Annali italiani di chirurgia最新文献

{"title":"Spontaneous Gallbladder Perforation in a Patient With Osteogenesis Imperfecta Type III: A Rare Case Report.","authors":"Huseyin Esin","doi":"10.62713/aic.3768","DOIUrl":"https://doi.org/10.62713/aic.3768","url":null,"abstract":"<p><strong>Aim: </strong>Osteogenesis imperfecta (OI), also known as brittle bone disease, is an inherited connective tissue disorder (CTD) characterized by recurrent fractures, low bone mass, skeletal deformity, and variable short stature. Gallbladder perforation (GBP) is a rare but serious complication of acute cholecystitis, associated with high morbidity and mortality due to diagnostic delays in both calculous and acalculous cases. This case highlights the importance of maintaining a high index of suspicion for spontaneous ischemic GBP in patients with CTDs such as OI Type III.</p><p><strong>Case presentation: </strong>A 20-year-old woman with severe OI type III presented to the emergency department with a two-day history of abdominal pain and distension. Abdominal computed tomography revealed free intraperitoneal air anterior to the liver and adjacent to the falciform ligament, which was suggestive of GBP. No gallstones or sludge were identified within the gallbladder lumen. An emergent open cholecystectomy was performed. Intraoperative findings revealed a concealed perforation at the gallbladder fundus. Due to dense adhesions and the inability to achieve the critical view of safety, a partial cholecystectomy was performed to reduce the risk of biliary and vascular injury.</p><p><strong>Results: </strong>OI poses significant clinical challenges, including abnormal coagulation, airway obstruction, cardiovascular complications, and delayed wound healing. The patient recovered without complications and was discharged on the seventh postoperative day, remaining asymptomatic during the three-month follow-up period.</p><p><strong>Conclusions: </strong>This case demonstrates that GBP, though rare, should be considered a potential complication in patients with CTDs such as OI Type III. Early recognition and appropriate management are crucial for improving clinical outcomes.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 4","pages":"465-469"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143959821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Application of a New Model for Disease Classification in Minimally Invasive Treatment of Concomitant Cholecystolithiasis and Choledocholithiasis.","authors":"Yiwei Liu, Yusha Xiao, Pengpeng Liu, Jianwei Lan, Dekun Song, Longhui Xie, Quanyan Liu","doi":"10.62713/aic.3771","DOIUrl":"10.62713/aic.3771","url":null,"abstract":"<p><strong>Aim: </strong>There is no consensus regarding the minimally invasive treatment method for concomitant cholecystolithiasis and choledocholithiasis. Therefore, this study aimed to develop a universal classification system for minimally invasive surgeries, thereby supporting development of consensus in guidelines for diagnosing choledocholithiasis.</p><p><strong>Methods: </strong>This retrospective study included 1044 consecutive patients with concomitant cholecystolithiasis and choledocholithiasis who underwent different minimally invasive surgical treatments at the Zhongnan Hospital of Wuhan University, China, between January 2014 and April 2021. To identify the key factors influencing the choice of different minimally invasive surgical procedures, clinical data for all hospitalized patients were analyzed. The patients were followed up through outpatient visits or telephonic calls at 1 week, 6 weeks, 3 months, 6 months, and 1 year or immediately if symptoms developed following discharge from the hospital. This information was integrated in the form of a new disease classification model, and the optimal treatment approaches were screened.</p><p><strong>Results: </strong>A significant correlation was observed between the choice of minimally invasive surgical procedures and the concomitant common bile duct (CBD) (p < 0.001), stone size (p < 0.001), or stone number (p < 0.001). A new clinical classification model was developed for patients with concomitant gallbladder (GB) and CBD stones based on the CBD diameter, stone sizes, and stone numbers, and the patients were sorted into Type I, II, III, and Ⅳ, respectively. Three invasive surgical methods were performed in patients with type I patients, revealing the laparoscopic cholecystectomy + Laparoscopic Transcystic Common Bile Duct Exploration (LC + LTCBDE) method as a preferred option for these patients. Furthermore, five surgical methods were performed on patients with type II CBD stones, demonstrating LC + LTCBDE as the viable option for these patients. Additionally, among the four minimally invasive surgical methods applied in patients with type III, the LC + laparoscopic choledochotomy for common bile duct exploration (LCCBDE) + Duodenoscope or LC + LCCBDE + primary closure demonstrated favorable results in this group of patients. Among the three methods applied in type IV patients, LC + laparoscopic choledocholithotomy and T-tube drainage (LCTD) were found to be more favorable.