Digestive Surgery最新文献

{"title":"Current approaches to diagnosis and management of Acute Mesenteric Ischaemia - a scoping review.","authors":"Liam Costello, William P Duggan, Michael Flanagan, Conor Toale, Dara O Kavanagh","doi":"10.1159/000547297","DOIUrl":"https://doi.org/10.1159/000547297","url":null,"abstract":"<p><strong>Introduction: </strong>Acute mesenteric ischaemia (AMI) is a life-threatening condition with mortality exceeding 50%. This scoping review evaluates current diagnostic and management strategies, comparing endovascular and open surgical approaches.</p><p><strong>Methods: </strong>Following Arksey and O'Malley's framework, a systematic search was conducted in OVID MEDLINE, EMBASE, and Web of Science (2005-2024). English-language studies on AMI were included. Data on diagnostic methods, mortality, hospital/ICU stay, and surgical outcomes were extracted.</p><p><strong>Results: </strong>Thirty-nine studies (20,991 patients) were analysed. CT was the primary diagnostic tool, with diagnosis delays ranging from 13.9-48 hours. Endovascular interventions demonstrated lower 30-day mortality (0%-53.8%) versus open surgery (21%-81%). Hospital (5-15.35 vs. 5.7-27.26 days) and ICU stays (0-5.35 vs. 2-13 days) were shorter with endovascular management. Bowel resection and re-laparotomy rates were also reduced.</p><p><strong>Conclusion: </strong>Endovascular management is associated with improved outcomes, including reduced mortality and shorter hospital stays. Timely diagnosis and patient selection remain critical. A multidisciplinary approach is essential, though further prospective studies are needed to standardise protocols.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"1-26"},"PeriodicalIF":1.8,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144641978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Outcomes of Zenker's Diverticula Treatment: Invasive Procedures Ensure Sustained Quality of Life despite Higher Short-Term Morbidity.","authors":"Ulrich Nitsche, Marie Seitz, Helmut Friess, Hubertus Feussner, Norbert Hüser, Alissa Jell","doi":"10.1159/000546619","DOIUrl":"10.1159/000546619","url":null,"abstract":"<p><strong>Introduction: </strong>There is a lack of sufficient evidence-based data to support personalized treatment decisions for Zenker's diverticulum. This study evaluates not only short-term outcomes of different treatment approaches but also identifies prognostic factors for long-term recurrence-free survival and quality of life.</p><p><strong>Methods: </strong>We retrospectively analyzed all patients diagnosed with Zenker's diverticulum at our center between 2001 and 2021. Long-term follow-up data, including validated quality-of-life scores (EAT-10 and GIQLI), were evaluated.</p><p><strong>Results: </strong>Overall, 97 patients underwent open surgery (OS), 37 received endoscopic surgery (ES), and 17 patients were treated conservatively. Treatment-related morbidity was 25% for OS, 5% for ES, and nil for conservative management (p = 0.004). After a median follow-up of 107 months, patients treated with OS or ES experienced less dysphagia (p < 0.001) and regurgitation (p < 0.001) compared to initial presentation. ES patients had a more favorable quality-of-life score than those treated conservatively (GIQLI: 125 vs. 106; p = 0.010 but not EAT-10: 2 vs. 6; p = 0.207). Recurrence rates were 28% for OS, 62% for ES, and 65% for conservative treatment (p < 0.001). OS was identified as an independent prognostic factor for improved recurrence-free survival.</p><p><strong>Conclusion: </strong>Despite higher short-term morbidity, OS was associated with the best recurrence-free survival. Long-term symptoms and quality-of-life outcomes were favorable and comparable between OS and ES.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"1-11"},"PeriodicalIF":1.8,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robot-Assisted Minimally Invasive Esophagectomy: Current Best Practice.","authors":"Cezanne D Kooij, Lucas Goense, B Feike Kingma, Richard van Hillegersberg, Jelle P Ruurda","doi":"10.1159/000546749","DOIUrl":"10.1159/000546749","url":null,"abstract":"<p><strong>Background: </strong>Esophagectomy, the cornerstone in the multimodal treatment of esophageal cancer, has evolved from open surgery to minimally invasive esophagectomy (MIE) in recent decades. MIE reduces complications, facilitates faster recovery, and provides comparable or superior oncologic outcomes and survival rates compared to open surgery.