Pub Date : 2025-08-01DOI: 10.1016/j.jviscsurg.2025.02.009
Claire Goumard , Hadrien Tranchart
Cholecystectomy is one the most frequent procedures in digestive surgery. While the operation is generally associated with low rates of morbidity and mortality, frequency of occurrence can vary considerably according to surgical indication, time elapsed between symptom appearance and surgical intervention, anatomical area under treatment, and the experience of the different centers. Rehospitalization after cholecystectomy remains potentially problematic in numerous units, due in part to the ongoing development of day hospital treatment and short-term hospitalization. The objective of this update is to assess not only the rate, causes and risk factors of non-programmed hospitalizations subsequent to cholecystectomy, but also the available ways and means of prevention and management in the patient's best interests.
{"title":"Non-programmed rehospitalizations after cholecystectomy","authors":"Claire Goumard , Hadrien Tranchart","doi":"10.1016/j.jviscsurg.2025.02.009","DOIUrl":"10.1016/j.jviscsurg.2025.02.009","url":null,"abstract":"<div><div>Cholecystectomy is one the most frequent procedures in digestive surgery. While the operation is generally associated with low rates of morbidity and mortality, frequency of occurrence can vary considerably according to surgical indication, time elapsed between symptom appearance and surgical intervention, anatomical area under treatment, and the experience of the different centers. Rehospitalization after cholecystectomy remains potentially problematic in numerous units, due in part to the ongoing development of day hospital treatment and short-term hospitalization. The objective of this update is to assess not only the rate, causes and risk factors of non-programmed hospitalizations subsequent to cholecystectomy, but also the available ways and means of prevention and management in the patient's best interests.</div></div>","PeriodicalId":49271,"journal":{"name":"Journal of Visceral Surgery","volume":"162 4","pages":"Pages S4-S10"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144051827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-01DOI: 10.1016/j.jviscsurg.2025.04.007
Antoine Poirier, Laurent Brunaud, Claire Nominé Criqui
Acute intestinal intussusception after Roux-en-Y gastric bypass is a rare complication during pregnancy. An early surgical procedure, in close collaboration with obstetricians, is an essential means of avoiding small bowel resection and/or fetal complication.
{"title":"Intussusception after Roux-en-Y gastric bypass in Pregnancy","authors":"Antoine Poirier, Laurent Brunaud, Claire Nominé Criqui","doi":"10.1016/j.jviscsurg.2025.04.007","DOIUrl":"10.1016/j.jviscsurg.2025.04.007","url":null,"abstract":"<div><div>Acute intestinal intussusception<span> after Roux-en-Y gastric bypass is a rare complication during pregnancy. An early surgical procedure, in close collaboration with obstetricians, is an essential means of avoiding small bowel resection and/or fetal complication.</span></div></div>","PeriodicalId":49271,"journal":{"name":"Journal of Visceral Surgery","volume":"162 4","pages":"Pages 314-315"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-01DOI: 10.1016/j.jviscsurg.2025.03.003
Marc Pocard , Jean-Jacques Tuech
{"title":"Lymphatic mapping using patent blue dye injection for colon cancer","authors":"Marc Pocard , Jean-Jacques Tuech","doi":"10.1016/j.jviscsurg.2025.03.003","DOIUrl":"10.1016/j.jviscsurg.2025.03.003","url":null,"abstract":"","PeriodicalId":49271,"journal":{"name":"Journal of Visceral Surgery","volume":"162 4","pages":"Pages 296-304"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-01DOI: 10.1016/j.jviscsurg.2025.03.004
Charles Sabbagh , Quentin Denost , Denis Blazquez , Constantin Zaranis , Muriel Mathonnet , Claude Rambaud , Chloé Carrière , Alain Deleuze , Jean-Michel Fabre , Federation of Visceral, Digestive Surgery (FCVD)
Involving the patient in medical decision-making is called shared medical decision-making (SMD). While the concept of SMD is nothing new, implementation has been slow to develop within current clinical practice, although there is growing interest in this topic in the scientific literature. SMD requires full agreement with the patient, who becomes an actor in their own care, and whose goals sometimes differ from those of the doctor. In a systematic review, it was reported that 75% of surgeons were in favor of SMD, while only 54% of patients favored it. The tools that support SMD can be extremely variable; they are not merely a document of information but must offer guidance to help the patients clarify their choices. They must allow for quality time for discussion, even though the time spent on SMD is perceived as a hindrance to its widespread adoption. The objectives of this work are to specify the essential steps in setting up SMD, and the assessment tools and applications for SMD in digestive surgery.