</p><p><strong>Conclusions: </strong>In summary, this novel and simple clinical classification system, which is based on CBD diameter, stone sizes, and stone numbers, can assist clinicians in selecting a minimally invasive treatment approach for managing concomitant GB and CBD stones.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 2","pages":"244-260"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143432366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive Value of Systemic Immune-Inflammation Index Combined with Distal Ureteral Diameter Ratio for Early Breakthrough Urinary Tract Infection in Children with Primary Vesicoureteral Reflux.","authors":"Xiangxiang Chen, Weihua Zheng, Xiaoyu Tang, Yan Chen, Fang Chen, Xiujun Yang","doi":"10.62713/aic.3916","DOIUrl":"10.62713/aic.3916","url":null,"abstract":"<p><strong>Aim: </strong>To investigate predictive value of the systemic immune-inflammation index (SII) combined with the distal ureteral diameter ratio (UDR) for early breakthrough urinary tract infection (BT-UTI) in children with primary vesicoureteral reflux (VUR).</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 150 VUR patients admitted to ShangHai Children's Hospital from January 2021 to December 2023. Patients were divided into the early BT-UTI group (n = 52) and the non-earlyBT-UTI group (n = 98) based on whether early BT-UTI occurred. Univariate and binary logistics regression analyses were performed to identify factors influencing early BT-UTI in VUR children. Pearson correlation analysis was used to assess the relationship between variables, and receiver operating characteristic (ROC) curve was employed to evaluate the predictive value of SII combined with UDR for early BT-UTI in VUR children.</p><p><strong>Results: </strong>Comparisons of age, gender, body mass index (BMI), neutrophils (NEU), lymphocytes (LYM), red blood cells (RBC), white blood cells (WBC), comorbidities, length of hospital stay, and caregiver education level showed no statistically significant differences (p > 0.05). Differences in reflux grade, UDR, SII, and platelets (PLT) between the groups were statistically significant (p < 0.05). According to Pearson linear correlation analysis, SII was negatively correlated with LYM, and positively correlated with PLT and NEU (r = 0.366 and 0.839, respectively; p < 0.05). UDR was unrelated to NEU and LYM, and positively correlated with PLT (r = 0.280, p < 0.05), and SII was positively correlated with UDR (r = 0.162, p < 0.05). Binary logistic regression analysis indicated that UDR and SII were factors influencing early BT-UTI in VUR children (OR = 1.171 and 5.306, respectively; 95% confidence interval (CI) = 1.099-1.249 and 2.841-9.912, respectively; p < 0.05). The combined variables had an area under the curve (AUC) of 0.832 with a standard error of 0.032 (95% CI: 0.768-0.895), Youden index = 0.53, sensitivity of 90.4%, and specificity of 62.2%. The combined index had an AUC closest to 1, indicating the highest predictive value.</p><p><strong>Conclusions: </strong>UDR combined with SII boasts a high predictive value for early BT-UTI in VUR children.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 3","pages":"345-351"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency Minimally Invasive Surgery for Obturator Hernias: A Systematic Review.","authors":"Shannon Baker, Subham Jaiswal, Valentin Butnari, Aashlesha Sardesai, Ahmer Mansuri, Dixon Osilli, Francesco Di Nubila, Robert Buhain, Sayed Haschmat Sarwary, Sandeep Kaul","doi":"10.62713/aic.3806","DOIUrl":"https://doi.org/10.62713/aic.3806","url":null,"abstract":"<p><strong>Aim: </strong>Despite their rarity, obturator hernias pose significant clinical challenges due to their high complication rate and frequent emergency presentation. While minimally invasive surgery has proven effective and safe for elective groin hernia repair, its application in emergency settings, particularly for obturator hernias, lacks robust evidence, highlighting a critical knowledge gap in this area. This systematic review aims to evaluate the feasibility of a minimally invasive approach for the repair of obturator hernias in emergency settings.</p><p><strong>Methods: </strong>A systematic review was conducted searching PubMed, OVID, MEDLINE, Embase, and Cochrane reviews for ((obturator hernia) AND (laparoscop* OR minimal access OR robotic)) AND (strangulat* OR obstruct* OR incarcerat*). The time of the literature is from the establishment of each database to 1 September 2023. Critical appraisal used the Joanna Briggs Institute (JBI) appraisal checklist.