Annali italiani di chirurgia最新文献

Aim: This study aimed to explore influencing factors and develop a predictive model of endometrial polyps (EP) recurrence after hysteroscopic resection.

Methods: This retrospective study included 180 patients who underwent hysteroscopic resection for EP between January 2021 to December 2023. The patients were divided into a modeling group (n = 135) and a validation group (n = 45) in a 3:1 ratio. The patients in the modeling group were further divided into a recurrence group (n = 35) and a non-recurrence group (n = 100) based on whether their polyps recurred. General information on patients was compared between the two groups. Univariate and multiple logistic regression analyses were conducted to identify factors influencing EP recurrence post-hysteroscopic resection. A predictive model was developed, and the receiver operating characteristic (ROC) curve analysis was performed to determine the clinical utility of the model.

Results: Comparison of baseline characteristics between the modeling and validation groups showed no statistically significant differences (p > 0.05). However, 35 patients in the modeling group had recurrence, while 12 patients experienced recurrence in the validation group. Binary logistics regression analysis revealed matrix metalloproteinase-9 (MMP-9)/tissue inhibitor of metalloproteinase-1 (TIMP-1), hypoxia-inducible factor-1α (HIF-1α) and platelet-derived growth factor (PDGF) as independent predictors for polyp recurrence (p < 0.05). Furthermore, a model formula, p = eZ/1 + eZ, was developed. The slope of the calibration curve of this model in both groups were straight lines close to 1, indicating that the model's predicted recurrence risk strongly agreed with the actual risk. ROC analysis demonstrated that the area under the curve in the modeling group was 0.902, with standard error of 0.028 (95% confidence interval (CI): 0.885-0.954). The model yielded the Youden value of 0.79, with a sensitivity of 82.96% and a specificity of 95.66%. Moreover, the area under the curve in the validation group was 0.871, with a standard error of 0.040 (95% CI: 0.859-0.920). However, the model showed the Youden value of 0.59, with a sensitivity of 79.29% and a specificity of 79.96%. The Decision Curve Analysis (DCA) demonstrated significant clinical advantages of the model.

Conclusions: This study identified the influencing factors of EP recurrence and successfully constructed a predictive model based on these factors. After validation, the model demonstrates significant clinical utility.

Aim: The training of medical specialists is a decisive issue for the quality of medical practice. Autonomization in simple procedures and applying the peer education concept seem promising, particularly for general surgery. With this work, we wanted to assess whether there are differences between appendectomy operations performed by differently composed teams with the active involvement of resident doctors at a university centre.

Methods: We retrospectively analyzed the laparotomies and laparoscopic appendicectomies carried out at the Udine Surgery Clinic over a period of 10 years. The interventions were divided into groups according to the experience of the surgical team that performed them: G1 (consultant), G2 (senior resident + consultant), G3 (junior resident + consultant), and G4 (junior resident + senior resident).

Results: 510 appendectomy procedures were considered for the present analysis. 214 (42.0%) were performed by G1, 139 (27.3%) by G2, 79 (15.5%) by G3 and 78 (15.3%) by G4 group. No difference between the groups was shown in terms of complications, reinterventions, readmissions, length of stay, and duration of surgery. A statistically significant difference was shown in the age of the observed population with respect to the degree of experience of the surgical teams: younger patients were mainly operated on by more experienced teams, and in particular, pediatric laparoscopic appendectomy was performed mainly by consultants.

Conclusions: Appendectomy surgery can be performed by teams with varying levels of experience and is an example of an activity that can be used in Peer Education. It allows for the empowerment of younger residents and the autonomization of older residents in maintaining a medically, ethically, and legally correct standard of safe clinical practice.

Aim: The role of lymph node dissection (LND) in gastric adenocarcinoma (GAC) remained some controversy. This study reappraised the clinical implications of LND for GAC in terms of the numbers of total lymph node (TLN), positive lymph node (PLN) and negative lymph node (NLN).

