Updates in SurgeryPub Date : 2024-12-01Epub Date: 2024-09-06DOI: 10.1007/s13304-024-01975-4
Louise Almkvist, Ulf Gunnarsson, Karin Strigård
{"title":"Urgency an important factor when assessing fecal incontinence.","authors":"Louise Almkvist, Ulf Gunnarsson, Karin Strigård","doi":"10.1007/s13304-024-01975-4","DOIUrl":"10.1007/s13304-024-01975-4","url":null,"abstract":"<p><p>The aim of this study was to investigate if Low Anterior Resection Syndrome (LARS) score contributed with complementary information to Wexner score when assessing fecal incontinence (FI). The hypothesis was that LARS score would be likely to provide complementary information to Wexner score in the assessment of FI regardless of etiology. LARS score has been used as a complement to traditional scoring systems to assess bowel dysfunction, targeting FI among patients after radical cystectomy, in women with endometriosis, and in colorectal cancer patients. Wexner score as a single tool does not address the complexity of FI and urgency, a disabling symptom. A retrospective cohort study at a surgical outpatient clinic included patients diagnosed with FI who answered LARS and Wexner scores questionnaires at their first visit to the clinic between 1st January 2015 and 31st December 2018. Kendall's tau, Spearman rank correlation, Cohen's kappa, and scatterplots were analyzed for participants and specific subgroups to assess any correlation and agreement between answers to the two scoring systems. One hundred nineteen patients met the inclusion criteria, one hundred eight women and eleven men. Kendall's tau ranged from 0.32 to 0.39, indicating lack of correlation. Correlation coefficients using Spearman rank ranged from 0.36 to 0.55, i.e., only fair to moderate correlation. Kappa was 0.21-0.28, i.e., only slight to fair agreement. Distribution of LARS and Wexner scores in the scatterplot showed wide variability and lack of agreement. Combined use of both the Wexner and LARS scores provided complimentary information, and thus a more complete mapping of FI as well as taking all entities in consideration.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"2805-2811"},"PeriodicalIF":2.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11628434/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141220","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}
Updates in SurgeryPub Date : 2024-12-01Epub Date: 2024-09-21DOI: 10.1007/s13304-024-01986-1
Hany Hasan Elsayed, Hazem Youssef Sharkawy, Mohammed Attia Ahmed, Mohammed Abdel-Gayed, Mostafa Eldewer
{"title":"Effect of intraoperative hyperthermic intrathoracic chemotherapy after pleurectomy decortication for treatment of malignant pleural mesothelioma: a comparative study.","authors":"Hany Hasan Elsayed, Hazem Youssef Sharkawy, Mohammed Attia Ahmed, Mohammed Abdel-Gayed, Mostafa Eldewer","doi":"10.1007/s13304-024-01986-1","DOIUrl":"10.1007/s13304-024-01986-1","url":null,"abstract":"<p><p>Malignant pleural mesothelioma (MPM) is an aggressive malignancy with few long-term survivors. Despite the dismal prognosis, hyperthermic intrathoracic chemoperfusion (HITOC) was shown to improve survival in a selective group of patients. We analyzed the influence of HITOC following pleurectomy and decortication on postoperative morbidity and overall survival for patients suffering from localized mesothelioma. From March 2017 until August 2023, 55 patients with localized pleural mesothelioma underwent pleurectomy and decortication. Thirty patients performed only surgery while 25 consecutive patients had surgery followed by HITOC with cisplatin (125 mg/m<sup>2</sup>) infused for 70 min at a temp of 40-43 °C. We analyzed postoperative morbidity, HITOC-related complications, and the influence of HITOC on survival. The trial was registered on 19/08/2022 as NCT05508555. The HITOC group had a mean age of 53.1 ± 8.2 years while the surgery group (non-HITOC) had a mean age of 52.1 ± 8.6 years. The HITOC group had 17 (68%) men, whereas the surgery group included 18 (60%) males. The 30-day mortality in the HITOC group was 0% vs 1 case (3.3%) in the surgery group. HITOC-related transient complications occurred in 4/25 (16%) of the HITOC group (atrial fibrillation, renal impairment and transient hypotension). Progression-free survival in the HITOC group was 8 months (95% CI 4.3-11.6) vs 6 months (95% CI 2.5-9.9) in the surgery-only group (p = 0.79). The overall survival time in the HITOC group was 28 months (95% CI 21.5-34.5) vs 22 months (95% CI 17.5-26.5) in the surgery-only group (p = 0.75). Risk factors analysis for recurrence in the HITOC group confirmed a significant role for early stages (p = 0.03). HITOC following pleurectomy and decortication is a safe therapeutic option that may improve survival for selected patients with localized epithelial pleural mesothelioma. Patients with earlier-stage mesothelioma are more likely to benefit from radical surgery and HITOC.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"2893-2901"},"PeriodicalIF":2.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11628442/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142296538","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}