</p><p><strong>Results: </strong>A systematic review of 337 manuscripts identified 47 relevant studies, including 39 case reports, 4 case series, and 4 retrospective studies. Minimally invasive approaches, particularly totally extraperitoneal (TEP), transabdominal preperitoneal (TAPP), and the Kugel procedure, demonstrated favourable outcomes for obturator hernias, including shorter operative times, reduced hospital stays, low recurrence rates, effective management of complications, and improved diagnostics, with success dependent on timely intervention, bowel viability, and patient selection.</p><p><strong>Conclusions: </strong>The findings suggest that minimal access surgery can effectively avoid unnecessary laparotomy for hernial content assessment, particularly when employing the TAPP approach. While emergency repair of obturator hernias using minimal access techniques appears feasible and safe, achieving outcomes comparable to open surgery requires further high-quality evidence.</p><p><strong>Systematic review registration: </strong>PROSPERO: CRD42024503724.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 4","pages":"421-436"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conservative Management of Gastric Twist and Leak Post Band Removal and Sleeve Gastrectomy.","authors":"Mohammad N Nofal, Ali J Yousef, Mohammad Salah, Saad H Samarah","doi":"10.62713/aic.3742","DOIUrl":"10.62713/aic.3742","url":null,"abstract":"<p><strong>Aim: </strong>Gastric twist is a rare, however, troublesome complication of laparoscopic sleeve gastrectomy. This report describes a case complicated by perforation and leak in addition to twist. The patient was managed conservatively and successfully.</p><p><strong>Case presentation: </strong>A 29-year-old female patient with a body mass index (BMI) of 41.3 kg/m2 (111 kg/1.64 m), who underwent gastric band insertion six years ago, recently experienced postprandial vomiting. Endoscopic examination revealed grade A esophagitis, minor antral gastropathy, and mild bulbar duodenitis. Her BMI was calculated at 33.1 kg/m2 (89 kg/1.64 m). One week later, she had a laparoscopic band removal and sleeve gastrectomy using an endo GIA Tri-stapler. Both the surgical and postoperative periods proceeded without complications, and she was discharged home the next day after surgery. The patient was readmitted after two weeks due to an organo-axial gastric volvulus, which was managed with stent placement. Six weeks following, a stomach leak and peri splenic fluid collection were diagnosed. A 12 mm Ovesco clip was employed to seal a perforation situated 35 cm from the incisors. Subsequently, a MEGA bariatric stent was placed.</p><p><strong>Results: </strong>Two months after the removal of the MEGA stent, the patient had recovered completely and was in good health.</p><p><strong>Conclusions: </strong>Gastric twist after sleeve gastrectomy is a rare condition; a high index of suspicion is required for diagnosis. Prioritize conservative treatment to prevent the risk of revisional surgery.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 1","pages":"14-18"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endovascular Retrieval of Disconnected Tip From an Iliac Branch Device Stent Graft: A Case Report.","authors":"Ilaria Calicchio, Antonia Rinaldi, Nicola Cantile, Michele Vollono, Luca Del Guercio, Umberto Marcello Bracale, Davide Turchino","doi":"10.62713/aic.3784","DOIUrl":"https://doi.org/10.62713/aic.3784","url":null,"abstract":"<p><p>Endovascular repair of aneurysmal pathology in the aorto-iliac district presents one of the significant challenges in contemporary vascular surgery. Advances in techniques, materials, and devices have enhanced the ability of vascular surgeons in endovascular procedures, leading to the management of increasingly complex cases, with applications sometimes extending beyond the Instructions for Use (IFUs) of specific devices. In our case report, we describe the successful endovascular retrieval of a disconnected tip from an iliac branch device (IBD), preventing conversion to open surgery in a 73-year-old patient with a complex aortoiliac aneurysm. The case highlights the importance of exercising caution when treating patients with complex anatomy not in conformance with a device's IFU, even in high-volume centers with extensive endovascular expertise.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 5","pages":"572-578"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144075368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimally Invasive Endodontic Treatment of a Maxillary Lateral Incisor With Invasive Cervical Resorption and Dens in Dente: A Case Report.","authors":"Alfredo Iandolo, Davide Mancino, Massimo Pisano, Eduard Euvrard, Dina Abdellatif","doi":"10.62713/aic.3776","DOIUrl":"https://doi.org/10.62713/aic.3776","url":null,"abstract":"<p><strong>Aim: </strong>This case report describes the conservative endodontic treatment of a maxillary lateral incisor affected by both dens invaginatus and invasive cervical resorption.