Digestive Surgery最新文献

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Organ-Sparing Approach after Neoadjuvant Treatment in Oesophageal Cancer. 食管癌新辅助治疗后保留器官入路。
IF 1.2 3区 医学
Digestive Surgery Pub Date : 2025-01-01 Epub Date: 2025-07-29 DOI: 10.1159/000547632
Matteo Pittacolo, Oleksandr Khoma, Sjoerd M Lagarde, Bianca Mostert, Bas P L Wijnhoven
{"title":"Organ-Sparing Approach after Neoadjuvant Treatment in Oesophageal Cancer.","authors":"Matteo Pittacolo, Oleksandr Khoma, Sjoerd M Lagarde, Bianca Mostert, Bas P L Wijnhoven","doi":"10.1159/000547632","DOIUrl":"10.1159/000547632","url":null,"abstract":"<p><p><p>Background: Neoadjuvant chemoradiotherapy (nCRT) or perioperative chemotherapy followed by surgical resection is the standard of care for oesophageal and gastroesophageal junction cancer. Up to a third of patients will have a pathological complete response to neoadjuvant treatment. Given the significant morbidity associated with surgery, active surveillance is considered as a potential alternative for patients with clinical complete response post-nCRT. Summary: The preSANO and preSINO trials have validated a multimodal diagnostic strategy combining oesophagogastroduodenoscopy with bite-on-bite biopsies, endoscopic ultrasonography with fine-needle aspiration of suspicious lymph nodes, and PET-CT to detect residual disease. The SANO trial is assessing whether active surveillance leads to non-inferior overall survival compared to planned surgery. Early results of randomized studies support previous retrospective reports of comparable oncological outcomes, with improved quality of life in the surveillance group. Despite concerns of increased morbidity of postponed surgery upon recurrence, recent data indicate comparable surgical outcomes of delayed oesophagectomy. Ongoing trials, including SANO-2, CELEAC, and NEEDS, aim to rationalize surveillance protocols, while SANO-3 is investigating the role of adding immunotherapy in improving response durability. Key Messages: Active surveillance represents a promising alternative to surgery for oesophageal cancer patients achieving complete clinical response after neoadjuvant therapy. While it can spare patients the morbidity of oesophagectomy and significantly improve quality of life, it requires accurate response assessment and structured follow-up. Future developments, including immunotherapy and non-invasive diagnostics, may further refine this approach and expand its safe applicability. </p>.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"247-256"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12503578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144741619","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}
引用次数: 0
Are There Any Differences in Clinical Outcome after the Surgical Management of Patients with Stomach versus Duodenal Perforation? 胃穿孔与十二指肠穿孔手术治疗后的临床结果有什么不同?
IF 1.2 3区 医学
Digestive Surgery Pub Date : 2025-01-01 Epub Date: 2025-08-08 DOI: 10.1159/000547869
Saleh Lahes, Gudrun Wagenpfeil, Matthias Glanemann
{"title":"Are There Any Differences in Clinical Outcome after the Surgical Management of Patients with Stomach versus Duodenal Perforation?","authors":"Saleh Lahes, Gudrun Wagenpfeil, Matthias Glanemann","doi":"10.1159/000547869","DOIUrl":"10.1159/000547869","url":null,"abstract":"<p><p><p>Introduction: Free perforation of the stomach or the duodenum usually requires emergency surgery. In fact, perforation is associated with short-term mortality and morbidity in up to 30 and 50% of patients, respectively, due to secondary peritonitis and sepsis. We hypothesized that postoperative clinical outcomes with duodenal perforation (DP) are worse than those with stomach perforation (SP). This retrospective study aimed to compare the early postoperative clinical outcomes of patients with SP and DP, focusing on morbidity and mortality, to identify differences that could indicate potential changes in surgical management.</p><p><strong>Methods: </strong>A total of 110 patients underwent emergency surgery between 2012 and 2022 for free SP or DP. We compared the demographic, intra-, and postoperative data, including morbidity and mortality during primary hospitalization in the two groups of patients. One group consisted of patients with SP and the second group consisted of patients with DP.