{"title":"Shared medical decision making","authors":"Charles Sabbagh , Quentin Denost , Denis Blazquez , Constantin Zaranis , Muriel Mathonnet , Claude Rambaud , Chloé Carrière , Alain Deleuze , Jean-Michel Fabre , Federation of Visceral, Digestive Surgery (FCVD)","doi":"10.1016/j.jviscsurg.2025.03.004","DOIUrl":"10.1016/j.jviscsurg.2025.03.004","url":null,"abstract":"<div><div>Involving the patient in medical decision-making is called shared medical decision-making (SMD). While the concept of SMD is nothing new, implementation has been slow to develop within current clinical practice, although there is growing interest in this topic in the scientific literature. SMD requires full agreement with the patient, who becomes an actor in their own care, and whose goals sometimes differ from those of the doctor. In a systematic review, it was reported that 75% of surgeons were in favor of SMD, while only 54% of patients favored it. The tools that support SMD can be extremely variable; they are not merely a document of information but must offer guidance to help the patients clarify their choices. They must allow for quality time for discussion, even though the time spent on SMD is perceived as a hindrance to its widespread adoption. The objectives of this work are to specify the essential steps in setting up SMD, and the assessment tools and applications for SMD in digestive surgery.</div></div>","PeriodicalId":49271,"journal":{"name":"Journal of Visceral Surgery","volume":"162 4","pages":"Pages 274-282"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-01DOI: 10.1016/j.jviscsurg.2025.03.006
Zaki Boudiaf , Kamel Bentabak
Whether or not to mobilize the splenic flexure during laparoscopic colorectal surgery remains a subject of debate. Its usefulness in decreasing the rate of anastomotic leak has not been demonstrated. The difficulty of performing splenic flexure mobilization via laparoscopy and the increase in operative duration are its principal drawbacks. The splenic flexure is an anatomic threshhold zone with complex anatomy, particularly with numerous vascular variations. The laparoscopic approach to splenic flexure mobilization must take into account the embryologic planes while respecting its vascular supply. From the technical standpoint, laparoscopic splenic flexure mobilization can proceed from outside-in by a lateral or anterior approach or from inside-out by a medial approach immediately following the vascular transection. Splenic flexure mobilization can result in an average gain in length of 28 cm (extremes: 10–65 cm) as demonstrated by cadaver dissections, and allows a tension-free anastomosis in every case. The impact of splenic flexure mobilization on the rate of anastomotic leak has shown discordant results. Meta-analyses based on retrospective studies have not shown beneficial effects of SF mobilization. The only available randomized study demonstrated a statistically significant decrease of anastomotic leak in favor of SF mobilization (9.6% versus 17.9%, P = 0.04). Operative duration is prolonged by at least 30 minutes, a statistically significant difference, in most studies, but without a significant impact on the rate of conversion to laparotomy or on the global rates of morbidity and mortality. Pre-operative imaging can allow the surgeon to better plan the procedure while predicting potential operative difficulties. In the future, robotic surgery should permit safe SF mobilization thanks to improved vision and more stable exposure.
