Surgical Endoscopy最新文献

{"title":"Laparoscopic versus open parenchymal sparing liver resections for high tumour burden colorectal liver metastases: a propensity score matched analysis","authors":"Nadia Russolillo, Cristina Ciulli, Caterina Costanza Zingaretti, Andrea Pierluigi Fontana, Serena Langella, Alessandro Ferrero","doi":"10.1007/s00464-024-10797-9","DOIUrl":"https://doi.org/10.1007/s00464-024-10797-9","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>Laparoscopic liver resection (LLR) has proved effective in the treatment of oligometastatic disease (1 or 2 colorectal liver metastases CRLM) with similar long-term outcomes and improved short-term results compared to open liver resection (OLR). Feasibility of parenchymal sparing LLR for high tumour burden diseases is largely unknown. Aim of the study was to compare short and long-term results of LLR and OLR in patients with ≥ 3 CRLM.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>Patients who underwent first LR of at least two different segments for ≥ 3 CRLM between 01/2012 and 12/2021 were analysed. Propensity score nearest-neighbour 1:1 matching was based on relevant prognostic factors.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>277 out of 673 patients fulfilled inclusion criteria (47 LLR and 230 OLR). After match two balanced groups of 47 patients with a similar mean number of CRLM (5 in LLR vs 6.5 in OLR, <i>p</i> = 0.170) were analysed. The rate of major hepatectomy was similar between the two group (10.6% OLR vs. 12.8% LLR). Mortality (2.1% OLR vs 0 LLR) and overall morbidity rates (34% OLR vs 23.4% LLR) were comparable. Length of stay (LOS) was shorter in the LLR group (5 vs 9 days, <i>p</i> = 0.001). No differences were observed in median overall (41.1 months OLR vs median not reached LLR) and disease-free survival (18.3 OLR vs 27.9 months LLR).</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Laparoscopic approach should be considered in selected patients scheduled to parenchymal sparing LR for high tumour burden disease as associated to shorter LOS and similar postoperative and long-term outcomes compared to the open approach.</p>","PeriodicalId":501625,"journal":{"name":"Surgical Endoscopy","volume":"49 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140593627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of 30-day outcomes for open ventral hernia repair using self-gripping versus nonself-gripping mesh","authors":"Anoosh Bahraini, Justin Hsu, Steven Cochran, Shannelle Campbell, David Wayne Overby, Sharon Phillips, Ajita Prabhu, Arielle Perez","doi":"10.1007/s00464-024-10778-y","DOIUrl":"https://doi.org/10.1007/s00464-024-10778-y","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>The use of mesh is standard of care for large ventral hernias repaired on an elective basis. The most used type of mesh includes synthetic polypropylene mesh; however, there has been an increase in the usage of a new polyester self-gripping mesh, and there are limited data regarding its efficacy for ventral hernia. The purpose of the study is to determine whether there is a difference in surgical site occurrence (SSO), surgical site infection (SSI), surgical site occurrence requiring procedural intervention (SSOPI), and recurrence at 30 days after ventral hernia repair (VHR) using self-gripping (SGM) versus non-self-gripping mesh (NSGM).</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>We performed a retrospective study from January 2014 to April 2022 using the Abdominal Core Health Quality Collaborative (ACHQC). We collected data on patients over 18 years of age who underwent elective open VHR using SGM or NSGM and whom had 30-day follow-up. Propensity matching was utilized to control for variables including hernia width, body mass index, age, ASA, and mesh location. Data were analyzed to identify differences in SSO, SSI, SSOPI, and recurrence at 30 days.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>9038 patients were identified. After propensity matching, 1766 patients were included in the study population. Patients with SGM had similar demographic and clinical characteristics compared to NSGM. The mean hernia width to mesh width ratio was 8 cm:18 cm with NSGM and 7 cm:15 cm with SGM (<i>p</i> = 0.63). There was no difference in 30-day rates of recurrence, SSI or SSO. The rate of SSOPI was also found to be 5.4% in the nonself-gripping group compared to 3.1% in the self-gripping mesh group (<i>p</i> &lt; .005). There was no difference in patient-reported outcomes at 30 days.</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>In patients undergoing ventral hernia repair with mesh, self-gripping mesh is a safe type of mesh to use. Use of self-gripping mesh may be associated with lower rates of SSOPI when compared to nonself-gripping mesh.