</p><p><strong>Results: </strong>The incidence of any postoperative complication, the rate of planned reoperation, median operation time, as well as the median hospital stay after surgery were significantly increased in patients with DP compared to those with SP. In addition, surgical and nonsurgical complications, as well as mortality were common in the total patient population, and higher in DP than in SP patients; however, these differences were not statistically significant.</p><p><strong>Conclusion: </strong>Common postoperative problems occurring after surgery for DP or SP are similar and often life-threatening in both situations. However, patients with DP experienced these problems significantly more often, indicating a more complex injury that required considerably more medical intervention and extended treatment. </p>.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"220-228"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12503666/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144816043","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}
引用次数: 0
Retraction Statement. 撤销声明。
IF 1.8 3区 医学
Digestive Surgery Pub Date : 2025-01-01 Epub Date: 2025-04-28 DOI: 10.1159/000544961
{"title":"Retraction Statement.","authors":"","doi":"10.1159/000544961","DOIUrl":"https://doi.org/10.1159/000544961","url":null,"abstract":"","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":"42 3","pages":"154"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144648820","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}
引用次数: 0
Impact of Robotic Surgery on Postoperative Pancreatic Fistula for High-Risk Pancreaticojejunostomy after Pancreatoduodenectomy. 机器人手术对胰十二指肠切除术后高危胰空肠吻合术胰瘘的影响。
IF 1.8 3区 医学
Digestive Surgery Pub Date : 2025-01-01 Epub Date: 2025-01-24 DOI: 10.1159/000543737
Tomokazu Fuji, Kosei Takagi, Yuzo Umeda, Kazuya Yasui, Motohiko Yamada, Yasuo Nagai, Toshiyoshi Fujiwara
{"title":"Impact of Robotic Surgery on Postoperative Pancreatic Fistula for High-Risk Pancreaticojejunostomy after Pancreatoduodenectomy.","authors":"Tomokazu Fuji, Kosei Takagi, Yuzo Umeda, Kazuya Yasui, Motohiko Yamada, Yasuo Nagai, Toshiyoshi Fujiwara","doi":"10.1159/000543737","DOIUrl":"10.1159/000543737","url":null,"abstract":"<p><strong>Introduction: </strong>The safety and feasibility of robotic pancreatoduodenectomy (RPD) in high-risk patients for postoperative pancreatic fistula (POPF) have rarely been investigated, although the rate of POPF is lower than in open pancreatoduodenectomy (OPD). This study aimed to examine the impact of robotic surgery on POPF in high-risk patients after pancreatoduodenectomy (PD).</p><p><strong>Methods: </strong>We performed a retrospective study of 204 patients who underwent RPD and OPD between January 2018 and June 2023. Of the 204 patients, 126 with high-risk pancreaticojejunostomies for developing POPF were included. The outcomes of RPD and OPD were compared. Multivariate analyses were conducted to identify risk factors associated with the development of clinically relevant POPF (CR-POPF) after surgery.</p><p><strong>Results: </strong>Of the 126 patients, 50 underwent RPD and 76 underwent OPD. The incidence of CR-POPF was significantly lower in the RPD group than in the OPD group (6.0% vs. 38.2%, p < 0.001). Multivariate analyses identified OPD as an independent risk factor associated with CR-POPF (odds ratio [OR]: 7.87, 95% confidence interval [CI]: 2.11-29.4, p = 0.002).</p><p><strong>Conclusion: </strong>This study demonstrated the impact of robotic surgery on POPF in high-risk patients after PD. These results suggest that RPD may be significantly associated with a decreased incidence of CR-POPF in high-risk anastomoses.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"49-58"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045822","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}
引用次数: 0
Exploration of Risk Factors and an Identification Signature for Bacteremia in Acute Cholecystitis. 探讨急性胆囊炎菌血症的危险因素和识别特征。
IF 1.8 3区 医学
Digestive Surgery Pub Date : 2025-01-01 Epub Date: 2025-03-07 DOI: 10.1159/000545140
Satoshi Nishiwada, Tetsuya Tanaka, Kenji Uno, Yuki Kirihataya, Takeshi Takei, Tomomi Sadamitsu, Akihiro Kajita, Mayuko Kikuchi, Yoshiki Tamada, Masaru Enoki, Kazusuke Matsumoto, Junya Suzuki, Hazuki Horiuchi, Yasushi Okura, Teruyuki Hidaka, Masayoshi Sawai, Atsushi Yoshimura
