Journal of Gastrointestinal Surgery最新文献

{"title":"Tips for creating the ideal gastric conduit","authors":"Carolina Garcia, Ziad T. Awad","doi":"10.1016/j.gassur.2024.101927","DOIUrl":"10.1016/j.gassur.2024.101927","url":null,"abstract":"","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 2","pages":"Article 101927"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818321","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 impact of fellowship training on current practice patterns and the job market: a survey of Fellowship Council graduates","authors":"Michael Jureller ,&nbsp;D. Rohan Jeyarajah ,&nbsp;Imran Hassan ,&nbsp;Maria S. Altieri ,&nbsp;On behalf of the Society for Surgery of the Alimentary Tract Complex Gastrointestinal Fellowship Committee","doi":"10.1016/j.gassur.2024.101893","DOIUrl":"10.1016/j.gassur.2024.101893","url":null,"abstract":"<div><h3>Background</h3><div>General surgery has changed significantly over the last decades, with the need for advanced training and expertise. The Fellowship Council (FC) accredits fellowships that train approximately 200 fellows annually. This study aimed to analyze FC graduates’ perceptions of training, current practices, and the job market.</div></div><div><h3>Methods</h3><div>Data were collected between May 2022 and June 2022 via a survey (SurveyMonkey; Momentive Inc) distributed via email to 2119 previous FC graduates from 2012 to 2021.</div></div><div><h3>Results</h3><div>There were 257 respondents. However, less than half of the respondents (47%) came from surgeons within the first 3 years after training. Of the respondents, 38% had advanced gastrointestinal (GI) minimally invasive surgery (MIS) training, 26% had bariatric surgery training, 14% had foregut surgery training, and the remaining 22% had hepatobiliary, advanced/complex GI, advanced endoscopy, and colorectal surgery training. Most respondents performed acute care surgery (ACS) as part of their training. Of note, 75% of respondents take ACS call, and 55% of respondents do not perform some operations that they trained in during their fellowship. More than 60% of surgeons had difficulty securing employment.</div></div><div><h3>Conclusion</h3><div>Despite niche training, there exists a demand for ACS care. There may be an underutilization of advanced training, or this may reflect how surgeons enter practice and gain experience. The challenge in obtaining employment may be due to the saturation of the market, selectivity of the applicants, or hiring challenges during the COVID-19 pandemic. Most surgeons who undertook FC training practice surgery within their domains of training and with some components of ACS. Despite the desire to hire fellowship-trained surgeons, most FC graduates experience difficulty securing employment.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 2","pages":"Article 101893"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818316","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":"A systematic review and meta-analysis of factors associated with esophageal stent migration and a comparison of antimigration techniques","authors":"Olivia Heutlinger ,&nbsp;Nischal Acharya ,&nbsp;Sohrab Kharabaf ,&nbsp;Nisha Acharya ,&nbsp;Samantha Perez-Menendez ,&nbsp;Kate Kirby ,&nbsp;Brian Smith ,&nbsp;Ninh T. Nguyen","doi":"10.1016/j.gassur.2025.101977","DOIUrl":"10.1016/j.gassur.2025.101977","url":null,"abstract":"<div><h3>Background</h3><div>Esophageal stents are effective in managing various pathologies. However, they are limited by their most common complication: migration. This study aimed to present the largest comprehensive review of the risk factors associated with stent migration and the interventions leveraged to prevent stent migration.</div></div><div><h3>Methods</h3><div>A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The inclusion criteria were primary data sources (no systematic reviews), ≥18 years of age, esophageal stent placement, and reported indication for intervention, site of placement, and migration rate. A total of 162 studies met the inclusion criteria. Proportions experiencing migration were pooled using a random-effects model with a DerSimonian-Laird estimator to account for potential heterogeneity, and forest plots were used to visualize the treatment effects across studies.