Annals of Gastroenterological Surgery最新文献_第9页

Effect of Intraoperative Posture on Accurate Diagnostic Rate of Intraoperative Nerve Monitoring During Esophagectomy 术中姿势对食管切除术术中神经监测准确率的影响

IF 3.3 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of Gastroenterological Surgery

Pub Date : 2025-04-16 DOI: 10.1002/ags3.70022

Masami Yuda, Keita Takahashi, Yoshitaka Ishikawa, Takanori Kurogochi, Akira Matsumoto, Naoko Fukushima, Takahiro Masuda, Naoto Takahashi, Fumiaki Yano, Ken Eto

Background

The benefits of intraoperative nerve monitoring for identifying recurrent laryngeal nerves during esophageal cancer surgery have recently been reported. However, no standardized procedures have been established for the use of this system. This study aimed to identify factors affecting the diagnostic accuracy of intraoperative nerve monitoring for recurrent laryngeal nerve palsy and explore approaches to improve the precision and efficiency of intraoperative nerve monitoring in esophageal cancer surgery.

Methods

We analyzed 187 consecutive patients who underwent esophagectomy between 2011 and 2018, of whom 142 underwent intraoperative nerve monitoring. We evaluated factors affecting the diagnostic accuracy of intraoperative nerve monitoring for recurrent laryngeal nerve palsy.

Results

The overall incidence of postoperative recurrent laryngeal nerve palsy was 22% (32/142). Univariate analysis identified the left lateral decubitus position (vs. prone position) and not using video laryngoscope during intubation as risk factors for discrepancies between intraoperative nerve monitoring findings and postoperative recurrent laryngeal nerve palsy diagnosis. Multivariate analysis confirmed that the left lateral decubitus position (odds ratio: 4.24; 95% confidence interval: 1.09–13.4, p = 0.019) and not using video laryngoscope during intubation (odds ratio: 9.51; 95% confidence interval: 2.94–15.9, p = 0.001) were independent risk factors for recurrent laryngeal nerve palsy diagnostic discrepancies.

Conclusion

Adequate contact between the intubation tube and vocal cord muscles is crucial for effective intraoperative nerve monitoring during esophagectomy. Additionally, the intraoperative posture significantly affects diagnostic outcomes and should be carefully considered.

背景食管癌手术中术中神经监测对喉返神经识别的益处最近有报道。但是，没有为使用这一系统制定标准化程序。本研究旨在探讨影响喉返神经麻痹术中神经监测诊断准确性的因素，探讨提高食管癌手术术中神经监测的准确性和效率的途径。方法对2011年至2018年187例连续行食管切除术的患者进行分析，其中142例进行术中神经监测。我们评估影响术中神经监测对喉返神经麻痹诊断准确性的因素。结果术后喉返神经麻痹发生率为22%（32/142）。单因素分析发现，左侧侧卧位（相对于俯卧位）和插管时未使用视频喉镜是术中神经监测结果与术后喉返神经麻痹诊断差异的危险因素。多因素分析证实，左侧侧卧位（优势比：4.24；95%可信区间：1.09 ~ 13.4,p = 0.019）和插管时未使用视频喉镜（优势比：9.51；95%可信区间：2.94 ~ 15.9,p = 0.001）是喉返神经麻痹诊断差异的独立危险因素。结论食管切除术中气管插管与声带肌群的充分接触是术中有效监测声带神经的关键。此外，术中姿势显著影响诊断结果，应仔细考虑。

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引用次数: 0

FIB-3 index as a novel age-independent predictor of liver fibrosis and prognosis in hepatocellular carcinoma patients undergoing hepatectomy FIB-3指数作为肝细胞癌切除术患者肝纤维化和预后的新的年龄无关预测因子

IF 3.3 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of Gastroenterological Surgery

Pub Date : 2025-04-13 DOI: 10.1002/ags3.70010

Yuki Imaoka, Masahiro Ohira, Tsuyoshi Kobayashi, Naruhiko Honmyo, Michinori Hamaoka, Takashi Onoe, Daisuke Takei, Koichi Oishi, Tomoyuki Abe, Toshihiro Nakayama, Miho Akabane, Kazunari Sasaki, Hideki Ohdan, Hiroshima Surgical study group of Clinical Oncology (HiSCO)

Background

Liver fibrosis is a key factor in the progression of chronic liver diseases, including viral hepatitis and metabolic dysfunction-associated steatotic liver disease. If untreated, fibrosis can progress to cirrhosis, increasing the risk of liver cancer or failure. This study evaluates the Fibrosis (FIB)-3 index, a novel marker free from age-related biases, for predicting liver fibrosis and 5-year outcomes in hepatocellular carcinoma (HCC) patients undergoing hepatectomy.