</p><p><strong>Summary: </strong>Since the early 2000s, robot-assisted minimally invasive esophagectomy (RAMIE) has emerged, offering enhanced precision over MIE through features such as three-dimensional visualization, improved instrument dexterity, tremor filtration, and motion scaling. These innovations help overcome the challenges of MIE, particularly in the thoracic phase, where limited access and reduced instrument dexterity hamper the procedure. RAMIE is associated with lower complication rates, particularly pulmonary complications, improved recovery, and comparable oncological outcomes. Despite higher initial costs, its potential to reduce complications makes it financially comparable to other approaches. Moreover, mastering RAMIE requires navigating a significant learning curve, making collaboration and training vital. The integration of artificial intelligence and advancements in robotic platforms, including single-port systems, will broaden patient eligibility and improve outcomes.</p><p><strong>Key messages: </strong>RAMIE has established itself as an integral part of modern surgical practice and will continue to evolve, driving further innovation. Collaboration and training are essential for refining techniques and ensuring safe and effective implementation.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"1-9"},"PeriodicalIF":1.8,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12233966/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Routine Endoscopic Evaluation of Colorectal Anastomoses for Early Detection of Anastomotic Leakage (REAL Study): Protocol for a Multicenter Prospective Study.","authors":"David J Nijssen, Wytze Laméris, Quentin Denost, Antonino Spinelli, Eloy Espín-Basany, James Kinross, Jurriaan Tuynman, Roel Hompes","doi":"10.1159/000546041","DOIUrl":"10.1159/000546041","url":null,"abstract":"<p><strong>Introduction: </strong>Early detection and timely treatment of anastomotic leakage (AL) following rectal surgery are crucial for improving outcomes. However, no standardized early detection pathway exists. This study evaluates a multicenter clinical care pathway integrating bedside endoscopy to reduce time to diagnose AL.</p><p><strong>Methods: </strong>This international, multicenter, prospective observational study evaluates early endoscopic inspection for AL detection. Endoscopic assessments are performed at the bedside using a point-of-care digital rectoscope. Eligible patients include those undergoing colorectal resection for cancer with a colorectal or coloanal anastomosis within 15 cm of the anorectal junction. The clinical pathway includes bedside endoscopic inspection 3-6 days post-surgery, C-reactive protein-guided CT scans with rectal contrast, and follow-up endoscopy at 2-3 weeks. The primary outcome is time to AL diagnosis. Secondary outcomes include diagnostic accuracy, patient-reported comfort (Modified Gloucester Scale), stoma rate, anastomosis healing at 1 year, and cost-effectiveness. A propensity score-matched historical cohort will be used for comparison. Based on previous reports, we hypothesize this pathway will reduce the median diagnosis time from 15 to 5 days. With 95% confidence and 80% power, 130 patients are needed, with 153 total to account for a 15% maximum dropout rate.</p><p><strong>Conclusion: </strong>The REAL study is designed to evaluate whether a clinical pathway incorporating routine endoscopic assessment of colorectal anastomoses reduces time to diagnosis of AL and initiation of treatment.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"1-7"},"PeriodicalIF":1.8,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12215166/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Association between the Number of Retrieved Lymph Nodes and Survival in Gastric Cancer Surgery: A Dutch Population-Based Study.","authors":"Wei Keat Ooi, Sander J M van Hootegem, Low Kuan Yean, Leonie R van der Werf, Pieter C van der Sluis, Sjoerd M Lagarde, Bas P L Wijnhoven","doi":"10.1159/000546436","DOIUrl":"10.1159/000546436","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to evaluate whether the retrieval of 15 or more lymph nodes (LN) during gastrectomy for cancer is associated with better survival and more accurate pathological staging.</p><p><strong>Methods: </strong>Patients that underwent gastrectomy between 2011 and 2016 were reviewed from the Dutch Upper Gastrointestinal Cancer Audit. Patients with <15 and ≥15 LN retrieved were compared after propensity-score matching based on patient and tumor characteristics. The primary endpoint was 3-year overall survival.</p><p><strong>Results: </strong>A total of 2,047 patients were included in the study. After propensity score matching, 522 patients with ≥15 LNs were matched to 522 patients with <15 LNs. There was no statistically significant difference in overall survival between both groups with 3-year survival rates of 56% versus 59%, respectively. Patients with ≥15 LNs had a more advanced pN-category. While median survival was higher for patients with ≥15 LNs versus <15 LNs in the subgroups pN2, pN3a, and pN3b, no statistically significant differences were found. Similar results were found in the propensity score matched cohort using 23 LNs as cut-off.</p><p><strong>Conclusion: </strong>≥15 LNs retrieved during gastrectomy for cancer was associated with higher pN-stage, likely as a result of stage migration. Three-year overall survival was comparable for patients with ≥15 LNs and patients with <15 LNs retrieved.