Surgery open science最新文献

{"title":"A National Analysis of Alcohol Withdrawal Syndrome in Patients with Operative Trauma","authors":"Jeffrey Balian,&nbsp;Nam Yong Cho,&nbsp;Amulya Vadlakonda,&nbsp;Joanna Curry,&nbsp;Nikhil Chervu,&nbsp;Konmal Ali,&nbsp;Peyman Benharash","doi":"10.1016/j.sopen.2024.05.001","DOIUrl":"https://doi.org/10.1016/j.sopen.2024.05.001","url":null,"abstract":"<div><h3>Background</h3><p>Alcohol withdrawal syndrome (AWS) presents with a complex spectrum of clinical manifestations that complicate postoperative management. In trauma setting, subjective screening for AWS remains challenging due to the criticality of injury in these patients. We thus identified several patient characteristics and perioperative outcomes associated AWS development.</p></div><div><h3>Methods</h3><p>The 2016–2020 National Inpatient Sample was queried to identify all non-elective adult (≥18 years) hospitalizations for blunt or penetrating trauma undergoing operative management with a diagnosis of AWS. Patients with traumatic brain injury or with a hospital duration of stay &lt;2 days were excluded. Outcomes of interest included in-hospital mortality, perioperative complications, hospitalization costs, length of stay (LOS) and non-home discharge.</p></div><div><h3>Results</h3><p>Of an estimated 2,965,079 operative trauma hospitalizations included for analysis, 36,415 (1.23 %) developed AWS following admission. The AWS cohort demonstrated increased odds of mortality (Adjusted Odds Ratio [AOR] 1.46, 95 % Confidence Interval [95 % CI] 1.23–1.73), along with infectious (AOR 1.73, 95 % CI 1.58–1.88), cardiac (AOR 1.24, 95 % CI 1.06–1.46), and respiratory (AOR 1.96, 95 % CI 1.81–2.11) complications. AWS was associated with prolonged LOS, (β: 3.3 days, 95 % CI: 3.0 to 3.5), greater cost (β: +$8900, 95 % CI $7900–9800) and incremental odds of nonhome discharge (AOR 1.43, 95 % CI 1.34–1.53). Furthermore, male sex, Medicaid insurance status, head injury and thoracic operation were linked with greater odds of development of AWS.</p></div><div><h3>Conclusion</h3><p>In the present study, AWS development was associated with increased odds of in-hospital mortality, perioperative complications, and resource burden. The identification of patient and operative characteristics linked with AWS may improve screening protocols in trauma care.</p></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"19 ","pages":"Pages 199-204"},"PeriodicalIF":1.4,"publicationDate":"2024-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589845024000642/pdfft?md5=571f3cd4c6429fd655ec92996f71886a&pid=1-s2.0-S2589845024000642-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140951631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differences in preoperative frailty assessment of surgical candidates by sex, age, and race","authors":"Edouard H. Nicaise MD ,&nbsp;Gregory Palmateer BA ,&nbsp;Benjamin N. Schmeusser MD, MS ,&nbsp;Cameron Futral BS ,&nbsp;Yuan Liu PhD ,&nbsp;Subir Goyal PhD ,&nbsp;Reza Nabavizadeh MD ,&nbsp;David A. Kooby MD, FACS ,&nbsp;Shishir K. Maithel MD, FACS ,&nbsp;John F. Sweeney MD ,&nbsp;Juan M. Sarmiento MD, FACS ,&nbsp;Kenneth Ogan MD ,&nbsp;Viraj A. Master MD, PhD, FACS","doi":"10.1016/j.sopen.2024.05.003","DOIUrl":"https://doi.org/10.1016/j.sopen.2024.05.003","url":null,"abstract":"<div><h3>Introduction</h3><p>Surgical decision-making often relies on a surgeon's subjective assessment of a patient's frailty status to undergo surgery. Certain patient demographics can influence subjective judgment when compared to validated objective assessments. In this study, we explore the relationship between subjective and objective frailty assessments according to patient age, sex, and race.</p></div><div><h3>Methods</h3><p>Patients were prospectively enrolled in urology, general surgery, and surgical oncology clinics. Using a visual analog scale (0−100), operating surgeons independently rated the patient's frailty status. Objective frailty was classified using the Fried Frailty Criteria ranging from 0 to 5. Multivariable proportional odds models were conducted to examine the potential association of factors with objective frailty, according to surgeon frailty rating. Subgroup analysis according to patient sex, race, and age was also performed.</p></div><div><h3>Results</h3><p>Seven male surgeons assessed 203 patients preoperatively with a median age of 65. A majority of patients were male (61 %), white (67 %), and 60 % and 40 % underwent urologic and general surgery/surgical oncology procedures respectively. Increased subjective surgeon rating (OR 1.69; <em>p</em> &lt; 0.001) was significantly associated with the presence of objective frailty. On subgroup analysis, a higher magnitude of such association was observed more in females (OR 1.86; <em>p</em> = 0.0007), non-white (OR 1.84; <em>p</em> = 0.0019), and older (&gt;60, OR 1.75; <em>p</em> = 0.0001) patients, compared to male (OR 1.45; <em>p</em> = 0.0243), non-white (OR 1.48; <em>p</em> = 0.0109) and patients under 60 (OR 1.47; <em>p</em> = 0.0823).