Methods

Data from 1013 patients who underwent liver resection were analyzed in this multi-institutional study. The predictive performance of the FIB-3 index was compared with the original FIB-4 index, which incorporates age into its calculation.

Results

The FIB-3 index demonstrated superior accuracy for advanced fibrosis (≥F3) in elderly patients. A higher FIB-3 index was an independent risk factor for recurrence-free survival in elderly patients, underscoring its utility in this population. Notably, the application of appropriate cutoff values allowed the FIB-3 index to facilitate effective risk stratification for 5-year overall survival and recurrence-free survival.

Conclusions

The FIB-3 index served as an effective alternative to the FIB-4 index in assessing liver fibrosis among aged patients, and it effectively stratified the likelihood of the 5-year outcomes when utilized in conjunction with a specific cut-off after initial hepatectomy for HCC.

肝纤维化是慢性肝病进展的关键因素，包括病毒性肝炎和代谢功能障碍相关的脂肪变性肝病。如果不及时治疗，纤维化会发展为肝硬化，增加肝癌或肝功能衰竭的风险。这项研究评估了纤维化(FIB)-3指数，这是一种没有年龄相关偏差的新标志物，用于预测肝细胞癌（HCC）切除术患者的肝纤维化和5年预后。方法对1013例肝切除术患者的资料进行多机构分析。将FIB-3指数的预测性能与纳入年龄计算的原始FIB-4指数进行比较。结果FIB-3指数对老年晚期纤维化（≥F3）具有较高的准确性。较高的FIB-3指数是老年患者无复发生存的独立危险因素，强调了其在该人群中的实用性。值得注意的是，适当的临界值的应用使FIB-3指数能够促进5年总生存率和无复发生存率的有效风险分层。结论：FIB-3指数是评估老年患者肝纤维化的有效替代FIB-4指数，当与HCC初始肝切除术后的特定截止值结合使用时，它有效地分层了5年预后的可能性。

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引用次数: 0

A severity-based tumor-superior mesenteric/portal vein interface grading criteria as a predictor of survival outcomes in pancreatic head ductal adenocarcinoma patients undergoing pancreaticoduodenectomy following neoadjuvant chemoradiotherapy 基于肿瘤-肠系膜上/门静脉界面分级标准作为胰头导管腺癌患者在新辅助放化疗后行胰十二指肠切除术的生存预后预测因子

IF 2.9 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of Gastroenterological Surgery

Pub Date : 2025-04-10 DOI: 10.1002/ags3.70002

Benson Kaluba, Naohisa Kuriyama, Motonori Nagata, Takahiro Ito, Aoi Hayasaki, Takehiro Fujii, Yasuhiro Murata, Akihiro Tanemura, Masashi Kishiwada, Shugo Mizuno

Aim

To assess the ability of a new severity-based tumor-superior mesenteric/portal vein interface criteria to predict survival outcomes in pancreatic ductal adenocarcinoma patients undergoing pancreaticoduodenectomy after neoadjuvant chemoradiotherapy (CRT).

Methods

Two hundred and twenty-six post-CRT patients were enrolled and 22 had no tumor-SMV/PV contact, while the remaining 204 had. Based on correlation with overall survival (OS), circumferential (210 degrees) and contact length (25 mm) interface cut-off values were identified, then used to formulate no tumor-SMV/PV contact, non-severe, and severe interface criteria. Significant predictors of disease-free (DFS) and OS were identified.