{"title":"Exploration of Risk Factors and an Identification Signature for Bacteremia in Acute Cholecystitis.","authors":"Satoshi Nishiwada, Tetsuya Tanaka, Kenji Uno, Yuki Kirihataya, Takeshi Takei, Tomomi Sadamitsu, Akihiro Kajita, Mayuko Kikuchi, Yoshiki Tamada, Masaru Enoki, Kazusuke Matsumoto, Junya Suzuki, Hazuki Horiuchi, Yasushi Okura, Teruyuki Hidaka, Masayoshi Sawai, Atsushi Yoshimura","doi":"10.1159/000545140","DOIUrl":"10.1159/000545140","url":null,"abstract":"<p><strong>Introduction: </strong>Acute cholecystitis (AC) is one of the most common abdominal emergencies worldwide. Biliary infections can easily induce bacteremia, leading to severe general conditions including systemic inflammation and blood coagulation abnormalities. However, bacteremia in AC has not been investigated so far. Herein, we analyzed the blood cultures and clinical data of patients with AC to identify the risk factors and develop a statistical identification model for bacteremia.</p><p><strong>Methods: </strong>Of 319 consecutive patients with AC at our hospital, we retrospectively investigated 176 patients who were evaluated by blood culture at diagnosis to assess risk factors and develop an identification model for bacteremia in AC.</p><p><strong>Results: </strong>Based on blood culture results, 37 (21.0%) of 176 patients were diagnosed with bacteremia. The bacteremia-positive group had a significantly worse systemic status at diagnosis than the negative group, including age, severity grading, comorbidities, performance status, systemic inflammatory status, and blood coagulation abnormalities. Multivariate analysis revealed previous endoscopic papillary procedures, total bilirubin, and systemic inflammatory response syndrome ≥3 as significant risk factors for bacteremia. On dividing early and late cohorts according to the onset time of AC, an identification signature derived from the three risk factors robustly distinguished bacteremia in both cohorts (area under the curve, early cohort = 0.93; late cohort = 0.91).</p><p><strong>Conclusions: </strong>In this study, we identified risk factors and signatures that accurately detect bacteremia in patients with AC. This study enriches our medical knowledge of AC, helping us step toward designing individualized treatment strategies for this disease.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"84-96"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585131","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}
引用次数: 0
Total Pancreatectomy with "Superior Mesenteric Artery-First Approach". “SMA-First入路”全胰切除术。
IF 1.2 3区 医学
Digestive Surgery Pub Date : 2025-01-01 Epub Date: 2025-05-10 DOI: 10.1159/000546363
Kosei Takagi, Tomokazu Fuji, Kazuya Yasui, Motohiko Yamada, Takeyoshi Nishiyama, Yasuo Nagai, Noriyuki Kanehira, Toshiyoshi Fujiwara, Kosei Takagi
{"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, Kosei Takagi","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":"155-159"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","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}
引用次数: 0
Routine Endoscopic Evaluation of Colorectal Anastomoses for Early Detection of Anastomotic Leakage (REAL Study): Protocol for a Multicenter Prospective Study. 常规内镜评估结直肠吻合器早期发现吻合口漏(REAL研究):一项多中心前瞻性研究方案。
IF 1.2 3区 医学
Digestive Surgery Pub Date : 2025-01-01 Epub Date: 2025-05-20 DOI: 10.1159/000546041
David J Nijssen, Wytze Laméris, Quentin Denost, Antonino Spinelli, Eloy Espín-Basany, James Kinross, Jurriaan Tuynman, Roel Hompes
{"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":"185-191"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","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}
引用次数: 0
Empiric Antimicrobial Treatment of Anastomotic Leakage after Esophageal Resection: The Most Commonly Used Antimicrobial Regimens in the Netherlands and an Antimicrobial Treatment Recommendation Based on a Single-Center Population. 食管切除术后吻合口瘘的经验性抗菌治疗:荷兰最常用的抗菌方案和基于单中心人群的抗菌治疗推荐。
IF 1.8 3区 医学
Digestive Surgery Pub Date : 2025-01-01 Epub Date: 2025-03-05 DOI: 10.1159/000545046
Nicole Chatain Lorza, Esther M van Wezel, M H Edwina Doting, Jasper B van Praagh, Jan Willem Haveman
