Annali italiani di chirurgia最新文献

The most important and serious complication of thyroid surgery is recurrent laryngeal nerve (RLN) injury, and it has been noted that this risk increases considerably in the presence of anatomical variations. Double recurrent laryngeal nerve (DRLN) is very rare among RLN anatomical variations. There are only a few case reports on DRLN in the literature It is crucial to possess surgical expertise and ensure complete visualization of the nerve to minimize the likelihood of RLN injury. Intraoperative nerve monitoring (IONM) is particularly useful in identifying anatomical variations. In a 54-year-old woman undergoing diagnostic left lobectomy+isthmectomy, a left DRLN was identified during intraoperative exploration and meticulous nerve exploration with the assistance of IONM monitoring verified that the impulse conduction in both branches was identical. The surgical procedure was successfully performed without causing any harm to the nerve. Based on the case reports in the literature and our experience with this patient, we believe that surgical expertise and the utilization of IONM can decrease RLN nerve damage and reveal its anatomical variations during thyroid surgery.

Aim: This study aimed to investigate the impact of lymph node dissection on the prognosis of early epithelial ovarian cancer and to assess the factors associated with lymph node metastasis.

Methods: In this retrospective study, we collected and analyzed the demographic characteristics, clinical pathological data, and perioperative adverse events in newly diagnosed early epithelial ovarian cancer (EOC) patients, Federation International of Gynecology and Obstetrics (FIGO) stage IA-IIA. The patients underwent surgical treatment at the First, Second, and Third Affiliated Hospitals of Wenzhou Medical University in Zhejiang Province, China, between June 2012 and June 2022. The survival analysis was performed.

Results: We enrolled 284 patients in this study, including 246 stage I, 28 stage II, and 10 stage III patients after surgery. Among them, 42 patients did not undergo lymph node dissection, 113 underwent pelvic lymph node dissection only, and 129 underwent pelvic plus para-aortic lymph node dissection. Among the lymph node dissection group, only 8 patients had lymph node metastasis (8/242, 3.3%), including 6 with pelvic lymph node metastasis and 2 with pelvic plus para-aortic lymph node metastasis. The median follow-up duration was 63 months. The systematic lymph node dissection group significantly prolonged the median operation duration and increased intraoperative blood loss and postoperative complications (p < 0.05). Postoperative multivariate Cox regression analysis revealed FIGO stage III as an independent risk factor for Progression-Free-Survival (PFS) and Overall Survival (OS) (p < 0.05). Furthermore, the preoperative cancer antigen 125 (CA125) level was observed as an independent factor affecting lymph node metastasis.

Conclusions: Systematic lymph node dissection showed minimal effect on the survival rate of patients with clinically apparent early epithelial ovarian cancer and increased the postoperative complications of patients.

Background: Laparoscopic appendectomy has gained prominence in the management of acute appendicitis, necessitating secure closure of the appendiceal stump. Two common techniques for this purpose are Hem-o-lok clips (HC) and endoloops (EL), each offering distinct advantages.

Aims: This retrospective study aimed to compare the outcomes of the HC and EL closure techniques. Specifically, the study focused on postoperative complications, hospital stays, and readmission rates.

Materials and methods: A retrospective database review was conducted from November 2022 to August 2023. The study compared outcomes, postoperative complications, and the length of hospital stay in 123 patients who underwent appendiceal stump closure with HC and EL at the General Surgery Department of the Turkish Hospital in Doha, Qatar.

Results: Among the 123 patients who underwent laparoscopic appendectomy, appendiceal stump closure was performed with HC in 50 patients and EL in 73 patients. Six patients experienced infectious complications associated with the procedure. The hospital stays were similar in both groups (Group HC: 1.3 ± 2 days, Group EL: 1.4 ± 2 days), and there were two readmissions in each group.  Conclusion: The study supports the equivalence of HC and EL closure techniques. Both methods demonstrate comparable postoperative complications, hospital stays, and readmission rates. Surgeons can make informed decisions based on patient profiles and available resources.