Results

The severe group had significantly more UR-LA, cStage 3 cases, longer operation times, more intra-operative blood loss, R1 resection, and pPV invasion cases than the no tumor-contact and non-severe interface groups (p < 0.001). Median DFS were 37.7 (no tumor-contact), 17.0 (non-severe), and 5.2 (severe) months and OS was 56.7, 29.9, and 12.0. Among tumor-contact patients, the interface criteria (84.7%) had a better specificity in predicting pPV invasion than tumor-contact length (76.9%) and tumor-circumferential interface (73.8%). Those with pPV invasion had shorter DFS (16.7 vs. 5.7) and OS (28.3 vs. 13.6) than those without pPV invasion. Significant independent predictors of both DFS and OS were the interface criteria, resection margins, and pPV invasion. Clinical and pathological lymph node involvement also influenced DFS, while circumferential interface and pathological tumor stage also impacted OS.

Conclusion

Patients can be stratified as no tumor-contact, non-severe, or severe interface cases and the criteria might be useful in preoperatively predicting not only survival but also intra-operative outcomes and pPV invasion.

目的评估一种新的基于肿瘤严重程度-肠系膜上/门静脉界面标准预测胰管腺癌患者新辅助放化疗（CRT）后生存结果的能力。方法纳入226例crt后患者，22例无肿瘤- smv /PV接触，其余204例有。基于与总生存期（OS）的相关性，确定了周向（210度）和接触长度（25 mm）界面截止值，然后用于制定无肿瘤- smv /PV接触，非严重和严重的界面标准。确定无病（DFS）和OS的显著预测因子。结果重症组UR-LA、c3期病例、手术时间、术中出血量、R1切除、pPV侵袭病例明显多于无肿瘤接触组和非重症界面组（p < 0.001）。中位DFS分别为37.7个月（无肿瘤接触）、17.0个月（非严重）和5.2个月（严重），OS分别为56.7、29.9和12.0。在肿瘤接触患者中，界面标准（84.7%）预测pPV侵袭的特异性优于肿瘤接触长度（76.9%）和肿瘤周界面（73.8%）。pPV侵袭组的DFS （16.7 vs. 5.7）和OS （28.3 vs. 13.6）均短于无pPV侵袭组。DFS和OS的重要独立预测因子是界面标准、切除边缘和pPV侵袭。临床及病理淋巴结受累程度影响DFS，肿瘤周界面及病理分期影响OS。结论患者可分为无肿瘤接触病例、非严重病例和严重界面病例，术前诊断标准不仅可用于预测患者的生存，还可用于预测术中预后和pPV侵袭情况。

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引用次数: 0

Regional and patient characteristic disparities in the outcomes of minimally invasive surgery for colorectal cancer in Japan 日本结直肠癌微创手术结果的地区和患者特征差异

IF 2.9 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of Gastroenterological Surgery

Pub Date : 2025-04-03 DOI: 10.1002/ags3.70007

Atsushi Hamabe, Arata Takahashi, Hiraku Kumamaru, Hiroshi Hasegawa, Koki Otsuka, Yoshihiro Kakeji, Ken Shirabe, Masafumi Inomata, Yuko Kitagawa, Ichiro Takemasa

Aim

The use of minimally invasive surgery, including laparoscopic and robotic surgery, for gastrointestinal cancer has been rapidly increasing. This study aimed to clarify whether differences in minimally invasive surgery outcomes are associated with regional and patient characteristics.

Methods

A total of 123 771 right hemicolectomy and 126 965 low anterior resection cases performed between 2013 and 2019 were selected from the National Clinical Database for analysis. Patients were stratified by regional and economic variables, and open and minimally invasive surgical outcomes were evaluated.

Results

In secondary medical regions characterized by urban settings and numerous designated cancer care hospitals, the observed 30-day mortality of low anterior resections was lower only in the minimally invasive surgery group. For right hemicolectomies in regions with many designated cancer care hospitals, the observed incidence of postoperative complications was also lower in the minimally invasive group. Residents of high-income areas undergoing low anterior resection had a lower frequency of 30-day reoperation regardless of the type of surgery and a lower 30-day mortality in the minimally invasive group. For both right hemicolectomy and low anterior resection, patients with longer travel distances had fewer postoperative complications and lower 30-day reoperation rates in the minimally invasive group than in the open surgery group.

Conclusion

This study found regional and patient characteristic disparities in minimally invasive surgical outcomes; national policies should be implemented to address these inequities.