Updates in SurgeryPub Date : 2024-12-01Epub Date: 2024-10-01DOI: 10.1007/s13304-024-02016-w
Xi Wang, Xinqun Chai, Ruiya Tang, Yunjie Xu, Qinjunjie Chen
{"title":"Comparison of laparoscopic hepatectomy and radiofrequency ablation for small hepatocellular carcinoma patients: a SEER population-based propensity score matching study.","authors":"Xi Wang, Xinqun Chai, Ruiya Tang, Yunjie Xu, Qinjunjie Chen","doi":"10.1007/s13304-024-02016-w","DOIUrl":"10.1007/s13304-024-02016-w","url":null,"abstract":"<p><p>This study was designed to compare the efficacy of laparoscopic hepatectomy (LH) and radiofrequency ablation (RFA) in terms of their therapeutic effect on small hepatocellular carcinoma (SHCC). The SEER database was employed to integrate SHCC patients who had received treatment with either LH (n = 1132) or RFA (n = 797). The LH group (n = 623) and the RFA group (n = 623) were matched with 1:1 propensity score matching (PSM) in order to reduce the possibility of selection bias. The Kaplan-Meier method and Cox proportional hazards regression method were employed to ascertain the prognostic factors associated with overall survival (OS) and disease-specific survival (DSS). Both before and after PSM, the 1, 3 and 5-years OS and DSS were significantly higher in the LH groups compared to the RFA group. Besides, for SHCC with tumor size ≤ 2cm (n = 418), even P values not reaching statistical significance, the survival curves were compatible with a superiority of LH over RFA for OS and DSS in overall (P = 0.054 and P = 0.077), primary SHCC (P = 0.110 and P = 0.058) and recurrent SHCC (P = 0.068 and P = 1.000) cohorts. In contrast, for SHCC with tumor size between 2 and 3 cm (n = 828), LH group always had a better OS and DSS in the all cohorts (all P < 0.05). In addition, higher AFP level, poor differentiation grade, recurrent tumor and treatment type were independent prognostic factors for OS, while poor differentiation grade, larger tumor size and treatment type were the independent prognostic factors for DSS (all P < 0.05). LH was associated with better OS and DSS than RFA in SHCC patients. Even in tumor size ≤ 2 cm, LH still should be the first choice as its long-term survival benefits.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"2755-2766"},"PeriodicalIF":2.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11628577/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142362159","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":"Pseudoangiomatous stromal hyperplasia (PASH) of the breast: A case series.","authors":"Eduardo Spina, Emanuela Esposito, Claudio Siani, Valeria Varone, Gerardo Ferrara, Raimondo di Giacomo","doi":"10.1007/s13304-024-02013-z","DOIUrl":"10.1007/s13304-024-02013-z","url":null,"abstract":"<p><p>Pseudoangiomatous stromal hyperplasia (PASH) is a benign mesenchymal proliferative lesion of the breast. In 2005, only 109 cases have been reported since its initial description in 1986 by Vuitch et al. when it presented in one patient as a palpable breast mass. We retrospectively reviewed data from 2020 to 2023 of patients diagnosed with PASH by surgical excision. Our 13 cases represent one of the most numerous reported from a single institution. All histologic specimens were examined by a single pathologist. All patients had breast masses on imaging or were clinically evident. Eleven of the patients (84.6%) were diagnosed by surgical excision, whilst only two (15.4%) were diagnosed by core needle biopsy. Imaging revealed no strongly distinctive features for PASH. The age of the patients ranged from 25 to 68 years. All but one of the women were premenopausal at the time of diagnosis. This study suggests that PASH is a lesion whose diagnosis is often incidental and the recommended treatment is more commonly surgical.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"2953-2959"},"PeriodicalIF":2.