Methods: A total of 106 GAC patients receiving an upfront gastrectomy (laparoscopic/laparotomy surgery, 19/87) with LND (D1/D1+/D2 dissection, 5/53/48) between Jan 2017 and Dec 2021 in Cathay General Hospital, Taipei were analyzed. The surgical-pathological T-/N-/M-status and cancer stage were determined according to the American Joint Committee on Cancer (AJCC) 8th edition. The numbers of TLN, PLN and NLN were recorded for analysis (TLN = PLN + NLN). The associations between prognosis and related variables, including pathological findings, the clinical implications of TLN/PLN/NLN and extent for LND, were all deeply studied.

Results: Advanced T-status (p < 0.001), N-status (p = 0.025), M-status (p = 0.001) and cancer stage (p = 0.001) had a negative effect on survival. The severity of N-status was associated with the progression of T-status (p < 0.001), M-status (p = 0.015) and cancer stage (p < 0.001). For all 106 GAC patients (p = 0.002/0.017) and the 25 T1 GAC patients (p = 0.052/0.015), those undergoing TLN >17 (≥18) had a more PLN and a higher rate of N(+) than those ≤17. For 65 N(+) GAC patients, an extension of TLN to ≥23 allowed the detection of a median value for PLN of 7, the N3-status. NLN >9 (≥10) was related to a better prognosis (p = 0.066) and lower HR (p = 0.073) for N(+) GAC patients. TLN with threshold value ≥20 owned the best power to distinguish NLN >9 (≥10) from ≤9 among N(+) GAC patients (p < 0.001). A D2 dissection could achieve these thresholds, including TLN ≥18 (p = 0.001) for GAC patients, TLN ≥23 (p = 0.028) for N(+) GAC patients, and NLN ≥10 (p = 0.012) as well as TLN ≥20 (p = 0.011) for N(+) GAC patients, more effectively than a D1/D1+ dissection.

Conclusions: A value of TLN ≥18 is necessary for de-novo GAC patients during gastrectomy to detect possible N(+) status, and ≥23 is recommended for N(+) GAC patients to identify the possible N3-status. A value of NLN ≥10 could reach a better survival for N(+) GAC patients and it requires a value of TLN ≥20 to achieve. A D2 dissection is recommended for GAC patients during gastrectomy. LND establishes adequate N-status staging and increases survival for GAC patients.

Aim: The use of upper eyelid lipofilling to prevent ocular complications in patients affected by facial nerve palsy is compared to other treatment options.

Case presentation: Ten patients treated with lipofilling of the upper eyelid, who were indicated for facial rehabilitation were identified from the Maxillo-facial Surgery Unit, Policlinico Umberto I. For all patients, fat harvested from the abdomen was processed with soft and short centrifugation.

Results: Satisfactory aesthetical and functional results were obtained in most cases. All patients reported a considerable reduction in the use of artificial tear drops and ointment for corneal lubrication. A second procedure was needed in one case to refill the eyelid, and in another one to correct poor aesthetical results. No patients developed postoperative ocular surface disorders.

Conclusions: The lipofilling of the upper eyelid procedure was easy to perform, leading to minimal complications rate. Given the small sample size and variability of samples collected in the current study, future studies involving larger cohorts are required to validate the efficacy of upper eyelid lipofilling in comparison to other treatments.

Aim: This study aimed to evaluate the short- and long-term outcomes and complications of total knee arthroplasty (TKA) using posterior-stabilized (PS) and cruciate-retaining (CR) prosthesis in patients with osteoarthritis (OA) and valgus knee deformity.

Methods: A retrospective analysis was conducted on 200 patients with OA and valgus knee deformity who underwent TKA between February 2021 and November 2023. The cohort was divided into the PS group (n = 108) and the CR group (n = 92). Clinical outcomes, including Range of Motion (ROM), Hospital for Special Surgery (HSS) knee score, and Visual Analog Scale (VAS) score, were assessed at 1 week, 1 month, 3 months, 6 months, and 1 year postoperatively. Pre- and postoperative valgus angles were measured, and the incidence of complications was recorded.