</p>","PeriodicalId":501625,"journal":{"name":"Surgical Endoscopy","volume":"57 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140593632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of postoperative opioid use in ventral and incisional hernia repair","authors":"Do Hyun Yun, Margaret A. Plymale, Douglas R. Oyler, Svetla S. Slavova, Daniel L. Davenport, John Scott Roth","doi":"10.1007/s00464-024-10808-9","DOIUrl":"https://doi.org/10.1007/s00464-024-10808-9","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>One in two ventral and incisional hernia repair (VIHR) patients have preoperative opioid prescription within a year before procedure. The study's aim was to investigate risk factors of increased postoperative prescription filling in patients with or without preoperative opioid prescription.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>VIHR cases from 2013 to 2017 were reviewed. State prescription drug monitoring program data were linked to patient records. The primary endpoint was cumulative opioid dose dispensed through post-discharge day 45. Morphine milligram equivalent (MME) was used for uniform comparison.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>205 patients were included in the study (average age 53.5 years; 50.7% female). Over 35% met criteria for preoperative opioid use. Preoperative opioid tolerance, superficial wound infection, current smoking status, and any dispensed opioids within 45 days of admission were independent predictors for increased postoperative opioid utilization (<i>p</i> &lt; 0.001).</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Preoperative opioid use during 45-day pre-admission correlated strongly with postoperative prescription filling in VIHR patients, and several independent risk factors were identified.</p>","PeriodicalId":501625,"journal":{"name":"Surgical Endoscopy","volume":"71 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140593535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for stoma prolapse after laparoscopic loop colostomy","authors":"Yusuke Takashima, Hitoshi Hino, Akio Shiomi, Hiroyasu Kagawa, Shoichi Manabe, Yusuke Yamaoka, Chikara Maeda, Shunsuke Kasai, Yusuke Tanaka","doi":"10.1007/s00464-024-10802-1","DOIUrl":"https://doi.org/10.1007/s00464-024-10802-1","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>Stoma prolapse (SP) is a common stoma-related complication, particularly in loop colostomies. This study aimed to investigate potential risk factors for SP development after laparoscopic loop colostomy.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>In total, data from 140 patients who underwent laparoscopic loop colostomy were analyzed between September 2016 and March 2022. Risk factors for SP were investigated retrospectively.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>The median follow-up duration after colostomy was 12.5 months, and SP occurred in 33 (23.6%) patients. Multivariate analysis showed that being overweight (body mass index ≥ 25; odds ratio [OR], 8.69; 95% confidential interval [CI], 1.61–46.72; <i>p</i> = 0.012) and having a thin rectus abdominis penetration of the stoma (&lt; 8.9 mm; OR, 8.22; 95% CI, 2.50–27.05; <i>p</i> &lt; 0.001) were independent risk factors for SP. Other patient characteristics and surgical factors associated with stoma construction were unrelated to SP development.</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>Being overweight and the route penetrating the thinner rectus abdominis during stoma construction was associated with a significantly higher incidence of SP after laparoscopic loop colostomy. Selecting a construction site that penetrates the thicker rectus abdominis muscle may be crucial for preventing SP.</p><h3 data-test=\"abstract-sub-heading\">Graphical abstract</h3>\u0000","PeriodicalId":501625,"journal":{"name":"Surgical Endoscopy","volume":"100 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140593630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic-assisted repair of combined ventral hernias and diastasis recti: minimizing seroma incidence by quilting","authors":"Jean-Pierre Cossa, Philippe Ngo, Dominique Blum, Edouard Pélissier, Jean-François Gillion","doi":"10.1007/s00464-024-10801-2","DOIUrl":"https://doi.org/10.1007/s00464-024-10801-2","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>To reduce the incidence of seromas, we have adapted the quilting procedure used in open abdominoplasty to the endoscopic-assisted repair of concomitant ventral hernia (VH) and diastasis recti (DR). The aim of this study was to describe the technique and assess its efficacy by comparing two groups of patients operated on with the same repair technique before and after introducing the quilting.