{"title":"Mobilization of the splenic flexure in laparoscopic colorectal surgery: Why and how?","authors":"Zaki Boudiaf , Kamel Bentabak","doi":"10.1016/j.jviscsurg.2025.03.006","DOIUrl":"10.1016/j.jviscsurg.2025.03.006","url":null,"abstract":"<div><div>Whether or not to mobilize the splenic flexure during laparoscopic colorectal surgery remains a subject of debate. Its usefulness in decreasing the rate of anastomotic leak has not been demonstrated. The difficulty of performing splenic flexure mobilization via laparoscopy and the increase in operative duration are its principal drawbacks. The splenic flexure is an anatomic threshhold zone with complex anatomy, particularly with numerous vascular variations. The laparoscopic approach to splenic flexure mobilization must take into account the embryologic planes while respecting its vascular supply. From the technical standpoint, laparoscopic splenic flexure mobilization can proceed from outside-in by a lateral or anterior approach or from inside-out by a medial approach immediately following the vascular transection. Splenic flexure mobilization can result in an average gain in length of 28<!--> <!-->cm (extremes: 10–65<!--> <!-->cm) as demonstrated by cadaver dissections, and allows a tension-free anastomosis in every case. The impact of splenic flexure mobilization on the rate of anastomotic leak has shown discordant results. Meta-analyses based on retrospective studies have not shown beneficial effects of SF mobilization. The only available randomized study demonstrated a statistically significant decrease of anastomotic leak in favor of SF mobilization (9.6% versus 17.9%, <em>P</em> <!-->=<!--> <!-->0.04). Operative duration is prolonged by at least 30<!--> <!-->minutes, a statistically significant difference, in most studies, but without a significant impact on the rate of conversion to laparotomy or on the global rates of morbidity and mortality. Pre-operative imaging can allow the surgeon to better plan the procedure while predicting potential operative difficulties. In the future, robotic surgery should permit safe SF mobilization thanks to improved vision and more stable exposure.</div></div>","PeriodicalId":49271,"journal":{"name":"Journal of Visceral Surgery","volume":"162 4","pages":"Pages 283-295"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Unplanned readmission (UR) is defined as an unforeseen readmission of a patient within 30 days of discharge to the same facility for a reason other than mental health, chemotherapy or dialysis. In the literature, UR rates after groin hernia repair range from 2.7 to 5.1% after open or laparoscopic primary ventral hernia repair, and 12% after complex incisional hernia repair. Postoperative complications are the major cause of UR, irrespective of the type of parietal surgery. Risk factors for UR include diabetes, smoking, chronic obstructive pulmonary disease, obesity, therapeutic anticoagulation, ASA score ≥ 3, long duration or emergency surgery, and low socioeconomic status. Anticipating and managing these risk factors can help limit UR.
{"title":"Unplanned rehospitalizations after abdominal wall surgery: Update according to a review of the literature","authors":"Benoit Romain , Manon Viennet , Jean-François Gillion , Niki Christou","doi":"10.1016/j.jviscsurg.2025.03.009","DOIUrl":"10.1016/j.jviscsurg.2025.03.009","url":null,"abstract":"<div><div>Unplanned readmission (UR) is defined as an unforeseen readmission of a patient within 30<!--> <span>days of discharge to the same facility for a reason other than mental health, chemotherapy or dialysis. In the literature, UR rates after groin hernia<span> repair range from 2.7 to 5.1% after open or laparoscopic primary ventral hernia repair, and 12% after complex incisional hernia repair. Postoperative complications are the major cause of UR, irrespective of the type of parietal surgery. Risk factors for UR include diabetes, smoking, chronic obstructive pulmonary disease, obesity, therapeutic anticoagulation, ASA score</span></span> <!-->≥<!--> <!-->3, long duration or emergency surgery, and low socioeconomic status. Anticipating and managing these risk factors can help limit UR.</div></div>","PeriodicalId":49271,"journal":{"name":"Journal of Visceral Surgery","volume":"162 4","pages":"Pages S11-S15"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-01DOI: 10.1016/j.jviscsurg.2024.12.004
Renxi Li , Jayati Atahar , Ahmed Noureldin , Susan Kartiko
Background
Open inguinal hernia repair (OIHR) can be conducted under either general anesthesia (GA) or local anesthesia (LA). Despite a lack of evidence supporting improved perioperative outcomes, GA is the predominant anesthesia type used in OIHR. Frailty is defined as a clinically recognizable state of age-related increased vulnerability. This study aimed to compare the 30-day perioperative outcomes of frail patients undergoing OIHR with either GA or LA.