Results: Both groups exhibited significant postoperative improvements in ROM, HSS scores, and VAS scores compared to preoperative (p < 0.001). The CR group demonstrated superior early postoperative outcomes, with higher HSS scores, greater ROM, and lower VAS scores at 1 week, 1 month, and 3 months (p < 0.001). However, no significant differences were observed between the groups at 6 months and 1 year (p > 0.05). Radiographic analysis indicated effective correction of valgus angles in both groups postoperatively (p < 0.001), with no significant intergroup differences (p > 0.05). The complication rate was significantly lower in the CR group compared to the PS group (p < 0.05).

Conclusions: CR and PS prostheses effectively correct valgus deformity, alleviate pain, and improve knee function. However, the CR prosthesis offers advantages in reducing early postoperative pain, swelling, and complications, facilitating faster functional recovery. The selection of the appropriate prosthesis based on patient-specific characteristics is critical to optimizing TKA outcomes.

Aim: Gastrointestinal (GI) complications following cardiac surgery are infrequent, but associated with high rates of postoperative mortality. The aim of our study was to identify risk factors predisposing patients to GI complications following cardiac surgery and describe the outcomes of patients suffering a GI complication.

Methods: This was a retrospective cohort study of 6769 consecutive patients undergoing cardiac surgeries (at least one of coronary artery bypass grafting (CABG), aortic valve replacement, mitral valve replacement, or surgery on thoracic aorta) at a single Scottish centre between 1 January 2015 and 27 September 2023. Cohort demographics, intra-operative details and postoperative outcomes were compared between patients who did and who did not experience a gastrointestinal GI complication.

Results: Patients who experienced a GI complication had greater rates of thirty-day mortality (14.4% vs 2.4%, p < 0.001) and in-hospital mortality (6.8% vs 1.1%, p < 0.001) compared with those who did not. We identified previous percutaneous coronary intervention (PCI) (Odds ratio (OR) 2.27 [1.24-4.17], p = 0.007) and combined cardiac surgery (OR 1.67 [1.02-2.74], p = 0.043) as two risk factors for developing a GI complication, in addition to several previously identified risk factors (postoperative atrial fibrillation, postoperative vascular complication, use of pre-operative inotropes and increased age).

Conclusions: GI complications frequently occur in elderly, co-morbid patients and in conjunction with other complications. Particularly lethal are mesenteric ischemia, GI bleeding, and small bowel obstruction. Extra caution should be observed in the patient group undergoing more than one cardiac procedure or those with a prior history of coronary artery disease. Prompt emergency laparotomy is a potentially life-saving intervention in promptly diagnosed patients, but confers a high risk of intra-operative and thirty-day mortality.

Aims: This study combined a new ultrasound venous filling degree (VFD) parameter with the Caprini score to assess the clinical value of the Caprini score in predicting deep venous thrombosis (DVT) of the lower extremities.

Methods: This retrospective study included 150 inpatients undergoing orthopedic lower extremity surgery at the First Affiliated Hospital of the Air Force Medical University between June 2023 and June 2024. They included 41 (27.3%) cases of knee arthroplasty, 32 (21.3%) hip arthroplasty, 30 (20%) knee arthroscopy, 28 (18.7%) lower limb fractures, 12 (8%) bone tumor, and 7 (4.7%) cases of other surgery types. The data collected involved preoperative vein diameter, flow velocity, blood flow, venous lumen cross-sectional perimeter (C), lumen cross-sectional area (A), C2/A ratio (VFD) of the common femoral vein (CFV), femoral vein (FV), and popliteal vein (POV). The postoperative sonographic parameters and clinical data were compared between the DVT and non-DVT groups. Receiver operating characteristic (ROC) curve of parameters was evaluated as predictive values for DVT. Additionally, the C2/A ratio was combined with the Caprini score to assess their combined impact on DVT prediction.

