1,721,075 research outputs found
Impact of surgical repair on type IV paraesophageal hernias (PEHs)
Get PDFBackground Paraesophageal hernias (PEHs; types II-III-IV) account for about 5% of all hiatal hernias (HHs). The peculiarity of PEHs is the presence of a herniated sac which contains a more or less important part of the stomach, along with other abdominal organs in type IV PEHs. Surgical treatment is more complex since it requires a reduction not only of the herniated content but also of the "container," namely the sac adherent to mediastinal structures. Since type III and IV PEHs are mostly grouped together as large PEHs, there is a lack of articles in the literature with regards to clear surgical outcomes, as well as management algorithms in type IV PEHs. This study aims to compare outcomes in type IV vs. type III PEHs after surgical repair. Methods A retrospective study of patients who underwent laparoscopic PEH hernia repair (LPEHR) was conducted in a single institution between 2006 and 2020. Patient baseline characteristics and surgical outcomes were analyzed. Results A total of 103 patients were included in the analysis. Patients presenting with type IV PEHs (12/103) were significantly older than patients with type III PEHs (91/104) (75.25 +/- 7.15 vs. 66.91 +/- 13.58 respectively (p = 0.039), and more fragile with a higher Charlson Comorbidity Index (CCI) (4.25 +/- 1.48 vs. 2.96 +/- 1.72, p = 0.016). Operative time was significantly longer (243 +/- 101.73 vs. 133.38 +/- 61.76, p = 0.002), and postoperative morbidity was significantly higher in type IV PEH repair (50% vs. 8.8% type III, p = 0.000). Conclusion Patients with type IV PEHs appear to be older and frailer. The higher incidence of postoperative complications in patients with type IV PEHs should advocate for a precise indication for surgical treatment, which should be performed in centers of expertise
Distal pancreatectomy in the new era of minimally invasive surgery: the on-going debate on the cost-effectiveness
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Effects of Laparoscopic Sleeve Gastrectomy on Gastric Structure and Function Documented by Magnetic Resonance Imaging Are Strongly Associated with Post-operative Weight Loss and Quality of Life: a Prospective Study
No full textBackground This prospective study applied magnetic resonance imaging (MRI) to assess the effect of laparoscopic sleeve gastrectomy (LSG) on gastric structure and function. The impact of these changes on patient outcomes was analyzed. Method Obese patients without gastrointestinal symptoms referred for bariatric surgery were recruited prospectively. Pre-operative assessment included (i) high-resolution manometry and pH-impedance monitoring and (ii) magnetic resonance imaging (MRI) measurement of gastric capacity, accommodation, and emptying with the 400 ml liquid Nottingham test meal (NTM). Studies were repeated 6-7 months after LSG. Weight loss and changes in the Gastrointestinal Quality of Life Index (GIQLI) assessed patient outcomes. Results From 35 patients screened, 23 (66%) completed the study (17 females, age 36 +/- 10 years, BMI 42 +/- 5 kg/m2). Mean excess weight loss was 59 +/- 18% at follow-up. Total gastric volume (capacity) after the meal was 467 mL (455-585 ml) before and 139 mL (121-185 ml) after LSG (normal reference 534 (419-675) mL), representing a mean 70% reduction (p < 0.0001). Similar findings were present for gastric content volume indicating rapid early-phase gastric emptying (GE) post-LSG. Conversely, late-phase GE was slower post-LSG (2.5 +/- 1.0 vs. 1.4 +/- 0.6 mL/min;p < 0.0001; (reference1.5(1.4-4.9) mL/min)). Patients with >= 80% reduction in gastric capacity had greater weight loss (p = 0.008), but worse gastrointestinal outcomes (p = 0.023). Conclusions MRI studies quantified the marked reduction in gastric capacity after LSG. The reduction in capacity was associated with rapid early- but slow late-phase GE after surgery. These changes were associated with weight loss; however, reductions in gastric capacity >= 80% were linked to increased acid reflux and impacted on gastrointestinal quality of life
Patient-specific stomach biomechanics before and after laparoscopic sleeve gastrectomy
Get PDFBackground Obesity has become a global epidemic. Bariatric surgery is considered the most effective therapeutic weapon in terms of weight loss and improvement of quality of life and comorbidities. Laparoscopic sleeve gastrectomy (LSG) is one of the most performed procedures worldwide, although patients carry a nonnegligible risk of developing post-operative GERD and BE. Objectives The aim of this work is the development of computational patient-specific models to analyze the changes induced by bariatric surgery, i.e., the volumetric gastric reduction, the mechanical response of the stomach during an inflation process, and the related elongation strain (ES) distribution at different intragastric pressures. Methods Patient-specific pre- and post-surgical models were extracted from Magnetic Resonance Imaging (MRI) scans of patients with morbid obesity submitted to LSG. Twenty-three patients were analyzed, resulting in forty-six 3D-geometries and related computational analyses. Results A significant difference between the mechanical behavior of pre- and post-surgical stomach subjected to the same internal gastric pressure was observed, that can be correlated to a change in the global stomach stiffness and a minor gastric wall tension, resulting in unusual activations of mechanoreceptors following food intake and satiety variation after LSG. Conclusions Computational patient-specific models may contribute to improve the current knowledge about anatomical and physiological changes induced by LSG, aiming at reducing post-operative complications and improving quality of life in the long run
