Annali italiani di chirurgia最新文献

Aim: Pneumothorax is a prevalent thoracic disorder, with management strategies primarily consisting of conservative treatment and minimally invasive surgery. However, their long-term efficacy remains controversial. This study conducted a systematic review and meta-analysis to compare clinical outcomes between these two approaches.

Methods: A comprehensive search was conducted in PubMed, Embase, Web of Science, and the Cochrane Library for randomized controlled trials (RCTs) and non-randomized controlled trials published between 1 January 2000 and 31 January 2025. Studies comparing total complications, recurrence rate during hospitalization, and overall recurrence rate between treatment groups were included. Fixed- or random-effects models were applied for meta-analysis. Begg's test was applied to assess publication bias, and sensitivity analysis was performed to evaluate model robustness.

Results: A total of nine studies were included in the meta-analysis. Compared to conservative treatment, video-assisted thoracoscopic surgery (VATS) significantly reduced the recurrence rate during hospitalization [odds ratio (OR) = 0.23, 95% CI (0.12-0.43), p < 0.00001] and the overall recurrence rate [OR = 0.16, 95% CI (0.08-0.31), p < 0.00001]. However, no statistically significant difference was found between the groups in terms of complication rate (p = 0.79). Additionally, Begg's test confirmed no significant publication bias (p > 0.05). Subgroup analysis indicated that pneumothorax type may contribute to the observed heterogeneity.

Conclusions: VATS reduces both the short-term recurrence rate during hospitalization and the overall recurrence rate in patients with pneumothorax, offering a clinical advantage in preventing early relapse. Individualized treatment strategies tailored to patient characteristics and pneumothorax type remain essential. Additional high-quality studies are needed to clarify its long-term efficacy.

Aim: Evaluation of the clinical efficacy of pedicle screw fixation combined with hemiarthroplasty versus simple hemiarthroplasty in elderly patients with unstable intertrochanteric fractures of the femur.

Methods: This retrospective analysis included 81 elderly patients with unstable intertrochanteric femoral fractures who underwent hemihip replacement surgery at the Yulin Hospital, the First Affiliated Hospital of Xi'an Jiaotong University, between May 2018 and May 2023. The patients' clinical data were collected and statistically analyzed. Study participants were divided into two groups: the experimental group (n = 40; those treated with the pile-building net fixation method combined with hemiarthroplasty) and the control group (n = 41; patients who received only hemiarthroplasty). The perioperative indicators, postoperative joint function scores, activities of daily living scores, and basic conditions of complications associated with surgical intervention were compared between the two groups.

Results: Comparison of perioperative indicators between the experimental and control groups revealed that the experimental group experienced significantly longer operation time and greater intraoperative blood loss than the control group (p < 0.05). Similarly, the average fracture healing time was significantly shorter in the experimental group than in the control group (p < 0.05). Six months postoperatively, the degree of hip joint pain, limping, walking distance, total Harris hip score, and Barthel index score were all found to be significantly higher in the experimental group compared to the control group (p < 0.05). In the experimental group, one case developed a urinary tract infection and two cases had a pulmonary infection after the operation. In the control group, one case showed deep vein thrombosis, two patients had delayed fracture healing, three patients had pulmonary infection, and one case had prosthesis loosening. Moreover, there was no statistically significant difference in the complication rate between the two groups (p > 0.05).

Conclusions: Although the pile-building net fixation method in hemiarthroplasty for unstable intertrochanteric fractures in elderly patients can prolong the operation time and increase blood loss, it facilitates fracture healing and improves postoperative joint function recovery, indicating potential clinical benefit.

Aim: Neoadjuvant chemotherapy (NACT) improves surgical outcomes in gastric cancer, yet its effect on early postoperative mental health remains unclear. This study aims to investigate the association between NACT and postoperative anxiety and depression.

Methods: A single-center, retrospective cohort study included 201 gastric cancer patients who underwent surgical resection from October 2023 to May 2024, categorized by NACT receipt. Psychological evaluation in the early postoperative phase was conducted using the Hospital Anxiety and Depression Scale (HADS), and associations with NACT were assessed through logistic regression.