</div></div><div><h3>Results</h3><div>A total of 14,092 patients were included in the analysis. The mean migration rate across all studies and stent types was 17.2%, and the mean reintervention rate was 83.2%. Cancerous indications, benign strictures, history of esophageal surgery, stent diameter of &lt;20 mm, plastic stents, and fully covered stents were associated with significantly higher migration rates. There was a trend toward stents using antimigration technology having lower migration rates (effect size [ES] = 0.15; 95% CI, 0.10–0.20) than those that did not (ES = 0.33; 95% CI, 0.18–0.48). However, this difference was not significant. There were no statistically significant differences among the stent fixation strategies (clips, sutures, wire hooks, and Shim technique).</div></div><div><h3>Conclusion</h3><div>Several risk factors are associated with stent migration. However, no currently available solutions can significantly reduce stent migration. Further optimization of these devices or the creation of new technology to prevent migration is required.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 4","pages":"Article 101977"},"PeriodicalIF":2.2,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074727","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":"Anatomical insights into Rouviere’s Sulcus through the Glissonean approach in minimally invasive right-sided sepatectomy","authors":"Sung Chun Cho ,&nbsp;Ji Hoon Kim","doi":"10.1016/j.gassur.2025.101981","DOIUrl":"10.1016/j.gassur.2025.101981","url":null,"abstract":"<div><h3>Background</h3><div>Understanding the liver anatomy, particularly the Rouviere sulcus (RS), is crucial for safely performing cholecystectomy and hepatectomy. As surgical interest in right-sided hepatectomies using the Glissonean pedicle approach has increased, a thorough understanding of the RS anatomy is becoming increasingly important. This study aimed to investigate the presence and anatomical contents of the RS during right-sided hepatectomy and to develop a preoperative assessment method to improve surgical safety and precision.</div></div><div><h3>Methods</h3><div>Patients who underwent laparoscopic or robotic right-sided hepatectomy with RS dissection were included in the study. The RS was categorized into open and closed types, and its contents were examined to identify the presence of Glissonean pedicles. The findings were compared with simulations generated from 3-dimensional reconstruction imaging for further analysis.</div></div><div><h3>Results</h3><div>Of the 83 patients, 62 (74.7%) had open-type RS, and 21 (25.3%) had closed-type RS. Among the open-type RS cases, 38 patients (61.3%) involved the right posterior Glissonean pedicle within the RS, whereas 19 patients (30.7%) involved segment 6 Glissonean pedicle. Preoperative imaging revealed that when the right posterior Glissonean pedicle did not form a common trunk with segments 6 and 7, the Glissonean pedicle of segment 6 was located within the RS. The variation observed in 5 cases (8.1%) with the right main Glissonean pedicle in the RS was significant and should be carefully considered during surgery.</div></div><div><h3>Conclusion</h3><div>A thorough understanding of the RS anatomy is essential for safe and precise right-sided hepatectomy. Our findings emphasize the variability of RS, particularly concerning the presence of different Glissonean pedicles, including the right posterior segment 6 and, in rare cases, the right main Glissonean pedicle. Our findings highlight the necessity for individualized preoperative imaging and careful consideration of anatomical variations to minimize complications during right-sided hepatectomy.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 4","pages":"Article 101981"},"PeriodicalIF":2.2,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143073206","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":"Invited commentary: human effluvia, microbiome-based biomarkers and cancer screening","authors":"John C. Alverdy","doi":"10.1016/j.gassur.2025.101976","DOIUrl":"10.1016/j.gassur.2025.101976","url":null,"abstract":"","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 4","pages":"Article 101976"},"PeriodicalIF":2.2,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143073207","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":"Achieving textbook outcomes with robotic-assisted Ivor Lewis esophagectomy: a single-center experience with 150 consecutive patients","authors":"Moshim Kukar ,&nbsp;Faisal Jehan ,&nbsp;Maureen Brady ,&nbsp;Kristopher Attwood ,&nbsp;Steven N. Hochwald","doi":"10.1016/j.gassur.2025.101979","DOIUrl":"10.1016/j.gassur.2025.101979","url":null,"abstract":"<div><h3>Background</h3><div>With published randomized data, minimally invasive esophagectomy (MIE) has become increasingly popular. However, substantial variability in techniques and outcomes still exists.