Digestive Surgery最新文献

{"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}

{"title":"The Role of Staging Laparoscopy in Stage IV Gastric Cancer Patients.","authors":"Leonardo Solaini, Federica Filippini, Daniele Marrelli, Marco Milone, Luigina Graziosi, Marco Realis Luc, Monica Gualtierotti, Silvia Sofia, Fausto Rosa, Maria Bencivenga, Sergio Alfieri, Giovanni Ferrari, Rossella Reddavid, Stefano De Pascale, Annibale Donini, Giovanni De Palma, Franco Roviello, Paolo Morgagni, Giorgio Ercolani","doi":"10.1159/000543489","DOIUrl":"10.1159/000543489","url":null,"abstract":"<p><strong>Introduction: </strong>Evidence regarding staging laparoscopy (SL) for clinical metastatic (cM+) gastric cancer (GC) patients is limited. Recently, an Italian Gastric Cancer Research Group (GIRCG) study showed SL changed peritoneal status in over 20% of cases. This study aimed to evaluate SL's role in cM+ patients and refine its indications.</p><p><strong>Methods: </strong>Clinical data of cM+ GC patients who underwent SL between 2010 and 2022 at nine GIRCG centers were retrospectively analyzed. The primary outcome was SL's yield, defined as peritoneal status changed by SL over all SLs.</p><p><strong>Results: </strong>Among 182 cM+ patients who received SL, 38 (20.9%) had SL-findings changing peritoneal status. Notably, 10.1% of cases with preoperative signs of carcinomatosis had no peritoneal disease, while 46.3% with extraperitoneal disease alone had peritoneal carcinomatosis (PC) at SL. Thirty-one patients (17.0%) underwent R0 resection: 17 (54.8%) with PC, 3 (9.7%) with liver metastases, 4 (12.9%) with PC and nodal metastases, 2 (6.4%) with lung, and 1 (3.2%) with bone metastases. Seventeen patients with suspected preoperative PC underwent curative treatment: 9 had peritoneal disease ruled out by SL, while the other 8 had limited PC, allowing R0 resection. Logistic regression revealed an inverse correlation between diffuse histotype and absence of PC at SL in patients with peritoneal involvement at imaging (p = 0.02).</p><p><strong>Conclusion: </strong>SL aids in directing cM+ GC patients to appropriate treatment, with a 20.9% yield. For those with peritoneal involvement at imaging, SL helps identify candidates for curative treatment. In patients with extraperitoneal disease, SL should be considered to assess potential radical strategies.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"77-83"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585132","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":"The Relevance of Radial Margin Status in Perihilar Cholangiocarcinoma: A State-of-the-Art Narrative Review.","authors":"Mario De Bellis, Maria Gaia Mastrosimini, Paola Capelli, Laura Alaimo, Simone Conci, Tommaso Campagnaro, Sara Pecori, Aldo Scarpa, Alfredo Guglielmi, Andrea Ruzzenente","doi":"10.1159/000535995","DOIUrl":"10.1159/000535995","url":null,"abstract":"<p><strong>Background: </strong>Prognosis of perihilar cholangiocarcinoma (PHCC) is poor, and curative-intent resection is the most effective treatment associated with long-term survival. Surgery is technically demanding since it involves a major hepatectomy with en bloc resection of the caudate lobe and extrahepatic bile duct. Furthermore, to achieve negative margins, it may be necessary to perform concomitant vascular resection or pancreatoduodenectomy. Despite this aggressive approach, recurrence is often observed, considering 5-year recurrence-free survival below 15% and 5-year overall survival that barely exceeds 40%.</p><p><strong>Summary: </strong>The literature reports that survival rates are better in patients with negative margins, and surprisingly, R0 resections range between 19% and 95%. This variability is probably due to different surgical strategies and the pathologist's expertise with specimens. In fact, a proper pathological examination of residual disease should take into consideration both the ductal and the radial margin (RM) status. Currently, detailed pathological reports are lacking, and there is a likelihood of misinterpreting residual disease status due to the missing of RM description and the utilization of various definitions for surgical margins.</p><p><strong>Key messages: </strong>The aim of PHCC surgery is to achieve negative margins including RM. More clarity in reporting on RM is needed to define true radical resection and consistent design of oncological studies for adjuvant treatments.