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11628433/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142372981","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":"Normalization of WISP1 circulating level and tissue expression following metabolic and bariatric surgery using rat model.","authors":"Fidele Kakule Kitaghenda, Jian Wang, Tianci Li, Jian Hong, Libin Yao, Xiaocheng Zhu","doi":"10.1007/s13304-024-01977-2","DOIUrl":"10.1007/s13304-024-01977-2","url":null,"abstract":"<p><p>Wingless-type inducible signaling pathway protein-1 (WISP1) is a newly recognized adipokine, associated with obesity and type 2 diabetes (T2DM). This study aimed to investigate the effect of metabolic and bariatric surgery (MBS) on WISP1 circulating (serum) levels and tissue expression using rat models. We initially investigated whether WISP1 circulating levels were altered between the T2DM and normal rats. After confirmation, Sprague-Dawley (SD) rats were obtained and randomly divided as follows: Roux-en-Y gastric bypass (RYGB) group (n = 10), sleeve gastrectomy (SG) group (n = 10), SHAM group (n = 10), and normal control (NC) group (n = 10). Rats were followed for 8 weeks postoperatively. Preoperative and postoperative WISP1 circulating (serum) levels, glucose tolerance test (OGTT), insulin tolerance test (ITT), postoperative WISP1 expression (visceral adipose tissue, VAT; and skeletal muscle, SM), body weight, food intake, and fasting blood glucose levels were recorded. MBS significantly induced glucose control and weight loss. At postoperative week 8, WISP1 serum levels decreased in the MBS groups (P < 0.05); furthermore, WISP1 expression in VAT and SM significantly decreased in the RYGB and SG groups than SHAM (P < 0.05, and P < 0.05, respectively). Whereas the difference in the expression level between SG and RYGB did not amount to statistical significance (P > 0.05). MBS significantly decreased WISP1 serum levels, tissue expression in the VAT, and SM. As WISP1 is a regulator of low-grade inflammation associated with obesity and T2DM, further studies are needed to explore its relevance in MBS.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"2841-2849"},"PeriodicalIF":2.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142475855","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}
Updates in SurgeryPub Date : 2024-12-01Epub Date: 2024-05-26DOI: 10.1007/s13304-024-01888-2
Adam Abu-Abeid, Noa Gosher, Mati Shnell, Sigal Fishman, Andrei Keidar, Guy Lahat, Shai Meron Eldar
{"title":"Revision of restrictive bariatric procedures in elderly patients: results at a 5-year follow-up.","authors":"Adam Abu-Abeid, Noa Gosher, Mati Shnell, Sigal Fishman, Andrei Keidar, Guy Lahat, Shai Meron Eldar","doi":"10.1007/s13304-024-01888-2","DOIUrl":"10.1007/s13304-024-01888-2","url":null,"abstract":"<p><p>Revisional Bariatric Surgery (RBS) is increasing in popularity. Elderly patients (> 65 years old) are sometimes referred for RBS evaluation. The aim of this study is to evaluate outcomes of elderly patients undergoing RBS. A retrospective analysis of a cohort from a single-tertiary bariatric center. All elderly patients undergoing RBS after restrictive procedures between 2012 and 2022 were included. Thirty Nine patients undergoing RBS were included in the comparative analysis - 23 patients (57.5%) after adjustable gastric banding (s/p LAGB) and 16 patients (40%) after Sleeve Gastrectomy (s/p SG). The mean age and body mass index (BMI) of patients were comparable (67.2 ± 2.8 years and 38.3 ± 7.4, respectively). There was no difference in associated medical problems except reflux which was higher in s/p SG (68% vs. 13%; p < 0.001). The mean time interval between surgeries was 8.7 ± 5.1 years. The surgeries included One anastomosis gastric bypass (n = 22), SG (n = 8) and Roux-en-y gastric bypass (n = 9). Early major complication rates were comparable (4.3% and 12.5%; p = 0.36), and readmission rate was higher in patients s/p SG (p = 0.03). Ninety percent of patients were available to a follow-up of 59.8 months. The mean BMI and total weight loss was 29.2 and 20.3%, respectively with no difference between groups. The rate of patients with associated medical problems at last follow-up was significantly reduced. Five patients (12.5%) underwent revisional surgery due to complications during follow-up. In conclusion, RBS in the elderly is associated with a reasonable complication rate and is effective in terms of weight loss and improvement of associated medical problems in a 5-year follow-up.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"2825-2831"},"PeriodicalIF":2.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11628429/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141155670","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}