</div></div><div><h3>Methods</h3><div>This was a retrospective analysis of 150 consecutive robotic-assisted MIEs (RAMIEs) from a prospectively maintained database from 2020 to 2024 at a single comprehensive cancer center. This study aimed to evaluate the textbook outcome rates after RAMIE.</div></div><div><h3>Results</h3><div>A total of 150 consecutive patients underwent RAMIE from 2020 to 2024. Tumor location included the esophagus in 18 patients, type 1 gastroesophageal junction (GEJ) in 52 patients, type 2 GEJ in 71 patients, and type 3 GEJ in 9 patients. Most patients had clinical stage T3 tumors. Neoadjuvant therapy was used in 85% of the patients. A complete pathologic response was observed in 27% of patients. The median number of lymph nodes retrieved was 21. Anastomotic leak occurred in 2 patients, none of whom required reoperation. The median hospital stay duration was 7 days. The 30- and 90-day mortality rates were 0.7% and 1.3%, respectively. In addition, the 90-day stricture rate after endoscopic dilation was 0.7%. Of note, 90% of patients had a textbook outcome.</div></div><div><h3>Conclusion</h3><div>This single-center experience highlights that the combination of a robotic platform and a side-to-side stapled anastomotic technique helps achieve exceptional postoperative outcomes for MIE, with a textbook outcome rate of 90%. With the increasing worldwide adoption of MIE, this seems to be an appropriate time to standardize operative techniques to optimize postoperative outcomes.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 4","pages":"Article 101979"},"PeriodicalIF":2.2,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074729","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":"Clinical features of abdominal immunoglobulin A vasculitis in adults: a single-center retrospective study","authors":"Zi-Ping Cai ,&nbsp;Hong-Yang Wu ,&nbsp;Shun Xu ,&nbsp;Wei Liu","doi":"10.1016/j.gassur.2025.101975","DOIUrl":"10.1016/j.gassur.2025.101975","url":null,"abstract":"","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 4","pages":"Article 101975"},"PeriodicalIF":2.2,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065768","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":"Cluster analysis of hepatocellular carcinoma prognosis using preoperative alpha-fetoprotein and des-gamma-carboxy prothrombin levels: a multi-institutional study","authors":"Yoshitaka Saegusa ,&nbsp;Yuki Imaoka ,&nbsp;Masahiro Ohira ,&nbsp;Tsuyoshi Kobayashi ,&nbsp;Naruhiko Honmyo ,&nbsp;Michinori Hamaoka ,&nbsp;Takashi Onoe ,&nbsp;Daisuke Takei ,&nbsp;Koichi Oishi ,&nbsp;Tomoyuki Abe ,&nbsp;Toshihiro Nakayama ,&nbsp;Miho Akabane ,&nbsp;Kazunari Sasaki ,&nbsp;Hideki Ohdan ,&nbsp;Hiroshima Surgical Study Group of Clinical Oncology","doi":"10.1016/j.gassur.2025.101980","DOIUrl":"10.1016/j.gassur.2025.101980","url":null,"abstract":"<div><h3>Background</h3><div>Hepatocellular carcinoma (HCC) remains the leading cause of cancer-related mortality worldwide and is characterized by high recurrence rates after curative resection. The tumor markers des-gamma-carboxy prothrombin (DCP) and alpha-fetoprotein (AFP) are crucial for HCC diagnosis and prognosis. However, their roles in the modern era of HCC epidemiology require reevaluation.</div></div><div><h3>Methods</h3><div>This multi-institutional retrospective study analyzed 1515 patients who underwent hepatectomy for primary HCC. Patients were classified into 4 clusters using k-means analysis based on preoperative DCP and AFP levels. Clinicopathologic characteristics, overall survival (OS), and recurrence rate (RR) were evaluated using Cox proportional hazards models and area under the receiver operating characteristic curve (AUROC) comparisons.</div></div><div><h3>Results</h3><div>Cluster 3 (concurrent elevations of DCP and AFP) had the poorest 5-year OS (52.8%) and the highest RR (79.3%), whereas cluster 4 (low levels of both markers) had the most favorable outcomes, with a 5-year OS rate of 71.5% and an RR of 55.7%. Cluster 1 (elevated DCP alone) was associated with larger tumors (median of 45 mm) and more frequent vascular invasion (43%) than cluster 2 (elevated AFP alone, median tumor size of 24 mm, and vascular invasion of 36%). DCP was a stronger predictor of 5-year OS in patients with preserved liver function (AUROC, 0.63), whereas AFP was more effective in stratifying RR in patients with impaired liver function (AUROC, 0.57). Non-B, non-C hepatitis (NBNC)-related HCC exhibited a distinct biomarker profile, with an elevated DCP level correlating with a higher 5-year RR (67%) than other etiologies.