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>This retrospective study included data prospectively registered in the French Club Hernie database from 176 consecutive patients who underwent surgery for concomitant VH and DR via the double-layer suturing technique. Patients were categorized into two groups: Group 1 comprised 102 patients operated before introducing the quilting procedure and Group 2 comprised 74 operated after introducing the quilting. To carry out comparisons between groups, seromas were classified into two types: type A included spontaneously resorbable seromas and seromas drained by a single puncture and type B included seromas requiring two or more punctures and complicated cases requiring reoperation.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>The global percentage of seromas was 24.4%. The percentage of seromas of any type was greater in Group 1 (27.5%) than in Group 2 (20.3%). The percentage of Type B seromas was greater in Group 1 (19.6%) than in Group 2 (5.4%), when the percentage of Type A seromas was greater in Group 2 (14.9) than in Group 1 (7.9%). Differences were significant (<i>p</i> = 0.014). The operation duration was longer in Group 2 (83.9 min) than in Group 1 (69.9 min). Four complications requiring reoperation were observed in Group 1: three persistent seromas requiring surgical drainage under general anesthesia and one encapsulated seroma.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Adapting the quilting technique to the endoscopic-assisted bilayer suturing technique for combined VH and DR repair can significantly reduce the incidence and severity of postoperative seromas.</p>","PeriodicalId":501625,"journal":{"name":"Surgical Endoscopy","volume":"60 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140593619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic submucosal dissection (ESD) outcomes in T1B esophageal cancer: a retrospective study","authors":"Michael Youssef, Christina Hanna, Douglas Motomura, Robert Bechara","doi":"10.1007/s00464-024-10824-9","DOIUrl":"https://doi.org/10.1007/s00464-024-10824-9","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background and aims</h3><p>The role of submucosal endoscopic dissection (ESD) in management of invasive esophageal cancer (EC) remains unclear. In this case series, we evaluate the clinical and technical outcomes of patients who underwent ESD with pathologically staged T1b EC.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>This retrospective study included patients who underwent ESD between December 2016 and April 2023 with pathologically staged T1b EC. Patient demographics, tumor characteristics, and ESD technical outcomes were analyzed. Patients were followed to determine disease-free survival and tumor recurrence rates.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Sixteen patients with a total of 17 pathologically staged T1b ECs were included in this case series with a median follow-up time of 28 months [range 3–75]. ESD had high en-bloc (100%) and R0 (82.3%) resection rates. 16/17 patients (94.1%) were discharged the same day, and there were no immediate perioperative complications. 4/17 patients (23.5%) had curative ESD resections with no tumor recurrence. Among those with non-curative resections (n = 13), 5 patients had ESD only, 6 had ESD + surgery, and 2 underwent ESD + chemoradiation. In the ESD only group, 2/5 patients (40%) had tumor recurrence. In the ESD + surgery group, one patient died from a surgical complication, and 1/5 (20%) had tumor recurrence at follow-up. There was no tumor recurrence among patients who had ESD + chemoradiation.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>ESD is safe with high en-bloc and R0 resection rates in T1b EC. Recurrence rates are low but patients need close monitoring. Larger-scale studies are needed to determine the long-term clinical efficacy of ESD in T1b EC.</p><h3 data-test=\"abstract-sub-heading\">Graphical abstract</h3>\u0000","PeriodicalId":501625,"journal":{"name":"Surgical Endoscopy","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140593529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantification of fluorescence angiography for visceral perfusion assessment: measuring agreement between two software algorithms","authors":"D. J. Nijssen, J. J. Joosten, J. Osterkamp, R. M. van den Elzen, D. M. de Bruin, M. B. S. Svendsen, M. W. Dalsgaard, S. S. Gisbertz, R. Hompes, M. P. Achiam, M. I. van Berge Henegouwen","doi":"10.1007/s00464-024-10794-y","DOIUrl":"https://doi.org/10.1007/s00464-024-10794-y","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>Indocyanine green fluorescence angiography (ICG-FA) may reduce perfusion-related complications of gastrointestinal anastomosis. Software implementations for quantifying ICG-FA are emerging to overcome a subjective interpretation of the technology. Comparison between quantification algorithms is needed to judge its external validity. This study aimed to measure the agreement for visceral perfusion assessment between two independently developed quantification software implementations.