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"92-102"},"PeriodicalIF":2.7,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140049051","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":"Liver Fibrosis Is Associated with Poorer Overall Survival and Higher Recurrence Rate in Patients with Cholangiocarcinoma.","authors":"Marcella Steffani, Ulrich Nitsche, Johanna Ollesky, Benedikt Kaufmann, Sarah Schulze, Alexander Novotny, Helmut Friess, Norbert Hüser, Christian Stoess, Daniel Hartmann","doi":"10.1159/000535733","DOIUrl":"10.1159/000535733","url":null,"abstract":"<p><strong>Introduction: </strong>Cholangiocarcinoma is the second most common primary liver tumour worldwide with an increasing incidence in recent decades. While the effects of fibrosis on hepatocellular carcinoma have been widely demonstrated, the impact on cholangiocarcinoma remains unclear. The aim of this study was to evaluate the impact of liver fibrosis on overall survival (OS) and disease-free survival (DFS) in patients who have undergone liver resection for cholangiocarcinoma.</p><p><strong>Methods: </strong>Eighty patients with cholangiocarcinoma who underwent curatively intended liver surgery between January 2007 and December 2020 were included in this retrospective single-centre study. Clinical and histopathological features were analysed. The primary endpoint was cause-specific survival. Secondary endpoints were DFS and identification of prognostic factors.</p><p><strong>Results: </strong>The present study shows that the median OS is significantly reduced in patients with fibrosis (p &lt; 0.001). The median OS in patients with fibrosis was three times shorter than in the group without fibrosis. In addition, a significantly shorter DFS was observed in patients with fibrosis (p &lt; 0.002). Multivariate analysis showed that fibrosis is the strongest independent factor with a negative impact on OS and DFS.</p><p><strong>Conclusion: </strong>Liver fibrosis has a significant impact on OS and DFS in patients with cholangiocarcinoma. Patients with known liver fibrosis require thorough perioperative care and postoperative follow-up.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"53-62"},"PeriodicalIF":2.7,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139702069","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 Frailty on Short-Term Outcomes of Hepatic Lobectomy in Patients with Intrahepatic Cholangiocarcinoma: Evidence from the US Nationwide Inpatient Sample 2005-2018.","authors":"Li Xu, Zhuo Shao, Hanchun Huang, Duo Li, Tianxiao Wang, Manar Atyah, Wenying Zhou, Zhiying Yang","doi":"10.1159/000536401","DOIUrl":"10.1159/000536401","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to evaluate associations between frailty and outcomes in patients with intrahepatic cholangiocarcinoma (ICC) undergoing hepatic lobectomy using a large, nationally representative sample.</p><p><strong>Methods: </strong>This population-based, retrospective observational study extracted the data of adults ≥20 years old with ICC undergoing hepatic lobectomy from the US Nationwide Inpatient Sample database between 2005 and 2018. Frailty was assessed by the validated Hospital Frailty Risk Score (HFRS). Associations between frailty and surgical outcomes were analyzed using logistic regression analyses.</p><p><strong>Results: </strong>After exclusions, 777 patients were enrolled, including 427 frail and 350 non-frail. Patients' mean age was 64.5 (±0.4) years and the majority were males (51.1%) and whites (76.5%). Frailty was significantly associated with increased odds of in-hospital mortality (aOR: 18.51, 95% CI: 6.70, 51.18), non-home discharge (aOR: 3.58, 95% CI: 2.26, 5.66), prolonged LOS (aOR: 5.56, 95% CI: 3.87, 7.99), perioperative cardiac arrest/stroke (aOR: 5.44, 95% CI: 1.62, 18.24), acute respiratory distress syndrome (ARDS)/respiratory failure (aOR: 3.88, 95% CI: 2.40, 6.28), tracheostomy/ventilation (aOR: 3.83, 95% CI: 2.23, 6.58), bleeding/transfusion (aOR: 1.67, 95% CI: 1.24, 2.26), acute kidney injury (AKI) (aOR: 14.37, 95% CI: 7.13, 28.99), postoperative shock (aOR: 4.44, 95% CI: 2.54, 7.74), and sepsis (aOR: 11.94, 95% CI: 6.90, 20.67).</p><p><strong>Discussion/conclusion: </strong>Among patients with ICC undergoing hepatic lobectomy, HFRS-defined frailty is a strong predictor of worse in-patient outcomes, including in-hospital death, prolonged LOS, unfavorable discharge, and complications (perioperative cardiac arrest/stroke, ARDS/respiratory failure, tracheostomy/ventilation, bleeding/transfusion, AKI, postoperative shock, and sepsis). Study results may help stratify risk in frail patients undergoing hepatic resection for ICC.