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"1-14"},"PeriodicalIF":1.8,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12233975/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144101639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Total Pancreatectomy with \"Superior Mesenteric Artery-First Approach\".","authors":"Kosei Takagi, Tomokazu Fuji, Kazuya Yasui, Motohiko Yamada, Takeyoshi Nishiyama, Yasuo Nagai, Noriyuki Kanehira, Toshiyoshi Fujiwara","doi":"10.1159/000546363","DOIUrl":"10.1159/000546363","url":null,"abstract":"<p><strong>Introduction: </strong>Total pancreatectomy (TP) is a technically demanding procedure for patients with multifocal pancreatic diseases. Although the benefits of the superior mesenteric artery (SMA)-first approach for pancreatic cancer (PC) have been reported in pancreatic surgery, few studies have demonstrated surgical techniques of SMA-first approach in TP.</p><p><strong>Methods: </strong>This report presents our novel SMA-first approach for PC in TP, including six steps. First, the resectability was confirmed (step 1). Next, SMA approach was applied (step 2). In this step, the anterior and left sides of the SMA were dissected, and the left renal vein was confirmed. Following retroperitoneal dissection (step 3), the pancreatic body and tail were completely mobilized (step 4). Subsequently, Whipple procedure was performed with lymphadenectomy around the right side of the SMA (step 5). Finally, hepaticojejunostomy and gastrojejunostomy were performed (step 6). Using SMA-first approach, en bloc resection with adequate lymphadenectomy around the SMA and retroperitoneal dissection was performed.</p><p><strong>Conclusion: </strong>The present study presents surgical techniques of TP using the SMA-first approach for PC. This unique approach may be useful to perform TP for PC to obtain negative resection margins.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"1-5"},"PeriodicalIF":1.8,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143986027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is the Risk of Developing a Crohn's Disease Increased after Appendectomy? A Systematic Review of the Literature and Meta-Analysis.","authors":"Isabelle Uhe, Eleftherios Gialamas, Christophe Combescure, Christian Toso, Emilie Liot, Guillaume Meurette, Frederic Ris, Jeremy Meyer","doi":"10.1159/000545339","DOIUrl":"10.1159/000545339","url":null,"abstract":"<p><strong>Introduction: </strong>The effect of appendectomy on the development of Crohn's disease (CD) is a matter of debate. The aim of this systematic review and meta-analysis was to gather the latest published data to determine whether patients with a history of appendectomy have an increased risk of developing CD or not.</p><p><strong>Methods: </strong>MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched for case-control and cohort studies assessing the risk of developing CD after appendectomy. The pooled adjusted and not adjusted odds ratio (OR) with 95% confidence intervals (CIs) were calculated for case-control studies. Heterogeneity was assessed. Studies were ranked using the Newcastle-Ottawa Scale (NOS) and were all of good quality.</p><p><strong>Results: </strong>Fourteen case-control studies and 6 cohort studies were included. Meta-analysis of case-control studies (33,243 patients) of raw OR shows a positive association between appendectomy and CD (OR: 1.51, 95% CI: 0.97-2.36, I2 = 87%), which was not statistically significant (p = 0.069). The meta-analysis of adjusted OR shows that appendectomy represents a statistically significant risk factor for the development of CD (OR: 1.86, 95% CI: 1.01-3.45, p = 0.047, I2 = 89%).</p><p><strong>Conclusion: </strong>Appendectomy appears to be a risk factor for the development of CD. However, the discrepant results obtained by meta-analysis of unadjusted OR, the heterogeneity between studies, and the lack of precision of the magnitude of the association mandate confirmation by a large epidemiological study.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"1-12"},"PeriodicalIF":1.8,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143973448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Early Oral Feeding on Postoperative Outcomes after Elective Colorectal Surgery: A Systematic Review and Meta-Analysis.","authors":"Soo Young Lee, Eon Chul Han","doi":"10.1159/000542595","DOIUrl":"10.1159/000542595","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to evaluate the influence of early oral feeding (EOF), a key component of enhanced recovery after surgery protocols, on postoperative outcomes in patients undergoing elective colorectal surgery.</p><p><strong>Methods: </strong>We searched the MEDLINE, Embase, Cochrane Library, and KoreaMed databases to include randomized clinical trials comparing EOF that started on postoperative day 1 and conventional oral feeding that commenced after first flatus. Two authors independently screened the retrieved records and extracted data. The primary outcome was total complications. Data were pooled, and the overall effect size was calculated using a fixed-effect model.