Annals of Surgical Treatment and Research最新文献

Purpose: Amyand's hernia (AH) is the name given to the type of hernia in which the appendix is found in a hernial sac. We aimed to share our clinical experience with a literature review for AH.

Methods: A total of 1,774 inguinal hernias and 13 AH cases were repaired in our clinic between 2009 and 2020. In addition, detailed clinical features about AH were extracted by including unpublished data of 165 cases, which were gathered from the extensive literature on childhood AHs using PubMed, Web of Science, and Cochrane databases.

Results: The rate of AH was 0.73% in all inguinal hernias; this rate was 8.6% for incarcerated hernias. The average age was 5.74 ± 7.27 months for AH. Our AH cases were seen in males and on the right side. AH is seen in 97.3% of males according to a review of 69 articles. The average age was 16.78 ± 30.46 months. One hundred sixty-five of the AH cases were on the right (88.7%). The main symptoms were swelling or redness in the inguinal region, pain, fever, and vomiting, along with patients presenting septic or with stercoral fistula.

Conclusion: If the appendix is normal and easily reduced, high ligation is sufficient. In cases where reduction is difficult and/or the appendix is inflamed, appendectomy and hospitalization should be performed.

Purpose: During the coronavirus disease 2019 (COVID-19) pandemic, frequent perioperative interactions between patients and medical staff increased the risk of nosocomial infections. Total 1-day perioperative completion (TODPC) involves conducting preoperative evaluations, performing the operation, and facilitating discharge within a single day. This study aimed to evaluate the safety of TODPC in reducing perioperative contact by utilizing online and telephone appointment systems for inguinal hernia (IH) repairs.

Methods: In this retrospective cohort study, we analyzed data from patients who underwent IH repairs. The study was divided into 2 periods relative to the COVID-19 pandemic: 18 months pre-pandemic (Group 1, September 2018-February 2020) and 18 months post-pandemic onset (Group 2, March 2020-August 2021). We compared the frequency of TODPC, daycare surgeries (which require hospital visits for preoperative evaluations and admission on the day of surgery), preoperative contacts, hernia types, incarcerations, organ resections, and instances of COVID-19 transmission among medical staff and patients.

Results: The study included 5,728 participants, comprising 4,614 pediatric and 1,114 adult patients. The rate of TODPC implementation was higher in Group 2 than in Group 1 (91.0% vs. 75.0%, P < 0.001). The incidence of organ resections was low and did not differ significantly between the 2 groups. Throughout the study, there were no reported nosocomial COVID-19 infections among patients, parents, caregivers, or medical staff.

Conclusion: TODPC for IH repair was a safe strategy for minimizing the need for organ resections and reducing the risk of mass COVID-19 infections during the pandemic period from March 2020 to August 2021.

Purpose: Bariatric surgery is the gold standard for the treatment of morbid obesity, but postoperative pain impedes recovery. Currently available pain-recovery treatments have patient safety concerns. This led to a noninferiority study of Welpass (Genewel Co., Ltd.) vs. On-Q PainBuster (B. Braun), each used alongside a traditional method of continuous local anesthetic administration, in patients undergoing bariatric surgery.

Methods: In this single-center prospective randomized clinical trial, patients were assigned in a 1:1 ratio to the treatment group (Welpass) and the control group (On-Q PainBuster), with ketorolac administered as needed after surgery according to the protocol. To assess efficacy, the total amount of ketorolac used up to 72 hours postoperatively was measured. Additionally, ketorolac usage and numerical rating scales (NRS) were recorded at 6, 24, 48, and 72 hours after operation.

Results: The total amounts of ketorolac used in the 72 hours postoperatively were 188.0 ± 84.6 mg in the treatment group and 198.7 ± 50.0 mg in the control group. The efficacy of the treatment group was noninferior to that of the control group, since the lower limit (-29.9 mg) of the confidence interval for the difference with the control group was greater than the prespecified noninferiority margin (-35.0 mg). Furthermore, when the NRS was evaluated after bariatric surgery, there was no significant difference in scores between the 2 groups at each time point (P > 0.05).

Conclusion: We found no difference in effect on pain between the 2 groups, supporting the use of Welpass in clinical practice for pain management in patients undergoing bariatric surgery.

Purpose: This study aimed to investigate the optimal withdrawal time (WT) for initial surveillance colonoscopy after curative resection for colorectal cancer (CRC) by comparing anterior/low anterior resection (AR/LAR) and right hemicolectomy (RHC) groups.

Methods: This retrospective study analyzed 1,212 patients who underwent initial surveillance colonoscopy after CRC resection between 2015 and 2022. The patients were divided into the AR/LAR (n = 846) and RHC (n = 366) groups. The optimal WT was determined using receiver operating characteristic curve analysis and validated using logistic regression models. The adenoma and advanced neoplasia detection rates (ADR/ANDR) were evaluated based on the optimal WT.