First world report of ICG fluorescence angiography integrated in the HUGOTM RAS system: assessment of bowel perfusion during fully robotic right hemicolectomy for cecal cancer
No full text: Indocyanine green (ICG) fluorescence angiography has rapidly spread due to its application in colorectal surgery in evaluating tissue perfusion. Simultaneously, new robotic platforms have been developed recently and used to perform several surgical procedure. We present the first application of the ICG fluorescence system RUBINA integrated in the HUGO RAS system in general surgery.A fully robotic right hemicolectomy was performed for a male patient suffering from cecal cancer using the HUGO RAS system. ICG fluorescence was used to assess tissue perfusion of the ileal and colic stumps before and after ileocolic anastomosis. The ICG fluorescence clearly showed with different modalities a good perfusion of the anastomosis. Moreover, the use of the integrated system with the HUGO platform was safe and easy to interpret in real-time
Endoscopic assessment of morphological and histopathological upper gastrointestinal changes after endoscopic sleeve gastroplasty
No full textBackground: Endoscopic sleeve gastroplasty (ESG) is a promising bariatric endoluminal procedure. Restriction and shortening of the stomach are obtained by means of non-resorbable full-thickness sutures, thus inducing the formation of several endoluminal pouches in which food can stagnate. The effect of ESG on the upper gastrointestinal tract has never been investigated.Objectives: This study objectively evaluates endoscopic macroscopic and histopathologic changes within 12-month follow-up (FU) in patients who underwent ESG.Setting: Retrospective study on a prospective database of patients who underwent ESG at our tertiary referral center between October 2016 and March 2019.Methods: All consecutive patients undergoing upper endoscopy (EGD) preoperatively and 6 and 12 months after ESG were included. The upper gastrointestinal tract was evaluated for mucosal abnormalities and biopsies were systematically taken.Results: Eighty-six patients were included. EGD results were as follows: esophagitis decreased from 14% preoperatively to 3.6% and 1.2% at 6-and 12-month FU, respectively (P = .001); 19.8% of patients presented preoperatively a type I hiatal hernia <4 cm and showed no size increment or de novo hiatal hernia at 6- and 12-months. The rate of preoperative hyperemic (23.2%) and erosive (3.5%) gastropathy decreased to 9.5% and 1.2% at 6 months and 17.4% and 1.2% at 12 months, respectively. Gastric ulcer (4.7%), duodenal hyperemic mucosa (1.2%) and duodenal micro-ulcerations (2.3%) detected preoperatively were not present at 6- and 12-month EGD. The rate of histopathological disease, which was 68.1% preoperatively, dropped to 29.2% at 12 months, chronic gastritis decreased from 40.3% to 26.4%, acute gastritis from 9.7% to 0%, and acute inflammation on chronic gastritis from 18% to 2.8% (P < .001).Conclusion: ESG is a safe procedure that does not promote the new onset of macroscopic and histopathologic abnormalities within 1-year follow-up. (C) 2021 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved
Response to the letter to the editor: Hyperglycemia or inappropriate fluid therapy
No full textWe thank Dr. Tez for his comments on our recent publication entitled “Postoperative hyperglycemia affects survival after gastrectomy for cancer: A single-center analysis using propensity score matching.”1 His Letter to the Editor raises an interesting and debated topic in abdominal surgery, namely the perioperative management of fluid and electrolytes. In this regard, multiple recent studies underlined the benefits of a restricted, intraoperative and postoperative strategy of fluid management. More specifically, these studies showed a decrease in postoperative mortality as well as the rates of gastrointestinal, cardiac, and pulmonary complications when a restricted fluid regimen is employed.2
Despite these premises, our study was conducted during a time period when the restricted fluid regimen was not routine practice. This explains the “liberal” fluid regimen we used during the study period. Its principle was based on the idea that adequate fluid support is mandatory after long duration, open abdominal operations. To verify the adequateness of the fluid volumes, several parameters were monitored, namely urine output, blood pressure, heart rate, and the daily output from nasogastric tube and surgical drains; adjustments of fluid therapy were made on the basis of these parameters as needed.