目的微创手术，包括腹腔镜手术和机器人手术，在胃肠道癌症治疗中的应用正在迅速增加。本研究旨在阐明微创手术结果的差异是否与区域和患者特征有关。方法从2013 - 2019年全国临床数据库中选取123 771例右半结肠切除术和126 965例下前切除术进行分析。根据地区和经济变量对患者进行分层，并评估开放和微创手术的结果。结果在以城市环境和众多指定的癌症护理医院为特征的二级医疗区域，观察到的前低位切除术30天死亡率仅在微创手术组较低。在肿瘤定点护理医院较多的地区进行右半结肠切除术，微创组观察到的术后并发症发生率也较低。无论手术类型如何，高收入地区接受低位前切除术的居民30天再手术频率较低，微创组30天死亡率较低。无论是右半结肠切除术还是低位前切除术，与开放手术组相比，微创组行走距离较远的患者术后并发症较少，30天再手术率较低。结论本研究发现微创手术结果存在地区差异和患者特征差异；应执行国家政策来解决这些不平等现象。

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引用次数: 0

Does surgical intervention contribute to survival for patients with para-aortic lymph node metastasis from colorectal cancer? 手术干预是否有助于结直肠癌主动脉旁淋巴结转移患者的生存？

IF 3.3 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of Gastroenterological Surgery

Pub Date : 2025-04-03 DOI: 10.1002/ags3.70019

Akira Ouchi, Koji Komori, Sono Ito, Yusuke Kinugasa, Soichiro Ishihara, Akio Shiomi, Yukihide Kanemitsu, Takeshi Suto, Hiroki Takahashi, Yoichi Ajioka, the study group for PALNM projected by JSCCR

Aims

There is a lack of compelling evidence supporting the benefit of surgical resection for para-aortic lymph node metastasis (PALNM) from colorectal cancer (CRC). We aimed to investigate the true impact of surgical resection on survival for patients with PALNM from CRC.

Patients and Methods

Patients diagnosed with PALNM from CRC at the Japanese Society for Cancer of the Colon and Rectum institutions between January 2011 and December 2015 were analyzed. Those who had received surgical resection and those who did not were matched one-on-one by the propensity score (PS)-matching method. A total of 77 PS-matched pairs extracted from 347 patients at 36 institutions were compared.

Results

Thirty-one (40.3%) patients each in the surgical resection and chemotherapy groups had distant metastasis other than PALNM, and the most dominant organ was the liver in 18 (23.4%) patients in both groups. In the surgical resection group, 56 (72.7%) patients achieved curative resection of all disease lesions, of which 49 (63.6%) were R0 resection. Three- and 5-year relapse-free survival of patients who achieved curative resection were 24.4% and 24.4%, respectively. Three- and 5-year overall survival (OS) of patients in the surgical resection were 68.4% and 40.2%, which were significantly better than that in the chemotherapy groups (40.9% and 27.7%), respectively (Log-rank p = 0.003).

Conclusion

The OS of patients with surgical resection for PALNM was significantly better than those without surgical resection. These results highlight the benefit of surgical intervention to survival for patients with resectable PALNM.

目前缺乏有力的证据支持手术切除结直肠癌（CRC）的腹主动脉旁淋巴结转移（PALNM）的益处。我们的目的是调查手术切除对结直肠癌PALNM患者生存的真正影响。患者和方法分析2011年1月至2015年12月在日本结肠直肠癌症协会机构诊断为结直肠癌PALNM的患者。接受手术切除的患者和未接受手术切除的患者通过倾向评分（PS）匹配方法进行一对一匹配。从36家机构的347例患者中提取77对ps匹配的配对进行比较。结果手术切除组和化疗组均有31例（40.3%）发生PALNM以外的远处转移，其中18例（23.4%）以肝脏为主。手术切除组56例（72.7%）患者病灶全部根治性切除，其中R0切除49例（63.6%）。获得根治性切除的患者3年和5年无复发生存率分别为24.4%和24.4%。手术切除组患者3年和5年总生存率（OS）分别为68.4%和40.2%，显著优于化疗组（40.9%和27.7%），差异有统计学意义（Log-rank p = 0.003）。结论手术切除PALNM患者的OS明显优于未手术切除PALNM患者。这些结果强调了手术干预对可切除PALNM患者生存的益处。

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引用次数: 0

Analysis of hospital costs for robotic and open pancreatectomy incurred during the implementation of a robotic pancreatectomy program at a cancer center 在某癌症中心实施机器人胰腺切除术项目期间，机器人胰腺切除术和开放式胰腺切除术的医院费用分析

IF 3.3 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of Gastroenterological Surgery

Pub Date : 2025-04-03 DOI: 10.1002/ags3.70017

Heather G. Lyu, Yuki Hirata, Pamela W. Lu, Jess E. Maxwell, Rebecca A. Snyder, Michael P. Kim, Hop Tran Cao, Ching-Wei D. Tzeng, Matthew H. G. Katz, Naruhiko Ikoma

Background

Costs associated with robotic pancreatectomy compared to those of open pancreatectomy are assumed to be high but are not well known, particularly during the initial implementation of the robot.