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>This retrospective cohort analysis included standardized ICG-FA video recordings of patients who underwent esophagectomy with gastric conduit reconstruction between August 2020 until February 2022. Recordings were analyzed by two quantification software implementations: AMS and CPH. The quantitative parameter used to measure visceral perfusion was the <i>normalized maximum slope</i> derived from fluorescence time curves. The agreement between AMS and CPH was evaluated in a Bland–Altman analysis. The relation between the intraoperative measurement of perfusion and the incidence of anastomotic leakage was determined for both software implementations.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Seventy pre-anastomosis ICG-FA recordings were included in the study. The Bland–Altman analysis indicated a mean relative difference of + 58.2% in the measurement of the <i>normalized maximum slope</i> when comparing the AMS software to CPH. The agreement between AMS and CPH deteriorated as the magnitude of the measured values increased, revealing a proportional (linear) bias (<i>R</i>² = 0.512, <i>p</i> &lt; 0.001). Neither the AMS nor the CPH measurements of the <i>normalized maximum slope</i> held a significant relationship with the occurrence of anastomotic leakage (median of 0.081 versus 0.074, <i>p</i> = 0.32 and 0.041 vs 0.042, <i>p</i> = 0.51, respectively).</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>This is the first study to demonstrate technical differences in software implementations that can lead to discrepancies in ICG-FA quantification in human clinical cases. The possible variation among software-based quantification methods should be considered when interpreting studies that report quantitative ICG-FA parameters and derived thresholds, as there may be a limited external validity.</p>","PeriodicalId":501625,"journal":{"name":"Surgical Endoscopy","volume":"298 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140593528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic lithotripsy combined with drug lithotripsy vs. drug lithotripsy for the treatment of phytobezoars: analysis of 165 cases","authors":"Xiao Zheng, Bin Qiu, Xiao-wei Jin, Lin-na Liu, Peng Wang, Hai-jing Yu, Juan Zhang, Wen-jing Geng, Rui Wang, Hua Liu","doi":"10.1007/s00464-024-10741-x","DOIUrl":"https://doi.org/10.1007/s00464-024-10741-x","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Aim</h3><p>To analyze efficacy of endoscopic lithotripsy combined with drug lithotripsy as compared with drug lithotripsy for the treatment of phytobezoars.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>We collected and evaluated case records of 165 patients with phytobezoars from 2014 to 2023. And we analyzed demographic and clinical characteristics, imaging features, endoscopic features, complications of phytobezoars, and compared efficacy between endoscopic lithotripsy combined with drug lithotripsy (Group A) and drug lithotripsy (sodium bicarbonate combined with proton pump inhibitor) (Group B).</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>The median age of patients with phytobezoars was 67.84 ± 4.286 years old. Abdominal pain was the most common symptom and peptic ulcers (67.5%) were the most common complication. Bezoar-induced ulcers were more frequent in the gastric angle. The success rate of phytobezoars vanishing in Group A and Group B were similar (92.3% vs. 85.1% within 48 h, 98.7% vs. 97.7% within a week), while the average hospitalization period, average hospitalization cost, second endoscopy rate, and average endoscopic operation time were significantly lower in patients in Group B than in Group A.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Drug lithotripsy is the preferred effective and safe treatment option for phytobezoars. We advise that an endoscopy should be completed after 48 h for drug lithotripsy.</p>","PeriodicalId":501625,"journal":{"name":"Surgical Endoscopy","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140593621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for diaphragmatic injury in subxiphoid video-assisted thoracoscopic surgery","authors":"Maodan Chen, Yang Huang, Juyi Hu, Longfei Jia, Yuanzhou Wu, Jing Feng, Fuwei Zhang, Jian Tong, Qunqing Chen, Hui Li","doi":"10.1007/s00464-024-10789-9","DOIUrl":"https://doi.org/10.1007/s00464-024-10789-9","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>Subxiphoid video-assisted thoracoscopic surgery (VATS) is considered a safe and feasible operation for anterior mediastinal mass resection. However, diaphragmatic injury, presented as tearing or puncturing, may occur during subxiphoid VATS despite of low incidence. This study aims to explore risk factors for diaphragmatic injury in subxiphoid VATS, as well as strategies to reduce occurrence of the injury.