Updates in SurgeryPub Date : 2024-12-01Epub Date: 2024-09-07DOI: 10.1007/s13304-024-01980-7
Maximilian Mahrhofer, Christoph Wallner, Raphael Reichert, Frederic Fierdel, Mattia Nolli, Maiwand Sidiq, Thomas Schoeller, Laurenz Weitgasser
{"title":"\"Identifying complication risk factors in reduction mammaplasty: a single-center analysis of 1021 patients applying machine learning methods\".","authors":"Maximilian Mahrhofer, Christoph Wallner, Raphael Reichert, Frederic Fierdel, Mattia Nolli, Maiwand Sidiq, Thomas Schoeller, Laurenz Weitgasser","doi":"10.1007/s13304-024-01980-7","DOIUrl":"10.1007/s13304-024-01980-7","url":null,"abstract":"<p><p>Various surgical approaches and pedicles have been described to ensure safe and satisfactory results in reduction mammaplasty. Although different breasts require different techniques, complications are common. This study aims to assess the incidence of complications following primary bilateral reduction mammaplasties across a diverse range of pedicle methods within one of the largest single-center cohorts to date, utilizing machine learning methodologies. A retrospective review of primary bilateral reduction mammaplasties at a single surgical center between January 2016 and March 2020 was performed. Patient medical records and surgical details were reviewed. Complications were compared among three different pedicles. Binary recursive partitioning (CART) machine learning was employed to identify risk factors. In total, 1021 patients (2142 breasts) met the inclusion criteria. The superomedial pedicle was the most frequently utilized (48.0%), with an overall complication rate of 21%. While pedicle-based subgroups demonstrated significant demographic variance, overall complication rates differed most between the inferior (24.9%) and the superomedial pedicle (17.7%). Statistical analysis identified resection weight as the sole significant independent risk factor (OR 1.001, p = 0.007). The machine learning model revealed that total resection weights exceeding 1700 g significantly increased the risk of overall complications, while a sternal notch to nipple (SNN)-distance > 36.5 cm correlated with complications involving the nipple-areola complex (NAC). Higher resection weights are associated with elevated complication rates. Preoperative assessment utilizing SNN-distance can aid in predicting NAC complications.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"2943-2952"},"PeriodicalIF":2.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146407","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}
Updates in SurgeryPub Date : 2024-12-01Epub Date: 2024-10-05DOI: 10.1007/s13304-024-02001-3
Anas Alzahrani, Nawaf Alhindi, Sultan Alotaibi, Khalid Alzibali, Abdullah Ali Alaqla, Saleh Alzahrani, Iram Mamdouh Alsallat, Mohammed Ghunaim, Mohammed Alharthi
{"title":"A systematic review and meta-analysis of randomized controlled trials for the management of ventral hernia: biologic versus synthetic mesh.","authors":"Anas Alzahrani, Nawaf Alhindi, Sultan Alotaibi, Khalid Alzibali, Abdullah Ali Alaqla, Saleh Alzahrani, Iram Mamdouh Alsallat, Mohammed Ghunaim, Mohammed Alharthi","doi":"10.1007/s13304-024-02001-3","DOIUrl":"10.1007/s13304-024-02001-3","url":null,"abstract":"<p><p>An abdominal wall hernia near the location of a prior surgical incision is referred to as an incisional hernia. A midline incisional hernia is the most prevalent form. The management of incisional hernia includes many options, from conservative to surgical. The surgeon might consider using a synthetic or biological mesh when discussing surgical options with patients. Our aim through this study is to comprehensively compare synthetic and biological mesh in terms of complication and infection rates for managing elective incisional hernia. This systematic review was designed and conducted using PRISMA guidelines. The literature was systematically searched in January 2023 using the following databases: MEDLINE, Cochrane, and EMBASE. Among the terms used to aid the search were the following: incisional hernia, ventral hernia, ventral herniorrhaphy, biologic mesh, polypropylene mesh, absorbable mesh, permanent mesh, biomaterial mesh, biological mesh, and synthetic mesh. The review of the literature resulted in a total of 3115 publications. By applying our criteria, six articles were included in this study, with 949 participants. Our meta-analysis showed the overall complication incidence displaying a significant difference favouring the synthetic mesh group (IV = 1.25, 95% CI 1.11-1.42, P = 0.0002). The operation failure rate, defined as hernia recurrence, also significantly favoured synthetic mesh (IV = 2.42, 95% CI 1.66-3.52, P < 0.00001). In conclusion, the present study found that the synthetic mesh proved superior in overall complication rate and operation failure compared to biologic mesh. However, it had no significant differences in other complications.