Study Design

Patients who underwent pancreatectomy for any diagnosis from January 2017 to August 2021 were identified retrospectively. Total hospital cost was calculated using intraoperative, inpatient, and outpatient costs within 30 days of surgery. The ratio of the total cost of each pancreatectomy to the average cost of all operations at our center was used to represent cost without sharing proprietary financial data. Propensity score matching was performed to account for significant differences between the two groups.

Results

We identified 679 patients who underwent pancreatectomies, 88 of which were robotic. After propensity score matching, the open cohort had 176 patients, and the robotic cohort remained at 88 patients. The median hospital length of stay was 2 days shorter for robotic than for open pancreatectomy (p < 0.001). The total hospital cost was markedly lower in the robotic pancreatectomy cohort. The inpatient and outpatient costs for robotic pancreatectomy were considerably lower than those for open pancreatectomy despite substantially higher intraoperative costs for the former procedure. A scatter plot of total costs after the initial adoption of the robot showed a trend of decreasing costs over time.

Conclusion

Overall, total hospital costs associated with robotic pancreatectomy were lower than those for open surgery, mainly driven by shorter length of stay. Our findings suggest that costs of robotic pancreatectomy may decrease further with increased surgeon experience.

与开放式胰腺切除术相比，机器人胰腺切除术的相关成本被认为是高的，但并不为人所知，特别是在机器人的初始实施阶段。研究设计回顾性分析2017年1月至2021年8月期间因任何诊断而行胰腺切除术的患者。总住院费用采用手术30天内的术中、住院和门诊费用计算。每次胰腺切除术的总成本与本中心所有手术的平均成本之比被用来表示成本，而不共享专有财务数据。进行倾向评分匹配以解释两组之间的显著差异。结果我们确定了679例接受胰腺切除术的患者，其中88例是机器人。倾向评分匹配后，开放队列有176名患者，机器人队列仍为88名患者。机器人胰腺切除术的住院时间中位数比开放式胰腺切除术短2天（p < 0.001）。在机器人胰腺切除术队列中，总住院费用明显较低。机器人胰腺切除术的住院和门诊费用明显低于开放式胰腺切除术，尽管前者的术中费用高得多。机器人初始使用后的总成本散点图显示了成本随时间降低的趋势。结论总体而言，机器人胰腺切除术的总住院费用低于开放手术，主要原因是住院时间较短。我们的研究结果表明，随着外科医生经验的增加，机器人胰腺切除术的成本可能会进一步降低。

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引用次数: 0

Short-term and long-term outcomes of self-expandable metallic stent placement versus creation of a diverting stoma for obstructive colorectal cancer: A systematic review and meta-analysis 自膨胀金属支架置入与建立转移造口治疗梗阻性结直肠癌的短期和长期结果：一项系统回顾和荟萃分析

IF 2.9 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of Gastroenterological Surgery

Pub Date : 2025-04-01 DOI: 10.1002/ags3.70011

Thanakorn Yingruxpund, Akihisa Matsuda, Takeshi Yamada, Chaiya Chansai, Hiroshi Yoshida

Aim

A diverting stoma (DS) is often used as a bridge to surgery in patients with obstructive colorectal cancer (OCRC). However, the self-expandable metallic stent (SEMS) has emerged as a less invasive option. This systematic review and meta-analysis compared the efficacy and safety of the SEMS with that of a DS for OCRC.

Methods

An electronic literature search through to May 2024 was performed to identify studies that compared the SEMS and DS as a bridge to surgery in patients with OCRC. The primary outcomes were postoperative complications and mortality. Secondary outcomes included clinical success of decompression, surgical site infection, anastomotic leakage, bleeding, permanent stoma creation, locoregional recurrence, and 3-year overall survival. The data were pooled using a random-effects model. The results are presented as odds ratios (ORs) with 95% confidence intervals (CIs).

