted in PubMed, Web of Science, Lens.org and the Cochrane Library up to August 28, 2024. Of 1650 articles initially identified, 34 were retained after exclusion of duplicate publications and analysis of titles, abstracts and texts.

Results: The analysis of these studies suggests that 3D reconstruction, in comparison to cross-sectional imaging, could improve preoperative evaluation, by facilitating the detection of anatomical variations, the assessment of resection margins, and the prediction of morbidity and mortality according to tumor volume and residual pancreatic parenchyma. 3D imaging could also improve intraoperative safety, with some series reporting a 50% reduction of blood loss and a 25% reduction in operating time. 3D reconstruction is also a promising tool for teaching surgical anatomy, particularly through 3D printing.

Conclusion: 3D reconstruction could improve outcomes of pancreatic surgery but requires robust comparative studies before becoming a standard evidence-based practice.

Introduction: In colorectal surgery, assessment of the vascularization of the intestinal segments to be anastomosed by injection of indocyanine green (ICG) is one of the intra-operative measures to decrease the risk of anastomotic leak (AL). The aim of this evidence-based review was to evaluate the effectiveness and utility of this measure.

Method: We conducted a comprehensive literature review in electronic databases (PubMed, Scopus, Cochrane Library), coupled with a manual search. Only randomized trials and meta-analyses were included. The primary outcome measure was clinical AL (Grade B and C according to the International Study Group of Rectal Cancer) RESULTS: A total of eight randomized trials and three meta-analyses were included. The conclusions of the three meta-analyses consistently showed a reduction in the risk of AL (by one-third in the most recent meta-analyses). However, the conclusions of the eight trials (especially those with the larger sample sizes) were discordant regarding colonic surgery (excluding rectal resection). In subgroup analysis, recent trials showed no difference in AL in favor of ICG for right colectomy, and data on left colonic or rectal surgery, although discordant, suggested that the benefit of ICG, although not statistically significant, was clinically relevant in the majority of studies.

Conclusion: According to currently available evidence, the use of ICG does not appear to be useful for right colectomies. However, the usefulness of ICG in left-sided colectomies and rectal resections is probable, although not formally proven.

Ostomies and their appliances have evolved considerably and are now part of our daily surgical routine. The first ostomies date back to Antiquity, but little progress was made until the 19th century, when surgical technique was perfected. This paved the way for the appearance and development of commercial stomal appliances in the 20th century. In France, the technique for creation of a stoma is currently based on the 2023 recommendations, but it is important to note that many points are based on expert consensus, and some have not led to recommendations. At the same time, enterostomal therapy and therapeutic patient education have become common practices, and a wide range of appliance choices are now offered to the patient. Despite these advances, several challenges persist, particularly in terms of overall accessibility, economic burden, ecological impact, and optimizing the experience of ostomy patients. Innovation must address these challenges to offer increasingly tailored, personalized, and sustainable solutions, with particular attention paid to the patient experience.