Background: Intrahepatic bile duct stones, a prevalent condition within hepato-biliary diseases, present a considerable challenge due to the high rates of recurrence, complications, and difficulty in treatment. Selecting an optimal surgical approach is vital for effective stone clearance and minimizing patient morbidity. While laparoscopic hepatectomy and percutaneous transhepatic choledochoscopy are established modalities, their comparative efficacy and safety profiles necessitate further investigation to inform clinical decision-making.

Objective: To explore the effectiveness and safety of different surgical methods for intrahepatic bile duct stones.  Methods: The clinical data of 65 patients with intrahepatic bile duct stones admitted to Nanchong Central Hospital, China, from January 2021 to January 2022 were retrospectively analyzed. According to the differences in surgical methods, patients undergoing laparoscopic hepatectomy were included in the laparoscopic group (n = 33), and patients undergoing percutaneous transhepatic choledochoscopy were included in the percutaneous transhepatic group (n = 32). The differences in perioperative indicators, inflammatory factors, postoperative complications, and one-year follow-up recurrence rates between the two groups were compared.

Results: Compared with percutaneous transhepatic group, laparoscopic group had significantly shorter operation time and hospitalization time (p < 0.05), and significantly higher blood loss (p < 0.05). After the operation, C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6) in the laparoscopic and percutaneous transhepatic groups were significantly lower than those in the same group before the operation (p < 0.05). CRP, TNF-α, and IL-6 in the laparoscopic group were significantly lower than in the percutaneous transhepatic group (p < 0.05). There was no significant difference in the incidence of postoperative complications and the recurrence rate of one-year follow-up between the laparoscopic group and the percutaneous transhepatic puncture group (p > 0.05).

Conclusion: Laparoscopic hepatectomy and percutaneous transhepatic choledochoscopy are both practical and safe, and the appropriate surgical scheme should be selected according to the patient's specific condition.

Background: This purpose aims to investigate the usefulness of CD133, a stem cell marker, for the prognosis of colon polyps. This study aimed to assess the adenomatous polyps that have an essential role in the development of colorectal cancer. The risk of colorectal carcinogenesis can be reduced by polypectomy and close medical supervision of the patients with adenomatous polyps. The prominence of stem cells in carcinoma development is also a recognized verdict. It must be noted that stem cell evaluation in adenomatous polyps may provide information about carcinoma development.

Method: Previously pathologically assessed colorectal polyps in 60 males and 40 females at Azerbaijan Medical University were reevaluated at the Pathology Department under the Meram Medical Faculty. Hematoxylin-eosin stained preparations were examined, and cases with and without dysplasia were determined. The image analysis program re-examined the preparations, and the same image analysis system automatically counted CD133 positive stained cells in the unit area. At the end of the follow-up period after polypectomy, the cases of malignancy were detected.

Results: The relationship between CD133 expression of dysplasia and malignancy was statistically compared. During the investigation, the statistically significant relationship between CD133 expression and dysplasia, as well as malignancy development, was observed in this study.

Conclusion: During the examination, the statistical significance of CD133 expression was detected in cases with dysplasia and malignancy. The investigation of CD133 expression in colorectal polyps is crucial in determining the presence of dysplasia and malignancy development, particularly in obtaining prognostic data in colorectal polyps.

Background: Cancer-related fatigue (CRF) stands out as one of the most prevalent subjective adverse reactions experienced by patients following chemotherapy, often resulting in unfavorable symptoms for elderly non-small cell lung cancer (NSCLC) patients during chemotherapy. Hence, the aim of this study was to explore the fluctuations in CRF levels among elderly NSCLC patients undergoing chemotherapy.

Methods: This retrospective study involved 400 elderly patients diagnosed with NSCLC. Standardized guidelines were employed to direct patient care following lung cancer surgery (T0), subsequent to the first (T1), second (T2), third (T3), and fourth (T4) cycles of chemotherapy. At various intervals, all patients underwent assessments utilizing the Piper Fatigue Scale, Karnofsky Performance Status (KPS) Scale, Pittsburgh Sleep Quality Index (PSQI) Scale, and Connor-Davidson Resilience Scale. Additionally, serum levels of IL-6 and TNF-α were quantified using enzyme-linked immunosorbent assay (ELISA).