</p></div><div><h3>Conclusion</h3><p>The surgeon's subjective assessment of frailty demonstrated tendencies to rate older, female, and non-white patients as frail; however, differences in patient sex, age, and race were not statistically significant.</p></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"19 ","pages":"Pages 172-177"},"PeriodicalIF":1.4,"publicationDate":"2024-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589845024000654/pdfft?md5=f2b407d2ef1a0d404346275d66f6c72b&pid=1-s2.0-S2589845024000654-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140946899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting the dynamics of organ failure in patients with acute pancreatitis depending on the mean platelet volume","authors":"Heorhii Levytskyi,&nbsp;Volodymyr Sheiko","doi":"10.1016/j.sopen.2024.04.011","DOIUrl":"https://doi.org/10.1016/j.sopen.2024.04.011","url":null,"abstract":"<div><h3>Background</h3><p>The aim of this study is to determine the correlation between the blood serum mean platelet volume (MPV) and the dynamics of the OF course during the early phase in patients with moderately severe and severe acute pancreatitis (AP).</p></div><div><h3>Methods</h3><p>The predetermined criterion was the presence of the OF according to the revised Atlanta criteria 2012 for moderately severe and severe AP. A prospective sample of patients was stratified by severity, and two groups were defined based on MPV. Demographic indicators, comorbidities and clinical outcomes were compared between these groups. Multifactorial analysis determined whether an elevated MPV is independently associated with early OF and other unfavorable outcomes.</p></div><div><h3>Results</h3><p>Out of 108 patients, 20 had moderately severe AP and 88 had severe AP. The blood serum MPV, measured within 72 h of the onset of AP symptoms was lower 11.8 fL in 32 patients and equal to or greater 11.8 fL in 76 patients. Patients with elevated MPV were older (63 vs. 48 years), had obesity (59.2 % vs. 25 %), diabetes mellitus (DM) (51.3 % vs. 12.5 %), ischemic heart disease (70.8 % vs. 28.1 %) and more frequently experienced persistent OF (93.4 % vs. 53.1 %) compared to those with MPV lower 11.8 fL. The incidence of early OF increased proportionally with the severity of MPV (81.6 % vs. 34.4 % in the group with MPV lower 11.8 fL, Ptrend &lt; 0.0001). In multifactorial analysis, adjusted for body mass index and DM, MPV equal to or greater 11.8 fL was independently associated with early OF.</p></div><div><h3>Conclusions</h3><p>Elevated blood serum MPV of patients with AP are independently and proportionally correlated with early organ failure in patients with alcoholic and idiopathic etiology of AP.</p></div><div><h3>Key message</h3><p>The study provides an evaluation of MPV as a prognostic marker for organ failure within the initial 7 days following the onset of acute pancreatitis symptoms. Additionally, alterations in MPV were identified in patients with acute pancreatitis who had diabetes or ischemic heart disease within the first 24 h of hospitalization.</p></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"19 ","pages":"Pages 166-171"},"PeriodicalIF":1.4,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589845024000605/pdfft?md5=757cb9fde123e716aef918fecde6f319&pid=1-s2.0-S2589845024000605-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140913903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Liver ultrasound: Normal anatomy and pathologic findings","authors":"Natasha Leigh,&nbsp;Chet W. Hammill","doi":"10.1016/j.sopen.2024.05.002","DOIUrl":"https://doi.org/10.1016/j.sopen.2024.05.002","url":null,"abstract":"<div><p>The goal of this article is to give an overview of intraoperative liver ultrasound, including the indications, different ultrasound techniques, and the ultrasound appearance of normal anatomy, more common anatomic variations, and common hepatic tumors.