Results

Five non-randomized studies that included 977 patients (SEMS, n = 427; DS, n = 550) were included. Postoperative complications (OR 0.78, 95% CI 0.60–1.01, p = 0.06) and mortality (OR 1.15, 95% CI 0.61–2.16, p = 0.67) were comparable between the groups. SEMS placement had a significantly lower clinical success of decompression but reduced the risk of surgical site infection (OR 0.45, 95% CI 0.27–0.77, p = 0.003). There was no significant between-group difference in frequency of anastomotic leakage (p = 0.68), bleeding (p = 0.94), permanent stoma formation (p = 0.95), locoregional recurrence (p = 0.31), or 3-year overall survival (p = 0.98).

Conclusion

Although clinical success was inferior to DS, SEMS contributed to comparable outcomes including postoperative complications, mortality, and long-term outcomes, but significantly reduced SSI. These findings support the broader adoption of SEMS in clinical practice, particularly requiring minimized invasiveness and improving patient quality of life are prioritized.

目的梗阻性结直肠癌（OCRC）患者常采用转移造口（DS）作为手术的桥梁。然而，自膨胀金属支架（SEMS）已成为一种侵入性较小的选择。本系统综述和荟萃分析比较了SEMS和DS治疗OCRC的疗效和安全性。方法通过电子文献检索到2024年5月，以确定比较SEMS和DS作为OCRC患者手术桥梁的研究。主要结局为术后并发症和死亡率。次要结局包括临床成功的减压、手术部位感染、吻合口漏、出血、永久性造口、局部复发和3年总生存。使用随机效应模型汇总数据。结果以95%置信区间（ci）的比值比（ORs）表示。结果5项非随机研究纳入977例患者(SEMS, n = 427；纳入DS （n = 550）。两组术后并发症（OR 0.78, 95% CI 0.60-1.01, p = 0.06）和死亡率（OR 1.15, 95% CI 0.61-2.16, p = 0.67）具有可比性。SEMS放置的临床减压成功率显著降低，但降低了手术部位感染的风险（OR 0.45, 95% CI 0.27-0.77, p = 0.003）。吻合口漏（p = 0.68）、出血（p = 0.94）、永久性造口（p = 0.95）、局部区域复发（p = 0.31）、3年总生存率（p = 0.98）两组间无显著差异。结论：虽然SEMS的临床成功率不如DS，但SEMS在包括术后并发症、死亡率和长期预后在内的结果上具有可比性，但SSI显著降低。这些发现支持在临床实践中更广泛地采用SEMS，特别是要求最小化侵入性和提高患者的生活质量。

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引用次数: 0

Comparison between olanexidine gluconate and conventional antiseptics for surgical site infection in gastroenterological surgery: A meta-analysis 葡萄糖酸奥兰内酯与常规防腐剂治疗胃肠外科手术部位感染的比较：荟萃分析

IF 3.3 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of Gastroenterological Surgery

Pub Date : 2025-03-31 DOI: 10.1002/ags3.70014

Akihisa Matsuda, Takeshi Yamada, Kay Uehara, Aya Yamagishi, Hiroshi Yoshida

Aim

To compare the preventative effect of the new antiseptic olanexidine gluconate (OLG) with conventional antiseptics on surgical site infections (SSIs) in gastroenterological surgery.

Methods

A comprehensive electronic literature search was conducted through November 2024 to identify studies comparing the occurrence of SSIs between OLG and conventional antiseptics (Conv), including povidone-iodine (PI) or chlorhexidine gluconate (CHG), for incisional site disinfection. The primary outcomes were the occurrence of overall SSI and incisional SSI (including superficial and deep incisional SSI). A meta-analysis was performed using random-effects models to calculate odds ratios (ORs) with 95% confidence intervals (CIs).

Results

Nine studies involving 7807 patients (OLG, n = 3491; Conv, n = 4316) were included. The overall SSI rates were 7.8% in the OLG group and 11.1% in the Conv group. OLG significantly reduced overall SSIs (OR: 0.65, 95% CI: 0.53–0.81, p < 0.001) without statistical heterogeneity. OLG also significantly reduced incisional SSIs (4.3% vs. 6.6%) (OR: 0.63, 95% CI: 0.49–0.81, p < 0.001) without statistical heterogeneity.