</p><p><strong>Results: </strong>We screened 13 studies, and 1,556 patients were included in the analysis. The EOF group exhibited fewer total complications (odds ratio [OR] 0.50; 95% confidence interval [CI] 0.38-0.65). Anastomotic leakage was also reduced in the EOF group (OR: 0.40; 95% CI: 0.19-0.83); however, an increased incidence of vomiting (OR: 1.58; 95% CI: 1.11-2.26) as well as a tendency of higher rate of nasogastric tube reinsertion (OR: 1.49; 95% CI: 0.96-2.31) were observed. The EOF group demonstrated a decreased time to flatus (mean difference [MD] -0.87; 95% CI: -1.00 to -0.74) and shortened hospital stay (MD: -0.76; 95% CI: -0.89 to -0.6). No significant difference in mortality was observed between the two groups (OR: 0.54; 95% CI: 0.15-2.01).</p><p><strong>Conclusion: </strong>EOF proved to be a safe and effective practice for patients undergoing elective colorectal surgery. However, the increased incidence of vomiting necessitates careful consideration.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"26-35"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142667396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor regarding the Article: \"Pathologic Outcomes and Survival in Patients with Rectal Cancer and Increased Body Mass Index\".","authors":"Xiaobo Xie","doi":"10.1159/000545530","DOIUrl":"10.1159/000545530","url":null,"abstract":"","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"152-153"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Procalcitonin as an Early Predictive Marker for Infectious Complications after Hepatectomy.","authors":"Haruki Mori, Hiromitsu Maehira, Nobuhito Nitta, Takeru Maekawa, Hajime Ishikawa, Katsushi Takebayashi, Sachiko Kaida, Toru Miyake, Masaji Tani","doi":"10.1159/000543635","DOIUrl":"10.1159/000543635","url":null,"abstract":"<p><strong>Introduction: </strong>The present study aimed to determine the clinical value of serum procalcitonin (PCT) level in predicting postoperative infections after hepatectomy.</p><p><strong>Methods: </strong>Medical records of 301 consecutive patients who underwent hepatectomy were retrospectively reviewed. We divided the patients into infection-positive and infection-negative groups. We investigated the changes in perioperative inflammatory markers such as C-reactive protein level (CRP) and PCT level. Associations between infectious complications and perioperative inflammatory markers were evaluated to identify predictive factors of infectious complications after hepatectomy.</p><p><strong>Results: </strong>Postoperative infectious complications occurred in 67 (22.3%) patients. The areas under the curve (AUCs) using PCT levels on postoperative days (PODs) 1 and 3 were 0.794 and 0.845, respectively, whereas those using CRP were 0.493 and 0.641, respectively. PCT level had a better AUC than CRP for predicting postoperative infectious complications on PODs 1 and 3. Multivariate analysis indicated PCT levels on PODs 1 and 3 were an independent predictor of infectious complications after hepatectomy.</p><p><strong>Conclusion: </strong>PCT is the only predictive marker for infectious complications after hepatectomy and is valuable for detecting infectious complications from POD 1.</p><p><strong>Introduction: </strong>The present study aimed to determine the clinical value of serum procalcitonin (PCT) level in predicting postoperative infections after hepatectomy.</p><p><strong>Methods: </strong>Medical records of 301 consecutive patients who underwent hepatectomy were retrospectively reviewed. We divided the patients into infection-positive and infection-negative groups. We investigated the changes in perioperative inflammatory markers such as C-reactive protein level (CRP) and PCT level. Associations between infectious complications and perioperative inflammatory markers were evaluated to identify predictive factors of infectious complications after hepatectomy.</p><p><strong>Results: </strong>Postoperative infectious complications occurred in 67 (22.3%) patients. The areas under the curve (AUCs) using PCT levels on postoperative days (PODs) 1 and 3 were 0.794 and 0.845, respectively, whereas those using CRP were 0.493 and 0.641, respectively. PCT level had a better AUC than CRP for predicting postoperative infectious complications on PODs 1 and 3. Multivariate analysis indicated PCT levels on PODs 1 and 3 were an independent predictor of infectious complications after hepatectomy.</p><p><strong>Conclusion: </strong>PCT is the only predictive marker for infectious complications after hepatectomy and is valuable for detecting infectious complications from POD 1.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"17-25"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11887988/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}