Results: Throughout the treatment regimen, patients exhibited a declining trend in CRF, CD-RISC, and KPS scores (p < 0.05, T0 vs T4), whereas the PSQI score demonstrated a notable increase (p < 0.05, T0 vs T4). Furthermore, ELISA results revealed that as treatment advanced, the average levels of inflammatory markers interleukin 6 (IL-6) and tumor necrosis factor (TNF)-α during the T4 period significantly decreased compared to those at T0 (p < 0.05).

Conclusion: As the number of chemotherapy treatments for elderly NSCLC patients increased, the severity of CRF and the manifestations of sleep disorders were escalated. Additionally, physical function, psychological resilience, as well as IL-6 and TNF-α levels, exhibited a downward trend.

Aim: Aspergillosis is the most common invasive fungal infection among lung transplant recipients (LTRs). Although its incidence is lower than that of bacterial or viral infections, it poses a similar or even higher mortality rate due to challenges in early diagnosis, limited treatment options, and various complications. Therefore, we aimed to evaluate the pulmonary aspergillosis cases in our tertiary lung transplant center.

Methods: A retrospective analysis of 146 LTRs was performed. The demographic data, microbiological and histopathological test results, and radiological findings used for Aspergillus identification were recorded.

Results: Aspergillus spp. was detected in 13 of 146 LTRs (9%), mean age 42.5 ± 14.06 years, an average of 18.9 months after lung transplantation. 3 cases (23%) had Aspergillus growth in tissue culture, and 2 (15.4%) showed fungal elements with septal hyaline fibrils in tissue pathology. Aspergillus spp Polymerase chain reaction (PCR) was positive in bronchoalveolar lavage of 8 (61.5%) cases. In addition, 4 (30.7%) cases had relevant tomography findings. The most common pathogens were A. Terreus (21%), A. Fumigatus (14%), and A. Flavus (14%). The mortality rate was 15%.

Conclusions: LTRs are at high risk of Aspergillus spp infections. Early diagnosis with microbiological, histopathological, and radiological tests, in addition to well-established prevention strategies, prophylaxis, and treatment will provide a better survival rate for patients.

Aim: In patients with early non-small cell lung cancer (NSCLC), single-port thoracoscopic anatomical segmentectomy is the primary therapeutic approach. However, the recovery of lung function is slow after operation. Conversely, anatomical segmental pneumonectomy, which excises a smaller volume of lung tissue, may facilitate more rapid functional recovery. This study aims to elucidate the comparative efficacy of these two surgical interventions by analyzing postoperative changes in cardiopulmonary function parameters and serum tumor markers.

Methods: A retrospective analysis was conducted on 120 patients with NSCLC between October 2020 and October 2023. The cohort was classified into two groups based on the surgical intervention: the pulmonary segmentectomy group (n = 57), which underwent uniportal video-assisted thoracoscopic anatomical pulmonary segmentectomy, and the lobectomy group (n = 63), which received uniportal video-assisted thoracoscopic anatomical lobectomy. Surgical parameters and perioperative stress indicators were recorded for both groups of patients. Additionally, cardiopulmonary function indicators and serum biomarker levels of the patients before and 3 months after operation were compared.