Methods
Patients who underwent initial OIHR were identified in the ACS-NSQIP database from 2005–2021. Patients with a Modified Frailty Index (mFI) ≥ 2 were included. Patients were divided based on GA or LA administered. Multivariable logistic regression was used to compare 30-day perioperative outcomes between frail patients undergoing OIHR under GA or LA.
Results
Among 20,129 frail patients who underwent initial OIHR, 13,473 had GA, and 3686 had LA. The 30-day mortality rates for LA and GA were low. However, frail patients who underwent LA had a lower risk of bleeding (aOR 0.282, P = 0.04), superficial surgical site infection (aOR 0.450, P = 0.03), and discharge not to home (aOR 0.792, P < 0.01). In addition, frail patients who underwent LA had shorter operation time (58.42 ± 25.26 vs 67.60 ± 37.17 mins, P < 0.01) and a shorter length of stay (0.45 ± 2.30 vs 0.57 ± 2.96 days, P < 0.01).
Conclusion
Although GA is the dominant anesthesia use (4:1) in OIHR among frail patients, LA emerges as a safe alternative to GA for these patients, offering potential benefits such as reduced complications and increased day-case surgery volume, which may be associated with decreased healthcare costs.
{"title":"Favorable 30-day outcomes of initial open inguinal hernia repair with local anesthesia among frail patients","authors":"Renxi Li , Jayati Atahar , Ahmed Noureldin , Susan Kartiko","doi":"10.1016/j.jviscsurg.2024.12.004","DOIUrl":"10.1016/j.jviscsurg.2024.12.004","url":null,"abstract":"<div><h3>Background</h3><div>Open inguinal hernia repair (OIHR) can be conducted under either general anesthesia (GA) or local anesthesia (LA). Despite a lack of evidence supporting improved perioperative outcomes, GA is the predominant anesthesia type used in OIHR. Frailty is defined as a clinically recognizable state of age-related increased vulnerability. This study aimed to compare the 30-day perioperative outcomes of frail patients undergoing OIHR with either GA or LA.</div></div><div><h3>Methods</h3><div>Patients who underwent initial OIHR were identified in the ACS-NSQIP database from 2005–2021. Patients with a Modified Frailty Index (mFI)<!--> <!-->≥<!--> <!-->2 were included. Patients were divided based on GA or LA administered. Multivariable logistic regression was used to compare 30-day perioperative outcomes between frail patients undergoing OIHR under GA or LA.</div></div><div><h3>Results</h3><div>Among 20,129 frail patients who underwent initial OIHR, 13,473 had GA, and 3686 had LA. The 30-day mortality rates for LA and GA were low. However, frail patients who underwent LA had a lower risk of bleeding (aOR 0.282, <em>P</em> <!-->=<!--> <!-->0.04), superficial surgical site infection (aOR 0.450, <em>P</em> <!-->=<!--> <!-->0.03), and discharge not to home (aOR 0.792, <em>P</em> <!--><<!--> <!-->0.01). In addition, frail patients who underwent LA had shorter operation time (58.42<!--> <!-->±<!--> <!-->25.26 vs 67.60<!--> <!-->±<!--> <!-->37.17 mins, <em>P</em> <!--><<!--> <!-->0.01) and a shorter length of stay (0.45<!--> <!-->±<!--> <!-->2.30 vs 0.57<!--> <!-->±<!--> <!-->2.96 days, <em>P</em> <!--><<!--> <!-->0.01).</div></div><div><h3>Conclusion</h3><div>Although GA is the dominant anesthesia use (4:1) in OIHR among frail patients, LA emerges as a safe alternative to GA for these patients, offering potential benefits such as reduced complications and increased day-case surgery volume, which may be associated with decreased healthcare costs.</div></div>","PeriodicalId":49271,"journal":{"name":"Journal of Visceral Surgery","volume":"162 3","pages":"Pages 178-184"},"PeriodicalIF":2.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142967154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-01DOI: 10.1016/j.jviscsurg.2025.01.003
R. Dugas , C. Lim , A. Leseigneur , M. Demouron , F. Mauvais , C. Sabbagh , J.-M. Regimbeau
Introduction
Surgeons and patients need to know the expected outcomes of right hemicolectomy for colon cancer in high-risk anesthetic patients.
