Journal of Visceral Surgery最新文献

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.

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.