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"42-52"},"PeriodicalIF":2.7,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139722049","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":"Information Needs in Patients with Potentially Curable Gastroesophageal Cancer.","authors":"Kammy Keywani, Egle Jezerskyte, Mirjam A G Sprangers, Wietse J Eshuis, Mark I Van Berge Henegouwen, Suzanne S Gisbertz","doi":"10.1159/000540439","DOIUrl":"10.1159/000540439","url":null,"abstract":"<p><strong>Introduction: </strong>Gastroesophageal cancer patients' information needs remain understudied, despite their complex treatment trajectories.</p><p><strong>Methods: </strong>This study examined the (i) information needs of patients with or without postoperative complications, (ii) information needs of male and female patients, and (iii) the association between information needs and health-related quality of life (HR-QoL) following gastroesophageal cancer surgery. Patients completed the EORTC-QLQ-INFO25, QLQ-C30, and QLQ-OG25 questionnaires before and after curative surgery. Five information needs domains were investigated: information about the disease, about treatments, about medical tests, about things patients can do to help themselves, and overall helpfulness. Additionally, HR-QoL domains global health status, eating restrictions, and anxiety were explored.</p><p><strong>Results: </strong>A total of 132 patients completed the questionnaires at baseline, 216 patients at 6-12 months, 184 patients at 18-24 months, and 163 patients at 3-5 years post-operation. There were no significant differences in information needs between patients with or without complications or between male and female patients. Patients with a higher global health status found the information more helpful at 6-12 months (p &lt; 0.001), 18-24 months (p &lt; 0.001), and 3-5 years (p &lt; 0.001) postoperatively, as did patients who experienced more anxiety at 18-24 months (p = 0.009) and 3-5 years (p &lt; 0.001).</p><p><strong>Conclusion: </strong>Gastroesophageal cancer patients, regardless of sex or postoperative complications, have consistent information needs, yet those with higher global health status and elevated anxiety levels find the information particularly helpful, emphasizing the importance of tailored communication strategies.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"122-132"},"PeriodicalIF":1.8,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11382635/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141792198","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":"Postoperative Ileus after Minimally Invasive Colorectal Surgery: A Summary of Current Strategies for Prevention and Management.","authors":"Eve K Abernethy, Emad H Aly","doi":"10.1159/000537805","DOIUrl":"10.1159/000537805","url":null,"abstract":"<p><strong>Background: </strong>Postoperative ileus (POI) is one of the most common postoperative complications after colorectal surgery and prolongs hospital stays. Minimally invasive surgery (MIS) has reduced POI, but it remains common. This review explores the current methods for preventing and managing POI after MIS.</p><p><strong>Summary: </strong>Preoperative interventions, including optimising nutrition, preoperative medicationn, and mechanical bowel preparation with oral antibiotics, may have a role in preventing POI. Transversus abdominis plane blocks and lidocaine could replace epidural analgesia in MIS. Fluid overload should be avoided; in some cases, goal-directed fluid therapy may aid in achieving this. Pharmacological agents, such as prucalopride and dexmedetomidine, could target mechanisms underlying POI. New strategies to stimulate vagal nerve activity may promote postoperative gastrointestinal motility. Preoperative bowel stimulation could potentially reduce POI following loop ileostomy closure. However, the evidence base for several interventions remains weak and requires further corroboration with robust studies.</p><p><strong>Key messages: </strong>Despite the increasing use of MIS, POI remains a major issue following colorectal surgery. Further strategies to prevent POI are rapidly emerging. Studies using standardised definitions and perioperative care will help validate these interventions and remove barriers to accurate meta-analysis. Future studies should focus on establishing the impact of these interventions on POI after MIS specifically.