Methods
This is a two-center study of high-risk anesthetic patients undergoing right hemicolectomy between 2009 and 2023. High-risk anesthetic patients were defined as those with ASA score ≥ 3. The primary endpoint was to assess the safety of right hemicolectomy evaluated as 90-day mortality and morbidity. Secondary endpoints included the occurrence of anastomotic leak, a textbook outcome and long-term survival. Factors associated with textbook outcome and definitive stoma were also investigated.
Results
A total of 220 patients were included (mean age: 76 ± 9 years). Of these, 8.6% of patients had a definitive stoma. Mortality and severe morbidity at 90 days were 7.3% and 14.6%, respectively. Readmission rate within 90 days was 15.9%. The rate of textbook outcome was 68.2%. In multivariable analysis, hemicolectomy without anastomosis was associated with a lower textbook outcome rate (OR = 0.4, 95% CI = 0.2–1.0; P = 0.04) and a higher definitive stoma rate (OR = 103, 95% CI = 9–1131; P = 0.0001) after right hemicolectomy.
Conclusions
Right hemicolectomy with immediate anastomosis in high-risk anesthetic patients with colon cancer is safe and effective with acceptable mortality and morbidity. Performing right hemicolectomy without anastomosis was a factor for failing to achieve textbook outcome and a risk factor for definitive stoma.
{"title":"Natural history of right hemicolectomy for cancer in high-risk anesthetic patients: Immediate anastomosis is a valid option","authors":"R. Dugas , C. Lim , A. Leseigneur , M. Demouron , F. Mauvais , C. Sabbagh , J.-M. Regimbeau","doi":"10.1016/j.jviscsurg.2025.01.003","DOIUrl":"10.1016/j.jviscsurg.2025.01.003","url":null,"abstract":"<div><h3>Introduction</h3><div>Surgeons and patients need to know the expected outcomes of right hemicolectomy for colon cancer in high-risk anesthetic patients.</div></div><div><h3>Methods</h3><div>This is a two-center study of high-risk anesthetic patients undergoing right hemicolectomy between 2009 and 2023. High-risk anesthetic patients were defined as those with ASA score<!--> <!-->≥<!--> <!-->3. The primary endpoint was to assess the safety of right hemicolectomy evaluated as 90-day mortality and morbidity. Secondary endpoints included the occurrence of anastomotic leak, a textbook outcome and long-term survival. Factors associated with textbook outcome and definitive stoma were also investigated.</div></div><div><h3>Results</h3><div>A total of 220 patients were included (mean age: 76<!--> <!-->±<!--> <!-->9 years). Of these, 8.6% of patients had a definitive stoma. Mortality and severe morbidity at 90 days were 7.3% and 14.6%, respectively. Readmission rate within 90 days was 15.9%. The rate of textbook outcome was 68.2%. In multivariable analysis, hemicolectomy without anastomosis was associated with a lower textbook outcome rate (OR<!--> <!-->=<!--> <!-->0.4, 95% CI<!--> <!-->=<!--> <!-->0.2–1.0; <em>P</em> <!-->=<!--> <!-->0.04) and a higher definitive stoma rate (OR<!--> <!-->=<!--> <!-->103, 95% CI<!--> <!-->=<!--> <!-->9–1131; <em>P</em> <!-->=<!--> <!-->0.0001) after right hemicolectomy.</div></div><div><h3>Conclusions</h3><div>Right hemicolectomy with immediate anastomosis in high-risk anesthetic patients with colon cancer is safe and effective with acceptable mortality and morbidity. Performing right hemicolectomy without anastomosis was a factor for failing to achieve textbook outcome and a risk factor for definitive stoma.</div></div>","PeriodicalId":49271,"journal":{"name":"Journal of Visceral Surgery","volume":"162 3","pages":"Pages 185-190"},"PeriodicalIF":2.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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