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>We retrospectively reviewed clinical records of 44 consecutive adult patients who underwent subxiphoid VATS. These patients were divided into two groups: diaphragmatic injury group and non-injury group. Perioperative outcomes and anatomic features derived from 3D CT reconstructions were compared between the two groups.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Significant differences were observed in operation time (223.25 ± 92.57 vs. 136.28 ± 53.05, <i>P</i> = 0.006), xiphoid length (6.47 ± 0.85 vs. 4.79 ± 1.04, <i>P</i> = 0.001) and length of the xiphoid below the attachment point on the diaphragm (24.86 ± 12.02 vs. 14.61 ± 9.25, <i>P</i> = 0.029). Odds ratio for the length of the xiphoid below the attachment point on the diaphragm was 1.09 (1.001–1.186), <i>P</i> = 0.048 by binary logistic regression analysis.</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>We identified the length of the xiphoid below the attachment point on the diaphragm as an independent risk factor for diaphragm injury during subxiphoid VATS. Prior to subxiphoid VATS, a 3D chest CT reconstruction is recommended to assess the patients’ anatomic variations within the xiphoid process. For patients with longer xiphoid process, a higher incision at the middle and upper part of the xiphoid process, and partial xiphoid process resection or xiphoidectomy is preferred.</p><h3 data-test=\"abstract-sub-heading\">Graphical abstract</h3>\u0000","PeriodicalId":501625,"journal":{"name":"Surgical Endoscopy","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140593526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary anastomosis with diverting loop ileostomy vs. Hartmann’s procedure for acute diverticulitis: what happens after discharge? Results of a nationwide analysis","authors":"Arturo J. Rios Diaz, Lisa A. Bevilacqua, Theodore E. Habarth-Morales, Alicja Zalewski, David Metcalfe, Caitlyn Costanzo, Charles J. Yeo, Francesco Palazzo","doi":"10.1007/s00464-024-10752-8","DOIUrl":"https://doi.org/10.1007/s00464-024-10752-8","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>Current guidelines recommend resection with primary anastomosis with diverting loop ileostomy over Hartmann’s procedure if deemed safe for acute diverticulitis. The primary objective of the current study was to compare the utilization of these strategies and describe nationwide ostomy closure patterns and readmission outcomes within 1 year of discharge.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>This was a retrospective, population-based, cohort study of United States Hospitals reporting to the Nationwide Readmissions Database from January 2011 to December 2019. There were 35,774 patients identified undergoing non-elective primary anastomosis with diverting loop ileostomy or Hartmann’s procedure for acute diverticulitis. Rates of ostomy closure, unplanned readmissions, and complications were compared. Cox proportional hazards and logistic regression models were used to control for patient and hospital-level confounders as well as severity of disease.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Of the 35,774 patients identified, 93.5% underwent Hartmann’s procedure. Half (47.2%) were aged 46–65 years, 50.8% female, 41.2% publicly insured, and 91.7% underwent open surgery. Primary anastomosis was associated with higher rates of 1-year ostomy closure (83.6% vs. 53.4%, <i>p</i> &lt; 0.001) and shorter time-to-closure [median 72 days (Interquartile range 49–103) vs. 115 (86–160); <i>p</i> &lt; 0.001]. Primary anastomosis was associated with increased unplanned readmissions [Hazard Ratio = 2.83 (95% Confidence Interval 2.83–3.37); <i>p</i> &lt; 0.001], but fewer complications upon stoma closure [Odds Ratio 0.51 (95% 0.42–0.63); <i>p</i> &lt; 0.001]. There were no differences in complications between primary anastomosis and Hartmann’s procedure during index admission [Odds Ratio = 1.13 (95% Confidence Interval 0.96–1.33); <i>p</i> = 0.137].</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Patients who undergo primary anastomosis for acute diverticulitis are more likely to undergo ostomy reversal and experience fewer postoperative complications upon stoma reversal. These data support the current national guidelines that recommend primary anastomosis in appropriate cases of acute diverticulitis requiring operative treatment.</p><h3 data-test=\"abstract-sub-heading\">Graphical abstract</h3>\u0000","PeriodicalId":501625,"journal":{"name":"Surgical Endoscopy","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140603010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}