{"title":"Empiric Antimicrobial Treatment of Anastomotic Leakage after Esophageal Resection: The Most Commonly Used Antimicrobial Regimens in the Netherlands and an Antimicrobial Treatment Recommendation Based on a Single-Center Population.","authors":"Nicole Chatain Lorza, Esther M van Wezel, M H Edwina Doting, Jasper B van Praagh, Jan Willem Haveman","doi":"10.1159/000545046","DOIUrl":"10.1159/000545046","url":null,"abstract":"<p><strong>Introduction: </strong>The development of anastomotic leakage (AL) after esophagectomy is a severe complication, often leading to mediastinitis and systemic infections. Effective empiric antimicrobial therapy is crucial, but there is no consensus on the optimal regimen. This study aimed to document antimicrobial regimens used in the Netherlands and to evaluate culture results from AL after esophagectomy at our center.</p><p><strong>Methods: </strong>An online questionnaire about the preferred antimicrobial treatment of AL after esophagectomy was sent to all upper gastrointestinal surgeons in the Netherlands. In addition, drain culture results from patients with AL after esophagectomy in our center were retrospectively analyzed.</p><p><strong>Results: </strong>From 76 responses, 28 were included, representing 13 of the 15 esophagectomy-performing centers in the Netherlands. For treating AL after esophagectomy, respondents typically choose broad-spectrum regimens covering Gram-negative, Gram-positive, and anaerobic bacteria. The cultures of 57 patients were analyzed. Overall, 61% had positive cultures for yeast, 61% of patients for Enterobacterales, and 16% for Pseudomonas and other non-fermenters.</p><p><strong>Conclusion: </strong>Based on the studied cultures, empiric antibiotics should cover Gram-positive, Gram-negative, anaerobe bacteria and Pseudomonas. We recommend the use of empiric amoxicillin/clavulanic acid with tobramycin for patients with AL after esophagectomy, which is now protocol in our center. The addition of antifungals remains debatable. Given the high incidence of yeast-positive cultures in the studied cohort, we recommend the addition of an echinocandin in clinically unstable patients.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"68-76"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12074614/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566311","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}
引用次数: 0
Patient Factors Influencing Surgical Technique in Hiatal Hernia Repair: In Search for Surgeons' Hidden Algorithm. 影响裂孔疝修补手术技术的患者因素:寻找外科医生的隐算法。
IF 1.8 3区 医学
Digestive Surgery Pub Date : 2025-01-01 Epub Date: 2025-04-08 DOI: 10.1159/000545340
Berdel Akmaz, Amber Hameleers, Sander M J van Kuijk, Jan Willem M Greve, Roy F A Vliegen, Evert-Jan G Boerma, Berry Meesters, Jan H M B Stoot
{"title":"Patient Factors Influencing Surgical Technique in Hiatal Hernia Repair: In Search for Surgeons' Hidden Algorithm.","authors":"Berdel Akmaz, Amber Hameleers, Sander M J van Kuijk, Jan Willem M Greve, Roy F A Vliegen, Evert-Jan G Boerma, Berry Meesters, Jan H M B Stoot","doi":"10.1159/000545340","DOIUrl":"10.1159/000545340","url":null,"abstract":"<p><strong>Introduction: </strong>Laparoscopic fundoplication is the current standard for HH repair. HH repair can be reinforced with additional anterior sutures, vertical mesh strips (VMS), or mesh placement. We analyzed the influence of patient factors on the surgical technique for laparoscopic repair in a teaching hospital.</p><p><strong>Methods: </strong>Between 2012 and 2019, all patients who underwent repair of HH were assessed in this retrospective cohort study. HH was measured on CT scans and baseline patient characteristics and surgical details were collected.</p><p><strong>Results: </strong>In total, 307 patients were included. A total of 208 patients underwent a Toupet fundoplication and 97 patients underwent a Nissen fundoplication. Reinforcements consisted of anterior sutures in 132 patients, VMS in 89 patients, and mesh in 17 patients. The use of anterior sutures was significantly associated with female gender, higher type of HH, and higher age. The use of VMS during surgery was significantly associated with higher type of HH, higher age, and larger transverse diameter of the HH. The use of mesh during surgery was significantly associated with higher type of HH and larger transverse diameter of the HH.</p><p><strong>Conclusion: </strong>In this retrospective study, the reinforcement techniques used during surgery were significantly associated with patient factors such as gender, body length and weight, type of HH, and transverse diameter. An unexpected patient-associated factor was age.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"127-135"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810719","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}