Results: There were significant differences in ultrasound parameters of CFV inner diameter, CFV blood flow, CFV-C, CFV-A, CFV-C2/A, FV blood flow, FV-C, FV-C2/A, POV blood flow, POV-C, POV-A, and POV-C2/A between the DVT group (24.7%, 37/150) and the non-DVT group (75.3%, 113/150) (all p < 0 .05). Area under curve (AUC) for the C2/A (CFV, FV, and POV) were 0.939 (95% confidence interval (CI): 0.888-0.972, p < 0.001), 0.937 (95% CI: 0.886-0.970, p < 0.001), and 0.917 (95% CI: 0.861-0.956, p < 0.001), respectively. When the Caprini score >2, an AUC for predicting DVT was 0.844 (95% CI: 0.776-0.899, p < 0.001). The AUC of the Caprini score >2 combined with C2/A (CFV, FV, and POV) were 0.953 (95% CI: 0.905-0.981, p < 0.001), 0.965 (95% CI: 0.922-0.988, p < 0.001), and 0.948 (95% CI: 0.900-0.978, p < 0.001), respectively.

Conclusions: The ultrasound parameter of VFD-C2/A shows a high predictive value for DVT in patients undergoing orthopedic surgery. Combined with the Caprini score, the predictive value of DVT may be further enhanced compared to using the Caprini score alone.

Aim: This study compared the short- and long-term efficacy of simple suture with omental patch repair (Graham patch) in open surgery versus laparoscopic omental patch repair (LOPR) in treating patients with Helicobacter pylori (H. pylori)-associated gastric ulcers with perforation, and analyzed the incidence of complications.

Methods: The clinical information of patients who had stomach perforation repair surgery in Deqing People's Hospital between January 2021 and January 2022 was retrospectively analyzed. The patients were divided into a control group (n = 54), whose subjects underwent the Graham patch repair, and an observation group (n = 52), whose subjects underwent laparoscopic gastric perforation repair. The general characteristics, therapeutic outcomes, intraoperative and postoperative surgical indicators, 1-year postoperative recurrence, and incidence of various postoperative complications were recorded and compared between the two groups.

Results: A total of 106 patients' clinical data were included in the study, of which 52 (49.1%) underwent LOPR and 54 (50.9%) were treated with Graham patch. The general characteristics of the patients in both groups were comparable. The observation group demonstrated significantly better outcomes in terms of operative time, intraoperative blood loss, and postoperative recovery time compared to the control group (p < 0.05). Moreover, the observation group had lower rates of postoperative complications and recurrence compared to the control group (p < 0.05).

Conclusions: LOPR is a potential therapeutic method for patients with H. pylori-associated gastric ulcers with perforations on grounds of its superior efficacy and decreased incidence of comorbidities.

Aim: This study aimed to evaluate the surgical outcomes of liver and lung hydatid cysts treated either simultaneously or in separate stages. The main focus was to determine the impact of surgical timing on postoperative complications and overall patient recovery, with an emphasis on minimally invasive techniques.

Methods: A retrospective analysis was conducted on 42 patients diagnosed with concomitant liver and lung hydatid cysts between March 2009 and July 2020. Surgical procedures included video-assisted thoracoscopic surgery (VATS), thoracotomy, laparoscopy, and laparotomy. Patient demographics, cyst characteristics, concomitant diseases, surgical procedures, postoperative complications, and recovery times were analyzed. The statistical significance of surgical outcomes between one-stage and two-stage procedures was assessed using appropriate statistical tests.

Results: Demographic analysis revealed that 57.1% of the participants were female and 42.9% male, with an average age of 36 years. Comorbidities were present in 23.8% of patients, with chronic obstructive pulmonary disease (COPD) being the most common at 11.9% and asthma at 7.1%. The complication rate was 35.3% in patients who underwent lung hydatid cyst surgery and 30.8% in those who underwent liver and lung hydatid cyst surgery. Although there was no statistically significant difference among the three groups (p = 0.840), liver surgery was associated with a longer hospital stay (p = 0.013). Minimally invasive surgical techniques (VATS, laparoscopy) had a lower complication rate (20% versus 40.9%, p = 0.143). These results suggest that minimally invasive techniques can reduce the risk of complications.

Conclusions: The timing of the surgical procedure, whether performed in one or two stages, had no significant effect on the complication rate. Minimally invasive techniques are recommended due to their lower complication rate and shorter recovery time.