Based on the evidence reported in the literature, however, we more recently changed our policy of fluid management. More specifically, the intraoperative infusion of fluid monitoring is based currently on the principles of goal-directed, hemodynamic therapy.3 Additionally, we also changed our postoperative fluid management in favor of a restricted fluid infusion. Moreover, we are applying the principles of the Enhanced Recovery After Surgery protocol4 to the majority of patients, with a consequent early oral feeding beginning the first day postoperatively
Editorial: New technological frontiers in the diagnosis and treatment of gastrointestinal cancers
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Capsule Endoscopy Versus Colonoscopy in Patients With Previous Colorectal Surgery: A Prospective Comparative Study
No full textBackground: Colonic capsule endoscopy (CCE) derived from the video capsule endoscopy, initially proposed to explore the small bowel, has demonstrated high sensitivity and specificity for colonic polyp detection. The primary outcome of the study was to assess the safety, feasibility, and reliability of CCE after colorectal surgery. Secondary outcomes were to identify the detection rate of colonic lesions and recognition of the surgical anastomosis as compared to colonoscopy.Methods: This is a prospective single-center study conducted over a 2-year period. Thirty-seven patients with a history of colorectal surgery were prospectively included in this study. Each patient received both CCE and colonoscopy, performed by different operators blinded to each other's results.Results: Thirty-two patients (86.5%) completed the study and were included in the final analysis. All capsules were naturally expelled. In three patients (9.4%), the anal verge was not identified during the CCE recording and the examination of the colon was considered incomplete. Surgical anastomosis was accurately identified by CCE in 78.2% of the patients versus 93.8% for colonoscopy (P = 0.65). Thirty-eight lesions were detected in 14 patients. The sensitivity of CCE to detect colonic polyps was 95.2% (95% confidence interval (CI): 77.3-99.2%), the specificity 82.4% (95% CI: 59.0-93.8%). Positive predictive value (PPV) and negative predictive value (NPV) of CCE to detect colonic polyps were 87.0% and 93.3%, respectively. No complications related to the passage of the capsule through the intestinal anastomosis were detected.Conclusions: CCE proved to be safe and feasible, reporting a similar detection rate of colonic lesion compared to colonoscopy
Billroth II reconstruction in gastric cancer surgery: A good option for Western patients
No full textPurpose: The aim of this study is to report the short and long-term results of a cohort of patients who underwent Billroth II (BII) Distal Gastrectomy (DG) for gastric cancer (GC), in a tertiary referral Western center. Methods: From January 2005 to December 2015, a prospective observational study was conducted in candidate patients to elective gastrectomy for cancer. Results: Among 514 patients observed with GC, a series of 258 patients underwent BII DG for middle/lower third GC. Postoperative mortality and complication rates were 1.5% and 12.4% respectively. The overall and disease-free 5-year survival rates were 78% and 69%, respectively. Young age, lymph nodes retrieved, radicality of resection, and early tumor stages were independent positive prognostic factors at multivariate analysis for 5-year overall survival. Abdominal complications and advanced tumor stages negatively influenced 5-year disease-free survival at multivariate analysis. Conclusion: BII provides excellent results in terms of short and long-term prognosis and should be regarded as an acceptable reconstructive option following DG for GC
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