Conclusions

To our knowledge, this is the first meta-analysis with a sufficient sample size to investigate the effect of OLG compared with other antiseptics, demonstrating that OLG significantly reduces overall SSIs and incisional SSIs in gastroenterological surgery without increasing adverse skin reactions. These findings may enhance SSI management for patients undergoing various types of surgeries by introducing new preventative strategies and potentially lowering SSI-related healthcare costs.

目的比较新型抗菌药物葡萄糖酸奥内酯（OLG）与常规抗菌药物对胃肠外科手术部位感染的预防效果。方法通过截至2024年11月的全面电子文献检索，比较OLG与常规消毒剂（包括聚维酮碘（PI）或葡萄糖酸氯己定（CHG））在切口部位消毒中ssi发生率的研究。主要结果是总体SSI和切口SSI（包括浅表和深切口SSI）的发生。采用随机效应模型进行meta分析，以95%置信区间（ci）计算优势比（ORs）。结果纳入9项研究，共7807例患者（OLG, n = 3491; Conv, n = 4316）。OLG组总体SSI发生率为7.8%，Conv组为11.1%。OLG显著降低总体ssi (OR: 0.65, 95% CI: 0.53-0.81, p < 0.001)，无统计学异质性。OLG也显著降低了切口ssi (4.3% vs. 6.6%) (OR: 0.63, 95% CI: 0.49-0.81, p < 0.001)，无统计学异质性。据我们所知，这是第一次有足够的样本量来研究OLG与其他防腐剂的效果的荟萃分析，表明OLG可以显著降低胃肠外科手术中的总体ssi和切口ssi，而不会增加皮肤不良反应。这些发现可能通过引入新的预防策略和潜在地降低SSI相关的医疗费用，加强对接受各种手术的患者的SSI管理。

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引用次数: 0

Reoperative pouch surgery for suspected Crohn's-related complications aided by biologic coverage: Early experience from an inflammatory bowel disease center 再手术眼袋手术治疗疑似克罗恩病相关并发症，辅以生物覆盖：来自炎症性肠病中心的早期经验

IF 3.3 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of Gastroenterological Surgery

Pub Date : 2025-03-25 DOI: 10.1002/ags3.70016

Mehmet Gulmez, Daniel J. Wong, Ariela K. Holmer, Eren Esen, Shannon Chang, Arman Erkan, David Hudesman, Andre da Luz Moreira, Feza H. Remzi

Aim

In patients with failing ileo-anal pouches there is often diagnostic uncertainty. In this setting, we may offer revisional pouch surgery with biologic “coverage” for presumed Crohn's disease (CD) which enables an alternative to pouch excision and end ileostomy to highly motivated patients. The aim of this study is to assess postoperative outcomes in patients who underwent revisional/redo ileal pouch anal anastomosis (IPAA) for failing pouches with biologic coverage for possible CD.

Methods

This is a retrospective cross-sectional study based on data from a tertiary inflammatory bowel disease center. Patients who underwent revisional/redo IPAA surgery between September 2016 and December 2022 were included. The primary outcome measure was the rate of functioning pouch.

Results

Of the 213 patients who underwent revisional/redo IPAA surgery, 17 underwent redo IPAA surgery with biologic coverage due to concern for CD. An additional seven patients were started on biologics between the two operative stages of redo IPAA surgery. At a median follow-up of 17 months, the functioning pouch rate was 75%.

Conclusions

Revisional IPAA surgery for suspected CD-related complications leading to pouch failure, in conjunction with concurrent medical therapy, provides a stoma-free alternative to patients otherwise facing pouch excision and end ileostomy. Despite the limited number of patients and varying follow-up times, this approach shows promise for maintaining pouch function in a challenging patient population.