</p></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"19 ","pages":"Pages 178-198"},"PeriodicalIF":1.4,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589845024000630/pdfft?md5=62adbcbf521285ce1356967216283261&pid=1-s2.0-S2589845024000630-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140951632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment preferences in diverticulitis are common and rarely change after a clinic visit","authors":"Anna A. Melio ,&nbsp;Meredith Johnson ,&nbsp;Jennifer A. Kaplan ,&nbsp;Ravi Moonka ,&nbsp;Vlad V. Simianu","doi":"10.1016/j.sopen.2024.04.010","DOIUrl":"10.1016/j.sopen.2024.04.010","url":null,"abstract":"<div><p>With the increasing prevalence of diverticulitis, professional guidelines encourage the individualization of treatment. However, the frequency of treatment preferences of both surgeons, and patients, and the resultant impact of that preference on diverticulitis management is underexplored. We reviewed 27 consecutive patient visits of 3 colorectal surgeons at our institution to evaluate factors that drove their treatment, as well as their equipoise for patient randomization into medical or surgical treatments. Using standardized pre- and post-visit questionnaires, we investigated the impact of the clinic visit on treatment recommendations. Our results demonstrate that our surgeons have a practice bias towards complicated disease, and have a preference towards operative management of diverticulitis, in both complicated and uncomplicated disease. This preference was frequently unchanged after clinic visit, which has implications for guiding truly shared decision making, as it continues to be the recommendation.</p></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"19 ","pages":"Pages 212-216"},"PeriodicalIF":1.4,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589845024000629/pdfft?md5=52707aa007d59555870eb2c696b2c84e&pid=1-s2.0-S2589845024000629-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141034655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A junior doctor led near-peer acute ENT/head and neck surgery workshop for medical students","authors":"Wendy Liu MBBS FRACS ,&nbsp;Tamara Preda MBBS FRACS ,&nbsp;Warren Hargreaves MBBS FRACS ,&nbsp;Reginald V. Lord MD FRACS","doi":"10.1016/j.sopen.2024.04.005","DOIUrl":"10.1016/j.sopen.2024.04.005","url":null,"abstract":"<div><h3>Background</h3><p>Near-peer teaching (NPT) involves teaching by peers who are at a close, but not the same, level of training. This study investigated whether a novel surgical NPT workshop, designed and delivered by junior doctors using simulation models for acute otolaryngology conditions, improved the knowledge and confidence level of senior medical students.</p></div><div><h3>Methods</h3><p>A one-day NPT workshop was held for medical students in their third year of a four-year postgraduate medical degree at the University of Notre Dame, Sydney, Australia. Four acute otolaryngology/head and neck surgery problems that might be encountered by junior doctors and require prompt management were chosen. These were post-operative neck swelling, epistaxis, and tracheostomy management (obstruction and bleeding). Six junior doctors facilitated didactic tutorials and practical skills training using models. Multiple choice question mini-tests and questionnaires were administered before and after the workshop to assess changes in students' knowledge and confidence in assessment, management, and practical skills.</p></div><div><h3>Results</h3><p>The most common reason for participation was to acquire knowledge and practical skills (93.2 %). Mean correct MCQ mini-test knowledge scores increased significantly from 60 % pre-workshop to 83.9 % post-workshop (<em>p</em> &lt; 0.05). Students reported significantly increased confidence in recognition and management of all four conditions. All students favoured including the course in their curriculum and would recommend the course to others. The tutors subjectively reported valuable teaching experience.</p></div><div><h3>Conclusion</h3><p>NPT is an effective method for teaching medical students how to assess and manage acute otolaryngology/ENT surgery conditions that may present as emergencies for junior medical officers on the ward.</p></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"20 ","pages":"Pages 7-13"},"PeriodicalIF":1.4,"publicationDate":"2024-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589845024000563/pdfft?md5=43cb87504d3d5e6257298128226ac0a1&pid=1-s2.0-S2589845024000563-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141053824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A prospective observational study of sleep patterns and work-related communications during home call for a pediatric surgery fellow","authors":"Steven L. Raymond MD ,&nbsp;Edward Tagge MD, MS","doi":"10.1016/j.sopen.2024.04.006","DOIUrl":"https://doi.org/10.1016/j.sopen.2024.04.006","url":null,"abstract":"<div><h3>Objective</h3><p>A pediatric surgery fellow is often regarded as a cornerstone of an academic children's hospital due to the need for their clinical services with overnight coverage being an important aspect of the care provided. There is little known about the objective sleep patterns and work-related communications of a pediatric surgery fellow during overnight home call. The aim of this study is to better understand the sleep patterns and interruptions of an on-call pediatric surgery fellow.