Digestive Surgery最新文献

{"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":"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":"192-203"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","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":"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":"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":"174-184"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","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":"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}

{"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":"97-104"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","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":"Current Practice in the Treatment of Colorectal Liver Metastases by Irreversible Electroporation: An International Questionnaire Survey (LIVERMET-IRE-Q).","authors":"Harry V M Spiers, Saurabh Jamdar, Santhalingam Jegatheeswaran, Nicola De Liguori Carino, Panagiotis Stathakis, Vinotha Nadarajah, Krishna V Menon, Sanjay Pandanaboyana, Adam E Frampton, Tze Min Wah, Shahid Farid, Hassan Z Malik, Robert P Jones, Jonathan Evans, Ajith K Siriwardena","doi":"10.1159/000543634","DOIUrl":"10.1159/000543634","url":null,"abstract":"<p><strong>Introduction: </strong>Irreversible electroporation (IRE) is a form of non-thermal ablation that delivers pulses of high-voltage electric current between electrodes. Although IRE has been demonstrated to achieve tumor necrosis, its role in the treatment of colorectal hepatic metastases is unestablished. This study is an international questionnaire survey on the use of IRE for patients with colorectal hepatic metastases.</p><p><strong>Methods: </strong>A questionnaire addressing views on the use of IRE for colorectal liver metastases was circulated to clinicians with an interest and/or expertise in this technique. The questionnaire addressed indications for the use of IRE in a range of scenarios: methods of use, assessment of treatment response, and outcome.</p><p><strong>Results: </strong>64 clinicians from 17 different countries replied to the questionnaire. The preferred mode of delivery of IRE was percutaneous treatment under computed tomographic guidance. Thirty-three (70% of 47 respondents) used IRE exclusively for lesions in proximity to inflow or outflow structures. Twenty (43% respondents) used IRE as their sole ablative treatment, while 19 (40% of 47 respondents) used IRE in combination with thermal ablation. The maximum number of lesions that could be treated by IRE was two and the preferred size of lesion was <3 cm.</p><p><strong>Conclusion: </strong>Respondents to this international questionnaire survey indicate that IRE is an acceptable ablative option for small colorectal liver metastases (<3 m in diameter) close to inflow/outflow structures.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"116-126"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143982983","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 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}