</p><p><strong>Case presentation: </strong>A maxillary lateral incisor (tooth 1.2), presenting with dens invaginatus and invasive cervical resorption, was diagnosed with irreversible acute pulpitis. Following 3D reconstruction using cone-beam computed tomography (CBCT), a minimally invasive root canal treatment was planned with a vestibular access through the resorption site to preserve as much tooth structure as possible. After removing the external resorptive tissue and placing a dental dam, the root canal system was shaped using modern rotary files in the martensitic phase. Subsequently, an effective irrigant activation protocol was implemented, and the canal was obturated with gutta-percha and a biosealer. After addressing the main root canal, the invaginated portion of the tooth was carefully treated to ensure complete disinfection and sealing.</p><p><strong>Results: </strong>The treatment, guided by a suite of advanced diagnostic and endodontic technologies, achieved optimal care and preservation of the affected tooth. This use of cutting-edge tools in the field informs us of the possibilities for advanced care and preservation.</p><p><strong>Conclusions: </strong>A one-year clinical and radiographic follow-up confirmed the treatment's success, demonstrating excellent clinical outcomes and tooth stability.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 4","pages":"443-450"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Intravenous Anesthesia With Remimazolam Besylate on Hemodynamics and Neuroprotection in Patients Undergoing Surgery for Craniocerebral Injury.","authors":"Hongpei Li, Kunpeng Liu, Hao Li, Juanjuan Gu, Lan Yao","doi":"10.62713/aic.3867","DOIUrl":"https://doi.org/10.62713/aic.3867","url":null,"abstract":"<p><strong>Aim: </strong>This study aimed to investigate the effect of intravenous anesthesia with remimazolam besylate on hemodynamics and neuroprotection in patients undergoing surgery for craniocerebral injury.</p><p><strong>Methods: </strong>This retrospective study analyzed the clinical data from 92 patients with craniocerebral injury who underwent craniotomy at Peking University International Hospital between May 2021 and August 2023. Based on anesthesia method applied, patients were divided into the observation group (n = 49) and the conventional group (n = 43). The conventional group underwent conventional anesthesia, and the observation group received intravenous anesthesia with remimazolam besylate. All patients were followed up for 3 months after surgery. Furthermore, perioperative hemodynamic indicators and neurological function were compared between the two groups at different time points, such as T0 (before surgery), T1 (30 minutes after anesthesia), T2 (at the end of surgery), and T3 (24 hours post-surgery). Additionally, perioperative indicators, postoperative adverse reactions, and prognosis were statistically analyzed.</p><p><strong>Results: </strong>From T0 to T1, heart rate (HR), peripheral capillary oxygen saturation (SpO₂), and mean arterial pressure (MAP) showed an increasing trend in both groups. Afterwards, HR and MAP demonstrated a decreasing trend in both groups, and ultimately restoring to T0 level. However, SpO₂ remained stable and then decreased slightly. The differences in HR, SpO₂, and MAP levels between the two groups and across different time points were statistically significant (p < 0.05). At T3, the levels of Tau protein, neuron-specific enolase, and glial fibrillary acidic protein were lower in the observation group than in the conventional group (p < 0.05). Furthermore, the observation group demonstrated shorter spontaneous breathing recovery time, eye-opening time, orientation recovery time, extubation time, length of intensive care unit (ICU) stays, and total hospital stay than the conventional group (p < 0.05). Additionally, the incidence rates of arrhythmia and pulmonary infection were lower in the observation group than in the conventional group (p < 0.05). Similarly, the observation group exhibited a better overall prognosis than the conventional group (p < 0.05).</p><p><strong>Conclusions: </strong>Intravenous anesthesia with remimazolam besylate in patients undergoing surgery for craniocerebral injury can maintain stable hemodynamics, protect neurological function, and promote post-surgery recovery.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 4","pages":"543-549"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143964139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pupillary Light Reflex Parameters as Predictors of Postoperative Nausea and Vomiting: A Prospective Study.","authors":"Yawen Zhang, Jin Jin, Leying Sun, Haoyi Ji, Jinjian Zhu, Dan Sheng, Qiang Song, Cunxian Shi","doi":"10.62713/aic.3900","DOIUrl":"10.62713/aic.3900","url":null,"abstract":"<p><strong>Aim: </strong>This study aims to investigate whether pupillary light reflex (PLR) parameters in dynamic pupillometry can effectively predict postoperative nausea and vomiting (PONV).