Results: Of the 201 patients, 57 (28.4%) received NACT. Postoperative assessments showed significantly higher rates of anxiety (78.95% vs. 61.11%, p = 0.016) and depression (56.14% vs. 38.89%, p = 0.026) in NACT recipients compared to non-NACT patients. After adjusting for confounders, NACT remained independently associated with an increased prevalence of anxiety (Odds Ratio [OR] = 2.25) and depression (OR = 2.00, both p < 0.05). Patients undergoing more than three NACT cycles exhibited increased anxiety (91.67% vs. 69.70%, p = 0.045) and depression (75.00% vs. 42.42%, p = 0.014), with higher mean HADS scores (both p < 0.05). These associations persisted in adjusted analyses for depression (OR, 4.07; 95% Confidence Interval [CI], 1.28-12.90; p = 0.017) and were marginal for anxiety (OR, 4.78; 95% CI, 0.94-24.33; p = 0.059). Patients with poor response (tumor regression grade [TRG] 2-3) also showed a trend toward increased anxiety risk (OR, 3.30; 95% CI, 0.83-13.12; p = 0.089).

Conclusions: NACT is independently associated with increased anxiety and depression in the early postoperative period, especially if chemotherapy cycles are prolonged.

Aim: Hirschsprung's disease, or aganglionosis of the colon, is a congenital disease characterized by a lack of neurons in the enteric plexus of the large bowel due to either migration failure or defective differentiation of neural crest cells. We aimed to conduct a historical systematic review of available literature and personal experience to exhibit the surgical techniques performed in the past and the current status quo of surgery for Hirschsprung's disease.

Methods: We searched PubMed, EMBASE, Google Scholar databases for studies examining surgery in aganglionosis or Hirschsprung's disease. The search included all studies published from inception until 9 November 2024. Eligible criteria included all peer-reviewed articles, not necessarily written in English, but also German, French, Italian, and Spanish items dealing with surgery and the prognosis of patients with Hirschsprung's disease after surgical intervention.

Results: A total of 2527 studies were reviewed, and the studies relevant to the surgery were extracted for this historical review. This article delivers a unique historical path and an analysis of some of the most critical surgical techniques for the approach to Hirschsprung's disease, with two outstanding sections on innovative robotic-assisted surgery and life quality after surgery. Currently, surgeons often tailor their approach to Hirschsprung's disease by combining their knowledge and expertise on several surgical procedures and incorporating subtle adjustments based on each patient's imaging, inspection, and pathological findings. The conventional wisdom held that surgeons should perform whichever surgery they felt most comfortable with, regardless of whether a particular technique produced better results. Although the core elements of surgical care have been identified and surgery has been shown to improve outcomes in patients affected with Hirschsprung's disease, the precise etiology and correct treatment for reconstitution of ganglion cells in the aganglionic portions of the bowel are lacking. The surgical treatment options for Hirschsprung's disease have been conceived and implemented after the etiology of Hirschsprung's disease was successfully clarified in the 1940s.

Conclusions: There is still no internationally valid agreement on which techniques should be used for the various forms of intestinal aganglionosis, especially for total colonic and ultra-short intestinal forms. On the other hand, minimally invasive surgery, artificial intelligence, and machine learning are quickly entering medicine and surgery. These approaches will probably modify the surgical approaches to Hirschsprung's disease. In the future, surgeons may integrate new knowledge derived from proteomics and genomics into current surgical procedures. This integration pinpoints a therapeutic approach that may eventually entail aspects of personalized medicine.

Aim: This systematic review with meta-analysis aims to compare postoperative length of stay (LOS) after carotid endarterectomy (CEA) and carotid artery stenting (CAS) and to identify potentially modifiable risk factors for prolonged hospitalization.

Methods: This systematic review was performed in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. A literature search was conducted in PubMed using the keywords "carotid endarterectomy" AND "length of stay", "carotid artery stenting" AND "length of stay", and "transcarotid arterial revascularization" AND "length of stay", over a 10-year period (September 2012-September 2023).

Results: The final analysis included 77 studies on CEA and 30 on CAS/transcarotid arterial revascularization (TCAR), with 15 studies reporting on both CEA and CAS. In total, 3,952,240 CEA patients (59.14% male, 40.86% female) and 201,937 CAS patients (62% male, 38% female) were included. Of the CEA patients, 77.93% were asymptomatic, compared to 63% of CAS patients (p = 0.671). The LOS was 2.04 days for CEA and 2.52 days for CAS (p = 0.399). In-hospital mortality was 0.3% for CEA and 0.57% for CAS (p = 0.132), while 30-day mortality was significantly higher for CAS (1.16% vs. 0.77%, p < 0.001). A higher percentage of symptomatic patients (estimate 0.0280; 95% CI: 0.0097-0.0462; p = 0.003), frail patients (estimate 0.0887; 95% CI: 0.0068-0.1706; p = 0.034) and major adverse cardiovascular events (MACE) patients (estimate = 0.3658; 95% CI: 0.1938-0.5379; p < 0.001) was associated with prolonged LOS after CEA. For higher proportions of CAS patients with chronic obstructive pulmonary disease (COPD) a longer LOS was observed (estimate 0.0960; 95% CI: 0.0029-0.1891; p = 0.043), while higher proportions of patients with arterial hypertension led to a shorter LOS (estimate -0.0545; 95% CI: -0.0884-(-0.0206); p = 0.002). A higher proportion of neurological complications was also associated with prolonged LOS in CAS (estimate 0.1622; 95% CI: 0.0805-0.2439; p < 0.001). Higher proportions of patients who received preoperative use of acetylsalicylic acid (Preop. ASA) led to a significantly shorter LOS for both CEA and CAS.