Results: The optimal WT was 7 and 6 minutes in the AR/LAR and RHC groups, respectively. In multivariate analysis, WT ≥7 and ≥6 minutes in the AR/LAR (odds ratio [OR], 2.38; 95% confidence interval [CI], 1.75-3.24; P < 0.001) and RHC (OR, 2.64; 95% CI, 1.59-4.39; P = 0.001) groups, respectively, were significant factors for adenoma detection. In the AR/LAR group, ADR was 41.5% for WT ≥7 minutes compared to 21.9% for WT <7 minutes (P < 0.001). In the RHC group, ADR for WT ≥6 minutes was 33.9% compared to 15.8% for WT <6 minutes (P < 0.001). The ANDR also significantly improved with longer WTs in both groups.

Conclusion: This study suggests that a minimum WT of 7 and 6 minutes for AR/LAR and RHC patients, respectively, during the initial surveillance colonoscopy after CRC resection is optimal for maintaining a satisfactory ADR and ANDR. These findings highlight the importance of tailoring colonoscopic procedures according to the type of surgical resection.

Purpose: Intensive cytotoxic chemotherapy increases the risk of infection in patients with cancer by inducing bone marrow suppression and mucosal injury. Febrile neutropenia (FN) is the most important clinical adverse event in patients with cancer receiving cytotoxic chemotherapy. To prevent FN, standard precautions including hand and respiratory hygiene are generally recommended, but the exact effect of non-pharmacologic intervention has not been clearly proven in the clinical setting. We aimed to compare the incidence of FN between the pre-coronavirus disease 19 (COVID-19) era vs. the post-COVID-19 era.

Methods: We retrospectively enrolled patients with breast cancer who received an adriamycin and cyclophosphamide (AC) regimen containing adjuvant chemotherapy at Jeju National University Hospital. We compared the incidence of FN between the pre- and post-COVID-19 period and analyzed characteristics of the event and other clinical risk factors.

Results: In total, 149 patients were enrolled, including 94 who received AC chemotherapy in the pre-COVID-19 era and 55 who received it in the post-COVID-19 era. Sixteen patients (10.7%) experienced FN. Fourteen (14.9%) and 2 events (3.6%) occurred in pre-COVID-19 and post-COVID-19 eras, respectively. The post-COVID-19 era was the only risk factor for FN (P = 0.032).

Conclusion: We found an association between FN occurrence and the COVID-19 outbreak, providing indirect evidence of the importance of non-pharmacological measures to reduce FN risk in patients with breast cancer. Further research is required to confirm the standard precautions for FN prevention in patients with cancer.

Purpose: Adrenocortical carcinoma (ACC) is a rare primary carcinoma originating in the adrenal gland with a poor prognosis and a high recurrence rate. This study evaluated the risk factors associated with recurrence in patients with early stage ACC after curative surgical resection.

Methods: The present study retrospectively evaluated the risk factors for recurrence in 38 patients with stages 1 and 2 ACC who underwent curative resection between 1995 and 2020.

Results: Recurrence was observed in 21 patients (55.3%), with no significant difference between stages 1 and 2 ACC (P = 0.640). The overall recurrence rate was higher in patients who underwent minimally invasive surgery than open adrenalectomy (71.4% vs. 51.6%). Of the 33 patients with gross tumor margins negative for malignancy, 16 (48.5%) experienced tumor recurrence, and all 5 patients with positive and unknown gross resection margins had recurrence. Recurrences were observed in 14 of the 30 patients (46.7%) negative for pathologic resection margins, 6 of the 7 patients (85.7%) with pathologically indeterminate margins, and 1 patient with pathologically positive margins.

Conclusion: The recurrence rates are high even in patients with early stage ACC, being higher in patients who undergo minimally invasive surgery than open adrenalectomy. Obtaining clear resection margins during surgery may reduce tumor recurrence; however, gross or pathologic margin safety was not a secure factor in preventing recurrence. None of the factors analyzed was a definitive predictor of poor prognosis.

Purpose: Several studies have evaluated the impact of sarcopenic obesity (SO) on postoperative complications, including postoperative pancreatic fistula (POPF), in patients undergoing pancreatoduodenectomy (PD). Previous studies have shown that SO increases POPF, but it remains unclear whether SO increases postoperative complications. In this study, we aimed to determine the relationship between SO and immediate postoperative complications.

Methods: From January 2005 to December 2019, the medical records of patients who underwent PD for periampullary cancer were retrospectively reviewed. Skeletal muscle index (SMI) and visceral fat area (VFA) were calculated from preoperative computed tomography images. Patients with high VFA were classified as obese, while those with low SMI were classified as sarcopenic. Patients were divided into 4 groups: normal group, sarcopenia only group, obesity only group, and SO group. Postoperative outcomes were compared between groups, and factors affecting postoperative complications were analyzed by multivariate analysis.

Results: Normal group (n = 176), sarcopenia only group (n = 130), obesity only group (n = 207), and SO group (n = 117) were analyzed retrospectively. SO group had significantly more frequent major complications compared to the normal group (P = 0.006), as well as a significantly more frequent clinically relevant POPF compared to the other groups (P = 0.002). In multivariate analysis, SO was an independent risk factor for major complications (P = 0.008) and clinically relevant POPF (P = 0.003).

Conclusion: SO is a factor associated with poor immediate postoperative outcomes after PD for periampullary cancer.

[This corrects the article on p. 205 in vol. 104, PMID: 37051159.].