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"2725-2731"},"PeriodicalIF":2.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378258","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":"Single-incision gasless trans-subclavian endoscopic approach thyroidectomy.","authors":"Jinxi Jiang, Gaofei He, Junjie Chu, Jianbo Li, Xiaoxiao Lu, Xianfeng Jiang, Li Gao, Deguang Zhang","doi":"10.1007/s13304-024-01948-7","DOIUrl":"https://doi.org/10.1007/s13304-024-01948-7","url":null,"abstract":"<p><p>The main purpose of the reported endoscopic thyroidectomy with the several incisions on the chest wall or other approaches was to meet the cosmetic demands of patients, but they had inherent technical disadvantages. To solve these problems, we developed a single-incision gasless trans-subclavian approach endoscopic thyroidectomy and evaluated its feasibility. We reviewed clinical data from 243 consecutive patients who underwent gasless trans-subclavian approach endoscopic thyroidectomy with a single incision at our centre from January 2021 to March 2022. Patients' basic information, the extent of surgery, the duration of surgery, the number of lymph node dissection, postoperative hospital stay, complications, and follow-up outcomes were collected and analysed. No cases converted to open surgery. The mean time for lobectomy + central neck dissection was 84.9 ± 29.9 min and 95.0 ± 24.3 min for lobectomy. The mean number of lymph node dissection in the central compartment was 5.6 ± 3.9, with a mean number of metastatic lymph nodes of 0.8 ± 1.6. Temporary recurrent laryngeal nerve (RLN) injury occurred in eigth patients, and minor lymphatic fistula occurred in one patient. During at least 6 months of follow-up, one patient was found to have a recurrence of lateral neck lymph nodes by ultrasound 6 months after surgery. The single-incision gasless trans-subclavian approach endoscopic thyroidectomy is a feasible and truly minimally invasive procedure for selected patients, providing a scarless cervical appearance. Given the simplicity and ease of learning, this surgical technique is well-suited for widespread clinical application.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142732788","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}
Diego Foschi, Giuliano Sarro, Micaela Serbelloni, Andrea Rizzi, Antonio Chiappa
{"title":"Type 2 diabetes mellitus remission following laparoscopic sleeve gastrectomy and hindgut-based procedure: a retrospective multicenter study.","authors":"Diego Foschi, Giuliano Sarro, Micaela Serbelloni, Andrea Rizzi, Antonio Chiappa","doi":"10.1007/s13304-024-02035-7","DOIUrl":"https://doi.org/10.1007/s13304-024-02035-7","url":null,"abstract":"<p><p>Sleeve gastrectomy (SG) is considered the standard bariatric surgery due to its excellent outcomes. However, in patients with obesity and type 2 diabetes mellitus (T2DM), SG alone carries a high risk of metabolic failure. To achieve better metabolic results, SG can be combined with either foregut- or hindgut-based procedures, although a direct comparison between these approaches is lacking. In this retrospective study, we compared the bariatric and metabolic effects of SG (n = 20 patients) with SG associated with duodenal diversion and ileal interposition (SG-DD-II) (n = 20), SG associated with duodenal-ileal anastomosis (SADI-S) (n = 20), and SG associated with single gastro-ileal anastomosis (SASI-S) (n = 20). Patient data, including anthropometric measurements and T2DM characteristics, were extracted from our database. The evaluation criteria included weight loss (% excess weight loss), fasting glycemia (FGL), glycated hemoglobin (HbA1C) percentage, and T2DM remission rates. Our statistical analysis (p < 0.05) revealed that shortly after surgery, all procedures demonstrated acceptable outcomes in terms of weight loss and T2DM remission. However, after 3 and 5 years post-surgery, the T2DM relapse rate was significantly higher following SG alone compared to hindgut-based operations. In patients with obesity and T2DM, we recommend combining SG with a hindgut-based procedure to reduce the long-term relapse rate.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142732792","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}