</p></div><div><h3>Design</h3><p>A prospective observational study of 60 call nights and 60 non-call nights of a pediatric surgery senior fellow was performed from September 2022 to February 2023.</p></div><div><h3>Setting</h3><p>An academic Children's Hospital.</p></div><div><h3>Participant</h3><p>An ACGME-accredited clinical pediatric surgery fellow.</p></div><div><h3>Results</h3><p>On average, the pediatric surgery fellow spent 6.9 and 5.8 total hours in bed and asleep each night, respectively. The total sleep time was less for call nights compared to non-call nights (5.4 versus 6.3 h, <em>p</em> &lt; 0.0001). The mean number of work-related communications per 12-hour night shift was four. The majority of communications were regarding new consults (63.8 %). The pediatric surgery fellow spent an average of 5.9 min per communication and approximately 23.8 min total during each 12-hour night shift. Approximately half of these communications occurred during sleep hours.</p></div><div><h3>Conclusions</h3><p>This study reveals overall sleep duration was below recommended levels. There were significant alterations in sleep patterns during call nights. Work-related communications further compounded sleep disturbances. Further research and interventions in this area are warranted.</p></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"19 ","pages":"Pages 158-161"},"PeriodicalIF":1.4,"publicationDate":"2024-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589845024000587/pdfft?md5=d5140325cdefcf2831f0064feb7197cf&pid=1-s2.0-S2589845024000587-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140842637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of two methods: Clipping and suturing in laparoscopic appendectomy","authors":"Parham Khoshdani Farahani ,&nbsp;Neda Safaei","doi":"10.1016/j.sopen.2024.04.007","DOIUrl":"https://doi.org/10.1016/j.sopen.2024.04.007","url":null,"abstract":"<div><h3>Objective</h3><p>Closure of the appendix stump after appendectomy is considered one of the most important parts of laparoscopic appendectomy. Various techniques are used during this surgery, commonly including endoclips and ligatures. Therefore, this study was conducted to compare endoclips with intra-corporeal ligatures in closing the appendix stump during laparoscopic appendectomy.</p></div><div><h3>Methods</h3><p>This retrospective study was conducted using data from 50 patients with acute appendicitis who underwent uncomplicated laparoscopic appendectomy. The data from patients whose stumps were closed using endoclips in 25 patients (Group I) and with intra-corporeal ligatures in 25 patients (Group II) were extracted and compared regarding the occurrence of intraoperative and postoperative complications.</p></div><div><h3>Results</h3><p>There were no differences between the two methods in terms of intraoperative and postoperative complications. The duration of surgery in the ligature group was significantly longer than in the clip group (<em>p</em> = 0.044). The hospital stay duration was clinically longer in the ligature group, but this difference was not statistically significant (<em>p</em> &gt; 0.05).</p></div><div><h3>Conclusion</h3><p>Endoclips for closing the appendix stump are safer with a shorter operating time and also a simpler method. Therefore, they could be a reliable alternative to the method of closing the appendix stump with ligatures.</p></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"19 ","pages":"Pages 162-165"},"PeriodicalIF":1.4,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589845024000599/pdfft?md5=e058de2c4eab33da85630eba9efbe2d7&pid=1-s2.0-S2589845024000599-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140894373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the safety and efficacy of a novel polysaccharide hemostatic system during surgery: A multicenter multispecialty prospective randomized controlled trial","authors":"Michael G. House MD ,&nbsp;Robin Kim MD ,&nbsp;Elaine E. Tseng MD ,&nbsp;Ronald P. Kaufman Jr MD ,&nbsp;Marc R. Moon MD ,&nbsp;Adam Yopp MD ,&nbsp;Viraj A. Master MD","doi":"10.1016/j.sopen.2024.04.009","DOIUrl":"10.1016/j.sopen.2024.04.009","url":null,"abstract":"<div><h3>Background</h3><p>Operative blood loss is associated with postoperative morbidity and mortality in surgery. Hemostatic agents are used as adjuncts for hemostasis during surgery and help to prevent postoperative bleeding. We evaluated the safety and efficacy of an investigational polysaccharide hemostatic (PH) topical product compared to a U.S. Food and Drug Administration (FDA)-approved control in clinical use comprising microporous polysaccharide hemospheres (MPH) to achieve hemostasis of bleeding surfaces during surgery.