Conclusions: CEA and CAS did not significantly differ in postoperative LOS or in-hospital mortality, but CAS had a higher 30-day mortality rate. Since postoperative complications, preoperative hypertension, and preoperative antiplatelet therapy are modifiable, LOS can serve as a quality parameter for CEA and CAS.

Aim: Insufficient awareness among clinicians regarding the performance of light-curing devices may lead to inadequate polymerization, which can ultimately compromise the long-term success of dental restorations. This study aimed to examine the radiant power of different light-curing unit (LCU) brands by using three types of radiometers in terms of clinic and LCU types, age, tip diameter, and LCU tip condition in the Aseer region.

Methods: LCUs were assembled from selected dental centers. LCU brands and data, including clinical dental age (<1, 1-3, and ˃3 years), nozzle state (intact, damaged, and presence of debris), and tip diameters (6-7, 8-9, and 10 mm), were recorded. The radiant power was categorized into ≤1000, 1000-1200, and >1200 mW/cm², which were labeled as adequate, sufficient, and adequate and sufficient, respectively, and recorded with three brands of digital radiometers (Woodpecker, Ivoclar, and Rogin). Analysis of Variance (ANOVA) and t-test were performed to determine the difference between and within groups, with a significance value of <0.05.

Results: Among 132 LCUs surveyed and assessed, a significant difference in the radiant power of LCUs was observed between governmental and private dental clinics, particularly with the Ivoclar radiometer (p < 0.05). No significant differences in radiant power values were detected between the radiometers and the assessed LCUs' nozzle. Older LCUs demonstrated higher radiant power in the ≤1000 mW/cm² category when measured with the Ivoclar radiometer. Differences in radiant power were noted on the basis of tip diameter and the presence of remaining bond and composite materials (p < 0.05).

Conclusions: The assessed LCU brands recorded marginally sufficient radiant power values in governmental and private dental clinics. The Rogin radiometer consistently demonstrated increased radiant power values across LCU brands and intact tip conditions. Differences in radiant power were noted in terms of tip diameter and the remaining bond and composite materials.

Aim: To present the successful management of an immature necrotic tooth through intentional replantation (IR) following the failure of a regenerative endodontic procedure (REP), highlighting IR as a viable alternative in complex cases.

Case presentation: A 9-year-old patient presented with necrotic tooth 45 complicated by right mandibular cellulitis. After initial infection management, REP was attempted following European Society of Endodontology (ESE) guidelines. Despite adherence to protocol, REP failed, as evidenced by persistent symptoms and a recurring fistula. IR was chosen given the unfavourable conditions for apexification and the patient's young age. During atraumatic extraction, the root fractured at a pre-existing defect, necessitating a modified reimplantation approach. The canal was treated ex vivo and sealed with calcium silicate-based cement (CSBC) before reimplantation.

Results: At a 36-month follow-up, the tooth remained functional and symptom-free, with no signs of reinfection.

Conclusions: While REPs are promising for managing necrotic immature teeth, failures necessitate alternative strategies. This case highlights IR as a viable treatment, preserving function and aesthetics when regenerative efforts are unsuccessful. Careful case selection, meticulous execution, and long-term follow-up are crucial for optimizing outcomes.

Adverse events associated with stent-grafts during complex aortic procedures are rare but can be difficult to manage. These occurrences can be reduced by precise planning and anticipating complications by considering the patient's anatomy and the characteristics of the graft. This paper describes an endovascular conversion following branched endovascular aneurysm repair (b-EVAR) for a pararenal abdominal aortic aneurysm (pAAA) caused by the distal displacement of the stent-graft during delivery system retrieval. A replanned endovascular strategy (endoconversion) was performed by the deployment of another b-EVAR as a bailout technique. Technical success was obtained and the post-operative course and follow-up was uneventful. High technical skills with the ability to predict and manage complications can play a crucial role in the management of intraoperative adverse events.