Digestive Surgery最新文献

{"title":"Endoscopic Negative Pressure Therapy for Post-Sleeve Gastrectomy Proximal Staple-Line Leaks: A Single-Center Experience of 40 Patients.","authors":"Vasiliki Christogianni, Matthias Ross, Radostina Dukovska, Ashwini Rao, Martin Buesing, Markus Reiser","doi":"10.1159/000545177","DOIUrl":"10.1159/000545177","url":null,"abstract":"<p><strong>Introduction: </strong>Post-sleeve gastrectomy (SG) proximal staple-line leak is a rare yet serious complication. Endoscopic negative pressure therapy (ENPT) has emerged as a safe technique, showing promising results in treating anastomotic leakages in the upper and lower gastrointestinal tract, often in conjunction with surgical interventions. A standardized treatment algorithm has not been established. This study aimed to assess the safety and efficacy of ENPT in the multidisciplinary management of proximal staple-line leaks after SG.</p><p><strong>Methods: </strong>This is an observational study of 40 post-SG proximal staple-line leak cases treated with an ENPT-based approach. Revisional surgery was performed in addition to ENPT in critically ill patients or nondiagnostic imaging results. Success was defined as the healing of the defect and paraluminal cavity with no further need for surgical or endoscopic intervention following ENPT.</p><p><strong>Results: </strong>Thirty-three patients were successfully treated with ENPT (82.5% success rate). Additional surgical interventions were performed in 37 patients, with re-laparoscopy, lavage, and drain of the abdominal cavity being the most frequently performed procedures. The mean duration of treatment was 25.6 days, with an average of 6.4 endoscopic interventions per patient.</p><p><strong>Conclusions: </strong>ENPT is a safe and effective technique for treating proximal staple-line leaks following SG. Its application should be considered alongside other endoscopic and surgical approaches.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"1-8"},"PeriodicalIF":1.8,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143604284","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":"Feasibility of Telementoring during Robot-Assisted Minimally Invasive Esophagectomy.","authors":"Robin B den Boer, Cas de Jongh, Gijs I van Boxel, Philippe Rouanet, Anne Mourregot, Jelle P Ruurda, Richard van Hillegersberg","doi":"10.1159/000542035","DOIUrl":"10.1159/000542035","url":null,"abstract":"<p><strong>Introduction: </strong>Telementoring could increase the quality, reduce the time, and increase cost efficiency of the proctoring program for robot-assisted minimally invasive esophagectomy (RAMIE). However, feasibility is unclear as no studies assessed telementoring for RAMIE.</p><p><strong>Methods: </strong>The feasibility of telementoring was assessed during the thoracic part of RAMIE procedures in three high-volume centers. RAMIEs were performed by trained surgeons, proctored by two experts. The primary outcome was the impact of the technology on conveying and understanding instructions.</p><p><strong>Results: </strong>Between December 2021 and December 2022, nine RAMIE procedures were proctored using telementoring. Overall quality of the telementoring technique was scored good to excellent (median score: good). The vast majority of the 24 proctor instructions were conveyed and understood fluently (n = 21, 96%). Most proctor instructions were aimed at improving surgical exposure (n = 9, 38%). The major point of criticism was the use of the audio as the communication through the headset of the performing surgeon was not accessible by the complete team.</p><p><strong>Discussion: </strong>Telementoring is deemed feasible for proctoring trained RAMIE surgeons after onsite proctoring. Technical improvements with regard to audio technology are warranted for broad implementation, especially in earlier training settings. The role of telementoring in the training pathway of learning surgeons needs clinical validation.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"1-8"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496908","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}

{"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}

{"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}

{"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}

{"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":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;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 &lt; 0.001). DRGF was more frequent after major PH (55/238 = 23% vs. 27/263 = 10%, p &lt; 0.001). DRGF occurred more often in patients with preoperative embolization (26/88 = 30% vs. 55/407 = 14%, p &lt; 0.001), biliary anastomosis (20/48 = 42% vs. 61/450 = 14%, p &lt; 0.001), and extrahepatic resection (37/108 = 34% vs. 45/393 = 11%, p &lt; 0.001). Patients with DRGF had longer median operation duration (374 vs. 263 min, p &lt; 0.001), more biliary leaks/bilomas (27/82 = 33% vs. 33/419 = 7.9%, p &lt; 0.001), and higher median blood loss (1,088 vs. 701 mL, p &lt; 0.001). DRGF patients developed more pneumonia (14/22 = 64% vs. 8/22 = 36%, p &lt; 0.001) and had longer median length of stay (19 vs. 8 days, p &lt; 0.001). On multivariable analysis, operation duration (OR 1.005, 95% CI: 1.002-1.008, p &lt; 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 &lt; 0.001) were independently associated with DRGF occurrence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;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}