引用次数: 0
Delayed Return of Gastrointestinal Function after Partial Hepatectomy: A Single-Center Cross-Sectional Study. 肝部分切除术后胃肠功能延迟恢复:一项单中心横断面研究。
IF 1.8 3区 医学
Digestive Surgery Pub Date : 2025-01-01 Epub Date: 2024-11-13 DOI: 10.1159/000542028
Giulia Piazza, Ismail Labgaa, Emilie Uldry, Emmanuel Melloul, Nermin Halkic, Gaëtan-Romain Joliat
{"title":"Delayed Return of Gastrointestinal Function after Partial Hepatectomy: A Single-Center Cross-Sectional Study.","authors":"Giulia Piazza, Ismail Labgaa, Emilie Uldry, Emmanuel Melloul, Nermin Halkic, Gaëtan-Romain Joliat","doi":"10.1159/000542028","DOIUrl":"10.1159/000542028","url":null,"abstract":"<p><strong>Introduction: </strong>Partial hepatectomy (PH) remains associated with complication rates around 30-50%. Delayed return of gastrointestinal function (DRGF) has been reported in 10-20%. This study aimed to assess DRGF predictors after PH.</p><p><strong>Methods: </strong>This study included all consecutive adult patients undergoing PH between January 01, 2010, and December 12, 2019. DRGF was defined as the need for postoperative nasogastric tube (NGT) insertion. Patients leaving the operation room with a NGT were excluded. Independent DRGF predictors were identified with multivariable logistic binary regression.</p><p><strong>Results: </strong>A total of 501 patients were included. DRGF occurred in 82 patients (16%). Among DRGF patients, 17% (n = 14) needed a second NGT placement. DRGF incidences were similar before and after Enhanced Recovery after Surgery implementation in 2013 (16/78 = 20% vs. 66/423 = 16%, p = 0.305). A hundred-and-twelve patients (22%) underwent a minimally invasive approach and DRGF incidence was significantly lower in this group (5/112 = 4.5% vs. 77/389 = 19.8%, p < 0.001). DRGF was more frequent after major PH (55/238 = 23% vs. 27/263 = 10%, p < 0.001). DRGF occurred more often in patients with preoperative embolization (26/88 = 30% vs. 55/407 = 14%, p < 0.001), biliary anastomosis (20/48 = 42% vs. 61/450 = 14%, p < 0.001), and extrahepatic resection (37/108 = 34% vs. 45/393 = 11%, p < 0.001). Patients with DRGF had longer median operation duration (374 vs. 263 min, p < 0.001), more biliary leaks/bilomas (27/82 = 33% vs. 33/419 = 7.9%, p < 0.001), and higher median blood loss (1,088 vs. 701 mL, p < 0.001). DRGF patients developed more pneumonia (14/22 = 64% vs. 8/22 = 36%, p < 0.001) and had longer median length of stay (19 vs. 8 days, p < 0.001). On multivariable analysis, operation duration (OR 1.005, 95% CI: 1.002-1.008, p < 0.001), major hepatectomy (OR 3.606, 95% CI: 1.931-6.732), and postoperative biloma/biliary leak (OR 6.419, 95% CI: 3.019-13.648, p < 0.001) were independently associated with DRGF occurrence.</p><p><strong>Conclusion: </strong>Postoperative DRGF occurred in 16% of the patients and was associated with a longer length of stay. Surgery duration, major PH and postoperative biloma/biliary leak were found as independent predictors of DRGF.</p><p><strong>Introduction: </strong>Partial hepatectomy (PH) remains associated with complication rates around 30-50%. Delayed return of gastrointestinal function (DRGF) has been reported in 10-20%. This study aimed to assess DRGF predictors after PH.</p><p><strong>Methods: </strong>This study included all consecutive adult patients undergoing PH between January 01, 2010, and December 12, 2019. DRGF was defined as the need for postoperative nasogastric tube (NGT) insertion. Patients leaving the operation room with a NGT were excluded. Independent DRGF predictors were identified with multivariable logistic binary regression.</p><p><strong>Results: </strong>A","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"9-16"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11887990/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142616557","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}
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