</div></div><div><h3>Conclusion</h3><div>Our study introduces tumor marker clustering as a novel analytical approach, providing a nuanced understanding of AFP and DCP’s combined utility in predicting prognosis and recurrence. Our findings highlight the independent and complementary roles of these biomarkers, particularly in NBNC-related HCC and in cases with impaired liver function. AFP and DCP remain crucial tools for recurrence risk assessment, guiding personalized management strategies, such as surveillance, neoadjuvant therapies, and tailored postoperative interventions.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 4","pages":"Article 101980"},"PeriodicalIF":2.2,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065783","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":"Cystic echinococcosis of the liver","authors":"Hassan Aziz ,&nbsp;Peyton Seda ,&nbsp;Yashant Aswani ,&nbsp;Matthew D. Gosse ,&nbsp;Aparna Joshi Krishnakumari ,&nbsp;Timothy M. Pawlik","doi":"10.1016/j.gassur.2025.101974","DOIUrl":"10.1016/j.gassur.2025.101974","url":null,"abstract":"<div><h3>Background</h3><div>Cystic echinococcosis (CE) is a widely endemic helminthic disease caused by infection with metacestodes (larval stage) of the <em>Echinococcus granulosus</em> tapeworm, which is transmitted by dogs and found on every continent, except Antarctica. This study aimed to review the life cycle, epidemiology, symptoms, diagnostic methods, and treatment of <em>E granulosus</em> infection of the liver.</div></div><div><h3>Methods</h3><div>A comprehensive review was conducted using MEDLINE/PubMed, Google Scholar, Cochrane Library, and the Web of Science, which were accessed between 1990 and 2024. The main search focused on “CE of the liver.” The following terms were used: cystic echinococcosis, hydatidosis, <em>E granulosus</em>, echinococcus life cycle, liver cyst, albendazole, liver resection, pericystectomy, cystobiliary fistula, and percutaneous aspiration injection and reaspiration (PAIR).</div></div><div><h3>Results</h3><div>CE should be considered in the differential diagnosis of hepatic cysts, especially among individuals with risk factors, such as those who have traveled to or immigrated from areas with a high prevalence. Echinococcus species require 2 hosts to complete their life cycle, with humans acting as intermediate hosts that become infected by ingesting eggs from contaminated environments, leading to cyst formation, typically in the liver or lungs. Symptoms are based on cyst size and location, such as abdominal pain, jaundice, respiratory distress, or neurologic deficits, and can lead to severe complications, such as cyst rupture, allergic reactions, sepsis, or secondary hydatidosis. Imaging plays a key role in evaluating cyst stage, size, location, and potential complications and in determining the appropriateness of a minimally invasive PAIR procedure. Although serum antibody tests typically have a low sensitivity, antigen assays or recombinant proteins may provide useful diagnostic information. For uncomplicated active cysts, the treatment options include chemotherapy alone or in combination with the PAIR technique.</div></div><div><h3>Conclusion</h3><div>Hepatic echinococcal cysts, which are relatively rare in North America, should be considered in the differential diagnosis of hepatic cysts, especially in individuals with risk factors.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 3","pages":"Article 101974"},"PeriodicalIF":2.2,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046911","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":"Foramen of Winslow hernia initially diagnosed as cecal volvulus","authors":"Bryan Chen ,&nbsp;Matthew Morris ,&nbsp;Michael Jureller","doi":"10.1016/j.gassur.2025.101973","DOIUrl":"10.1016/j.gassur.2025.101973","url":null,"abstract":"","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 4","pages":"Article 101973"},"PeriodicalIF":2.2,"publicationDate":"2025-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143059233","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}