Results: The operation time of the segmentectomy group was longer than that of the lobectomy group, the intraoperative blood loss was higher, and the postoperative hospital stay, chest drainage volume and drainage tube indwelling time were shorter (p < 0.001). After treatment, forced expiratory volume in one second (FEV1), forced vital capacity (FVC), FEV1/FVC and maximal voluntary ventilation (MVV) in the segmentectomy group were higher than those in the lobectomy group (p < 0.001). After treatment, stroke volume (SV) and left ventricular ejection fraction (LVEF) in the segmentectomy group were higher than those in the lobectomy group (p < 0.001). There were no significant differences in carbohydrate antigen 50 (CA50), carcinoembryonic antigen (CEA) and cytokeratin 19 fragment antigen 21-1 (CYFRA21-1) levels between the two groups after treatment (p > 0.05). The levels of Epinephrine (E), Noradrenaline (NE) and Cortisol (Cor) in the segmentectomy group were lower than those in the lobectomy group at one day after operation (p < 0.001).

Conclusions: Compared to uniportal video-assisted thoracoscopic anatomical lobectomy, anatomical pulmonary segmentectomy for the treatment of NSCLC is more effective in reducing surgical-induced damage to cardiopulmonary function and can lower perioperative oxidative stress response. However, both surgical approaches exhibit minimal impact on serum tumor marker levels.

Aim: We investigated the potential benefits of administering a nutraceutical combination of Bromelain (200 mg) and Boswellia serrata Casperome® (200 mg) on post-operative outcomes of hernioplasty with mesh.

Methods: One hundred eighty patients (27 females, 153 males) were enrolled to undergo open tension-free hernioplasty with the use of Progrip®. Patients were randomized to receive either one tablet of Siben® (study group) or placebo (control group) on an empty stomach, every twelve hours for eleven postoperative days. All patients filled out a medical questionnaire focused on postoperative pain, based on the Visual Analogue Scale (VAS) scale and the Short Form-36 (SF-36) questionnaire, at time T0 (day of surgery) and T28 (28th day after surgery).

Results: One-year results showed a significant improvement in the primary postoperative outcome in the study group. Perception of pain was significantly reduced in the Siben® group compared with controls, both on the seventh (p < 0.05) and the twenty-first (p < 0.05) postoperative day. Patients included in the Siben® group also resumed daily activities and returned to work earlier than the controls. Moreover, results of the SF-36 indicated better Quality of Life (QoL) scores in the study group compared to the placebo group.

Conclusions: Our analysis effectively demonstrates that the use of Siben® in open inguinal hernia mesh repair may improve short- and long-term surgical outcomes, contributing to a better QoL.

Background: The existence of anxiety and depression is not conducive to the rehabilitation of patients, so it is particularly important to apply reasonable and effective nursing methods in operating room to calm the negative emotions of patients. This study aimed to investigate the impact of operating room care utilizing the Wutong mode on the anxiety and depression levels of patients undergoing abdominal surgery.  Methods: The study included 167 patients who underwent abdominal surgery at our hospital from April 2021 to April 2023. These individuals were selected as the research subjects. Based on distinct perioperative management programs, the patients were categorized into the control group (comprising 85 patients receiving conventional perioperative management) and the study group (consisting of 82 patients undergoing operating room care based on the Wutong mode). Comprehensive baseline data, as well as scores from the Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory (BDI), Self-Rating Anxiety Scale (SAS), General Self-Efficacy Scale-6 (GSE-6), and Short-Form-36 Health Survey (SF-36), were collected from all participants. A comparative analysis was performed on sleep status, depression levels, anxiety levels, self-efficacy, and quality of life between the two groups.  Results: Following the intervention, the PSQI scores, as well as BDI and SAS scores of patients in both groups, were significantly reduced compared to pre-intervention levels (p < 0.001). Notably, the study group exhibited markedly lower PSQI scores, BDI scores, and SAS scores compared to the control group post-intervention (p < 0.001). Additionally, the GSE-6 scores of patients in both groups showed a substantial increase after the intervention compared to pre-intervention levels (p < 0.001). The study group demonstrated significantly higher GSE-6 scores and SF-36 scores than the control group after the intervention (p < 0.001).  Conclusion: The Wutong mode-based operating room care has a pronounced impact on patients undergoing abdominal surgery, demonstrating clear clinical application value. This finding offers valuable insights for the development and selection of perioperative nursing plans for patients, providing a significant reference point for healthcare practitioners.