{"title":"The Steep Ramp Test as Precursor to Assess Physical Fitness before Esophagectomy in Cancer Patients.","authors":"David J Crull, Iris Mekenkamp, Julia Mikhal, G Maarten-Friso Ruinemans, Marc J van Det, Ewout A Kouwenhoven","doi":"10.1159/000543029","DOIUrl":"10.1159/000543029","url":null,"abstract":"<p><strong>Introduction: </strong>Maximum oxygen uptake (VO2max) is a predictor for postoperative complications after esophagectomy. Cardiopulmonary exercise test (CPET) is the golden standard for measuring VO2max. The alternative steep ramp test (SRT) is less strenuous with several benefits, providing an estimation of VO2max. This study aimed to determine whether SRT is a reliable alternative for CPET to evaluate preoperative fitness.</p><p><strong>Methods: </strong>A total of 113 patients were included in this study. The agreement between SRT and CPET was analyzed using a t test, Intraclass correlation coefficient (ICC), and the Bland-Altman analysis. The threshold for adequate preoperative fitness was set at 17.0 mL/kg/min.</p><p><strong>Results: </strong>The mean difference between CPET and SRT was 2.77 mL/kg/min (95% confidence interval [CI]: 2.14-3.41). The ICC was 0.79 (95% CI: 0.70-0.85). The upper limit of agreement of the Bland-Altman was 9.44. The addition of 9.44 to the CPET threshold gives an SRT threshold of 26.44 mL/kg/min. Thirty-one (27.4%) patients scored higher than the SRT threshold.</p><p><strong>Conclusion: </strong>The SRT VO2max differs from VO2max as measured by CPET. However, the difference was found to be clinically irrelevant for a substantial portion of patients. Hence, SRT is a promising alternative to CPET for determining physical fitness and might render CPET obsolete for fit individuals.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"59-67"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142946391","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":"Longer Term Outcomes of Laparoscopic Peritoneal Lavage in the Management of Acute Hinchey III Perforated Diverticulitis: A Systematic Review and Meta-Analysis.","authors":"David Sciascia, Paul Neary, Shaheel Sahebally, Maria Whelan, Cillian Clancy, James Michael O Riordan, Alwaleed Abdelgadir, Dara Oliver Kavanagh","doi":"10.1159/000543241","DOIUrl":"10.1159/000543241","url":null,"abstract":"<p><strong>Introduction: </strong>This study aims to investigate the current evidence regarding long-term outcomes using laparoscopic peritoneal lavage (LPL) versus primary bowel resection (PR) in Hinchey III diverticulitis.</p><p><strong>Methods: </strong>A systematic review was undertaken based upon articles published between January 1, 2000, and March 1, 2024. Databases Pubmed, Scopus, and Embase were used employing the key search terms \"Diverticulitis\" and \"Peritoneal Lavage.\" Articles were selected according to the PRISMA guidelines and statistical analysis was undertaken. Cumulative analysis of diverticulitis recurrence and secondary outcomes of disease-related mortality, serious adverse events, stoma incidence, reoperation, and readmission rates were performed.</p><p><strong>Results: </strong>An initial search identified 506 articles for review. A total of 294 patients were included for final analysis from 3 prospective randomized controlled trials. There was no significant difference in disease-related mortality or serious adverse events between LPL and PR. There was significantly decreased likelihood of having a stoma in the LPL group; however, there was also a significantly increased likelihood of having recurrent diverticulitis. There was heterogenicity across all trials.</p><p><strong>Conclusion: </strong>There is a paucity of level 1 evidence available regarding the long-term outcomes of Hinchey III diverticulitis managed with LPL. At 3-year follow-up, there is a significantly decreased likelihood of having a stoma, tempered by the fact that there is a significantly increased likelihood of having recurrent diverticulitis. Further homogenous high-quality randomized studies are required to clarify whether LPL shows long-term benefit over PR.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"36-47"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142902716","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}