</p></div><div><h3>Study design</h3><p>This prospective multicenter trial enrolled patients undergoing open elective cardiac, general, or urologic surgery. Patients were stratified by bleeding severity and therapeutic area, then randomized 1:1 to receive PH or MPH. Bleeding assessments occurred intraoperatively using a novel bleeding assessment methodology. Primary endpoint was noninferiority as compared with control via effective hemostasis at 7 min. Patients were monitored and followed daily in the postoperative period until time of discharge and again at 6 weeks. Overall survival was assessed in oncology patients at 24 months. Safety of PH vs. MPH was determined by comparing relative incidence of adverse events.</p></div><div><h3>Results</h3><p>Across 19 centers, 324 (161 PH, 163 MPH) patients were randomized (48 % general surgery, 27 % cardiac surgery, and 25 % urologic surgery). PH was noninferior to MPH and met the primary endpoint of hemostatic success at 7 min at a non-inferiority margin of 10 %. No significant differences were found in adverse event rates. Six deaths were reported within the 6-week follow-up period. No difference in overall survival was observed at 2 years (76 % PH vs. 74 % MPH, <em>P</em> = .66) for patients undergoing cancer operations.</p></div><div><h3>Conclusion</h3><p>Across three therapeutic areas, PH was noninferior to MPH at all hemostasis assessment time points with no safety concerns. PH is an effective alternative to MPH for hemostasis during surgery.</p><p><span>ClinicalTrials.gov</span><svg><path></path></svg> Identifier: <span>NCT02359994</span><svg><path></path></svg></p></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"19 ","pages":"Pages 205-211"},"PeriodicalIF":1.4,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589845024000617/pdfft?md5=43bd953c9a3c5133f53c0ca6a92f24d6&pid=1-s2.0-S2589845024000617-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141040007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety of cholecystectomy performed by surgeons who prefer fundus first versus surgeons who prefer a standard laparoscopic approach","authors":"Åsa Edergren ,&nbsp;Gabriel Sandblom ,&nbsp;Mikael Franko ,&nbsp;Thorhallur Agustsson ,&nbsp;Yucel Cengiz ,&nbsp;Gona Jaafar","doi":"10.1016/j.sopen.2024.04.004","DOIUrl":"https://doi.org/10.1016/j.sopen.2024.04.004","url":null,"abstract":"<div><h3>Background</h3><p>An alternative method to standard laparoscopic cholecystectomy (SLC) is the “fundus first” method (FFLC). Concerns have been raised that FFLC can lead to misinterpretation of important anatomical structures, thus causing complications of a more serious kind than SLC. Comparisons between the methods are complicated by the fact that FFLC is often used as a rescue procedure in complicated cases. To avoid confounding related to this we conducted a population-based study with comparisons on the surgeon level.</p></div><div><h3>Method</h3><p>In GallRiks, the Swedish registry for Gallbladder surgery, we stratified all cholecystectomies performed 2006–2020 in three groups: surgeries carried out by surgeons that uses FFLC in &lt;20 % of the cases (N = 150,119), in 20–79 % of the cases (N = 10,212) and in 80 % or more of the cases (N = 3176). We compared the groups with logistic regression, adjusting for sex, age, surgical experience, year of surgery and history of acute cholecystitis. All surgical complications (bleeding, gallbladder perforation, visceral perforation, infection, and bile duct injury) were included as outcome. A separate analysis was done with regards to operation time.</p></div><div><h3>Results</h3><p>No difference in incidence of all surgical complications or bile duct injury were seen between groups. The rates of bleeding (OR 0.34 [0.14–0.86]) and gallbladder perforation (OR 0.61 [0.45–0.82]) were significantly lower in the “fundus first &gt; 80% group” and the operative time was shorter (OR 0.76 [0.69–0.83]).</p></div><div><h3>Conclusion</h3><p>In this study including &gt;160,000 cholecystectomies, both methods was found to be equally safe.</p></div><div><h3>Key message</h3><p>During laparoscopic cholecystectomy, the standard method of dissection and fundus first dissection are equally safe surgical techniques. Surgeons need to learn both methods to be able to use the one most appropriate for each individual case.</p></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"19 ","pages":"Pages 141-145"},"PeriodicalIF":1.4,"publicationDate":"2024-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589845024000551/pdfft?md5=509be43157d95a5abe94cb5fa07cccab&pid=1-s2.0-S2589845024000551-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140645305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}