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"79-91"},"PeriodicalIF":2.7,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11025667/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139740620","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":"Conventional Excisional Haemorrhoidectomy versus Transanal Haemorrhoidal Dearterialization for Haemorrhoids: A Systematic Review and Meta-Analysis.","authors":"Juliana Jee, Lauren Vourneen O'Connell, Ishapreet Kaur, Shaheel Mohammad Sahebally","doi":"10.1159/000540256","DOIUrl":"10.1159/000540256","url":null,"abstract":"<p><strong>Introduction: </strong>Although effective, conventional excisional haemorrhoidectomy (CEH) is associated with significant postoperative pain. Novel techniques such as transanal haemorrhoidal dearterialization (THD) are suggested to reduce pain but may result in higher recurrence rates. We aimed to compare short- and long-term outcomes of CEH and THD in the present meta-analysis.</p><p><strong>Methods: </strong>A PRISMA-compliant meta-analysis was performed, searching PubMed, Embase, and CENTRAL databases for randomised controlled trials (RCTs) from 1995 to December 2022. The primary objective was recurrence. Secondary objectives included complication rates, length of stay (LOS), operative time, and time to return to baseline. Random-effects models were used to calculate pooled effect size estimates. Subgroup analysis was also performed.</p><p><strong>Results: </strong>A total of 6 RCTs encompassing 465 patients were captured. There were 142 (59%) males in the CEH group and 129 (54%) in the THD group. On random-effects analysis, THD had a higher recurrence rate (odds ratio = 2.76, 95% confidence interval [CI] = 1.03-7.38, p = 0.04) albeit a shorter return to baseline compared to CEH (mean difference = -14.05 days, 95% CI = -20.38 to -7.72, p &lt; 0.0001). There were no differences in bleeding (p = 0.12), urinary retention (p = 0.97), incontinence (p = 0.41), anal stenosis (p = 0.19), thrombosed residual haemorrhoids (p = 0.16), operating time (p = 0.19), or LOS (p = 0.22). Results remained similar on subgroup analysis.</p><p><strong>Conclusions: </strong>CEH is associated with lower recurrence but similar complication rates to THD, although patients take longer to return to baseline function postoperatively.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"204-212"},"PeriodicalIF":1.8,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141859329","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":"Early Identification of Patients with Potential Failure of Nonoperative Management for Gastroduodenal Peptic Ulcer Perforation.","authors":"Toshimichi Kobayashi, Satoshi Tabuchi, Itsuki Koganezawa, Masashi Nakagawa, Kei Yokozuka, Shigeto Ochiai, Takahiro Gunji, Yosuke Ozawa, Toru Sano, Koichi Tomita, Naokazu Chiba, Eiji Hidaka, Shigeyuki Kawachi","doi":"10.1159/000535520","DOIUrl":"10.1159/000535520","url":null,"abstract":"<p><strong>Introduction: </strong>We aimed to identify objective factors associated with failure of nonoperative management (NOM) of gastroduodenal peptic ulcer perforation (GDUP) and establish a scoring model for early identification of patients in whom NOM of GDUP may fail.</p><p><strong>Methods: </strong>A total of 71 patients with GDUP were divided into NOM (cases of NOM success) and operation groups (cases requiring emergency operation or conversion from NOM to operation). Using logistic regression analysis, a scoring model was established based on the independent factors. The patients were stratified into low-risk and high-risk groups according to the scores.</p><p><strong>Results: </strong>Of the 71 patients, 18 and 53 were in the NOM and operation groups, respectively. Ascites in the pelvic cavity on computed tomography (CT) and sequential organ failure assessment (SOFA) score at admission were identified as independent factors for NOM failure. The scoring model was established based on the presence of ascites in the pelvic cavity on CT and SOFA score ≥2 at admission. The operation rates for GDUP were 28.6% and 86.0% in the low-risk (score, 0) and high-risk groups (scores, 2 and 4), respectively.</p><p><strong>Conclusion: </strong>Our scoring model may help determine NOM failure or success in patients with GDUP and make decisions regarding initial treatment.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"24-29"},"PeriodicalIF":2.7,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138440449","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}