目的回肠肛肠囊失败的患者常存在诊断不确定性。在这种情况下，我们可能会为假定的克罗恩病（CD）提供具有生物学“覆盖”的修正眼袋手术，这可以替代眼袋切除术和末端回肠造口术。本研究的目的是评估因生物覆盖可能的CD而失败的回肠袋肛门吻合术（IPAA）患者的术后结果。方法：这是一项基于三级炎症性肠病中心数据的回顾性横断面研究。纳入了2016年9月至2022年12月期间接受IPAA翻修/重做手术的患者。主要观察指标为功能袋率。结果213例患者接受了修复/重做IPAA手术，17例患者由于担心CD而接受了生物覆盖的重做IPAA手术。另外7例患者在重做IPAA手术的两个手术阶段之间开始使用生物药物。在平均17个月的随访中，功能袋率为75%。结论对疑似cd相关并发症导致的眼袋衰竭进行修正性IPAA手术，并结合同期药物治疗，为面临眼袋切除和回肠末端造口的患者提供了一个无瘘的选择。尽管患者数量有限，随访时间不同，但这种方法在具有挑战性的患者群体中显示出维持眼袋功能的希望。

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引用次数: 0

Indirect assessment of hemorrhoid incidence using invasive treatment data in Japan: A 5-year study based on nationwide health insurance claims 利用侵入性治疗数据间接评估日本痔疮发病率：一项基于全国健康保险索赔的5年研究

IF 3.3 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of Gastroenterological Surgery

Pub Date : 2025-03-25 DOI: 10.1002/ags3.70018

Masamitsu Kido, Tomohiro Arita, Katsutoshi Shoda, Ken Inoue, Hiroyuki Okimura, Hiroki Shimizu, Jun Kiuchi, Kenji Nanishi, Atsushi Shiozaki

Aim

The epidemiology of hemorrhoids is challenging because of variability in sampling methodologies and diagnostic criteria across different studies. This study indirectly clarified the epidemiology of hemorrhoids by investigating the number of invasive treatments for hemorrhoids (ITH) using a nationwide healthcare claims database.

Methods

The annual number and rate of ITH procedures per 100 000 people during 2018–2022 were examined. ITH covered by the Japanese healthcare insurance includes sclerotherapy, rubber band ligation, infrared coagulation, thrombectomy, hemorrhoidectomy, and stapled hemorrhoidopexy. The demographic peak patterns in the sex- and age-stratified data were analyzed. Annual trends were evaluated using the Jonckheere–Terpstra trend test or Poisson regression model.

Results

Over the 5-year period, the total number of ITH was 697 838, with a rate of 110.5 per 100 000 person-years. The male-to-female ratio was 1.2:1, indicating slight male predominance. Demographic peak analysis revealed bimodal peaks in males aged 40–44 and 75–79 years, and in females aged 35–39 and 75–79 years. No significant changes were observed in all ITH procedures. The age-adjusted number across all age groups per 100 000 person-years demonstrated annual decreasing trends for males but increasing trends for females (p < 0.0167). Subgroup analysis indicated a decrease among older cohorts in both males and females, in contrast to an increase among young and middle-aged females (p < 0.00088).

Conclusion

Distinct bimodal ITH peaks were observed in males and females in their 30s–40s and 70s. These findings provide valuable insights into the epidemiology of hemorrhoids.

目的痔疮的流行病学是具有挑战性的，因为在不同的研究取样方法和诊断标准的可变性。本研究通过使用全国医疗索赔数据库调查痔疮（ITH）侵入性治疗的数量，间接阐明了痔疮的流行病学。方法统计2018-2022年北京市每10万人每年ITH手术次数和比率。日本医疗保险所涵盖的ITH包括硬化疗法、橡皮筋结扎、红外线凝血、血栓切除术、痔疮切除术和痔钉固定术。分析了按性别和年龄分层数据的人口峰值模式。使用Jonckheere-Terpstra趋势检验或泊松回归模型评估年度趋势。结果5年期间，ITH患者总数为697 838例，发病率为110.5例/ 10万人-年。男女比例为1.2:1，男性略占优势。人口峰值分析显示，40-44岁和75-79岁男性和35-39岁和75-79岁女性出现双峰。所有ITH手术均未观察到明显变化。在所有年龄组中，每10万人年的年龄调整数显示，男性呈逐年下降趋势，而女性呈逐年上升趋势（p < 0.0167）。亚组分析显示，老年人群中男性和女性的发病率均有所下降，而年轻和中年女性的发病率则有所上升（p < 0.00088）。结论30 ~ 40岁和70多岁男性和女性有明显的ITH双峰。这些发现为痔疮的流行病学提供了有价值的见解。

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引用次数: 0