</p><p><strong>Methods: </strong>In this prospective observational study, patients scheduled to undergo elective lobectomy under general anesthesia were enrolled from 1 August 2023 to 7 October 2023 at Yantai Yuhuangding Hospital, a large regional tertiary hospital in Yantai City, Shandong Province, China. Preoperative pupillary parameters were measured using a portable infrared pupillometer, and the patients were followed up within 24 hours postoperatively to assess postoperative nausea and vomiting (PONV) and recovery quality. Logistic regression analysis and receiver operating characteristics (ROC) curves were used to evaluate the predictive efficacy of pupillary parameters, and mediation analysis was conducted to explore the mediating role of PONV between pupillary parameters and recovery quality.</p><p><strong>Results: </strong>Forty-six patients (29.9%) who experienced PONV had smaller maximum pupil diameter, average constriction velocity (ACV), maximum constriction velocity (MCV), and percentage pupil change. MCV was identified as an independent predictor of PONV, with each 1-unit increase in MCV reducing the risk of PONV by 87%. Gender was a protective factor, with males having a 65% lower risk of PONV compared to females. The ROC analysis showed that the area under the curve (AUC) value of MCV was 0.831 (95% confidence interval (CI): 0.760-0.902), indicating that the model has strong classification ability when using MCV as a predictor. Thus, PONV plays a full mediating role in the relationship between MCV and postoperative recovery quality.</p><p><strong>Conclusions: </strong>MCV is a reliable predictor of PONV, which plays a full mediating role in the relationship between MCV and postoperative recovery quality. Thus, with a capability in predicting PONV occurrence, preoperative MCV measurement can be employed for the purpose of improving patient recovery outcomes.</p><p><strong>Clinical trial registration: </strong>Chinese Clinical Trial Registry (ChiCTR2300073869).</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 5","pages":"681-694"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144075581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Autologous Flap-Supported vs. Stent-Supported Preventive Ileostomy in Laparoscopic Radical Resection of Low Rectal Cancer.","authors":"Xing Liu, Weilin Wang, Meng Li, Lei Gao","doi":"10.62713/aic.3703","DOIUrl":"10.62713/aic.3703","url":null,"abstract":"<p><strong>Aim: </strong>This study compared the clinical efficacy of preventive ileostomy supported by autologous flaps versus stents in laparoscopic radical resection of low rectal cancer.</p><p><strong>Methods: </strong>Sixty-four patients diagnosed with low rectal cancer who underwent laparoscopic radical resection in Fuyang Women's and Children's Hospital between April 2020 and December 2023 were included in this study. Based on the intraoperative support method, the patients were divided into a control group (n = 30) receiving stent support and a flap support group (n = 34) undergoing autologous flap support. Surgical outcomes, perioperative indicators, and postoperative complications were analyzed and compared between the groups. Patients were followed up for six months to evaluate recovery outcomes.</p><p><strong>Results: </strong>Significant differences were observed in operative time, total duration of surgery, intraoperative blood loss, and hospitalization costs between the two groups (p < 0.05). Postoperative levels of inflammatory markers, including C-reactive protein (CRP), interleukin-6 (IL-6), and procalcitonin (PCT), were elevated at 2, 4, and 6 days after surgery in both groups, while erythrocyte sedimentation rate (ESR) and prealbumin (PA) levels decreased in both groups compared to preoperative levels (p < 0.05). Notably, the flap support group demonstrated significantly lower CRP, IL-6, PCT, and ESR levels and higher PA levels at the same time points compared to the control group at 2, 4, and 6 days after surgery (p < 0.05). The complication rate in the flap support group (2.94%) was significantly lower than in the control group (20.00%) (p < 0.05). During the follow-up period, no cases of permanent fistula were observed in the flap support group, while the control group reported a 13.33% incidence of permanent fistula, indicating a statistically significant difference between the two groups (p < 0.05).</p><p><strong>Conclusions: </strong>Preventive ileostomy supported by autologous skin flaps offers advantages in laparoscopic radical resection for low rectal cancer. This approach simplifies the procedure, eliminates the need for secondary stent removal, reduces postoperative complications, and improves overall safety and recovery outcomes.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 2","pages":"188-193"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143432355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}