1,720,979 research outputs found
Classification of the severity of acute pancreatitis. How much is really needed a new classification.
No full textNon present
Barbed vs conventional sutures in bariatric surgery: a propensity score analysis from a high-volume center
No full textThe use of barbed sutures for constructing an anastomosis is favoured by a few bariatric surgeons as compared to conventional sutures. The aim of this study is to assess safety and efficacy of barbed sutures to close the gastric pouch-jejunal anastomosis (GPJA) in laparoscopic gastric bypass (Roux-en-Y gastric bypass-RYGB, and One-Anastomosis gastric bypass-OAGB) using propensity score-matching (PSM) analysis. A retrospective analysis of patients who underwent primary laparoscopic gastric bypasses between January 2012 and December 2017 was performed. Patients were divided into two different groups (RYGB-G and OAGB-G). PSM analysis was performed to minimize patient selection bias between the two types of sutures (barbed-BS and conventional-CS) in each group. A total of 808 patients were reviewed. After PSM, 488 (244 BS vs 244 CS) patients in RYGB-G and 48 in OAGB-G (24 BS vs 24 CS) patients were compared. Median operative time was significantly shorter (p < 0.001) for BS in RYGB-G. In OAGB-G, BS were associated with a shorter operative time, although no significant difference was observed (p = 0.183). Post-operative hospital stay was significantly shorter for BS in both the groups (p < 0.001). Post-operative 30th-day complications were comparable: no leakage or bleeding of GPJA was observed in BS groups. At median follow-up of 28.78 months, no late complications were observed. Barbed sutures appear to be effective to close GPJA during gastric bypass and as safe as conventional suture. Further studies are necessary to draw definitive conclusions
Prospective evaluation of total thyroidectomy versus ipsilateral versus bilateral central neck dissection in patients with clinically node-negative papillary thyroid carcinoma.
No full textBACKGROUND: Prophylactic central neck dissection (PCND) for papillary thyroid carcinoma (PTC) is controversial. We compared 3 different approaches to the management of central compartment nodes in patients with clinically unifocal and N0 PTC.
METHODS: A total of 186 patients were prospectively assigned to one of the following procedures: total thyroidectomy (TT), TT plus ipsilateral PCND (Ipsi-PCND), and TT plus bilateral PCND (Bil-PCND).
RESULTS: No difference was found concerning demographic, clinical or pathologic characteristics (P = NS). More patients in the Bil-PCND group had transient hypocalcemia (P < .001). One patient in the Bil-PCND group experienced permanent hypoparathyroidism (P = NS). One transient and one permanent unilateral laryngeal nerve palsy occurred in the Ipsi-PCND group (P = NS). Significantly more patients in the Bil-PCND and Ipsi-PCND groups had node metastases recognized (26 vs 18 vs 6; P < .001). Six of 26 pN1 patients (23%) in the Bil-PCND group had bilateral metastases. No difference was found concerning mean postoperative basal and stimulated thyroglobulin and mean postoperative radioiodine uptake. One patient in the Ipsi-PCND group experienced recurrent disease (P = NS).
CONCLUSION: TT seems adequate treatment for most patients with clinically N0 PTC. PCND could be considered for a more accurate staging. Ipsi-PCND could be a valid option, but it includes the risk of overlooking contralateral metastases
Can intraoperative frozen section influence the extension of central neck dissection in cN0 papillary thyroid carcinoma?
No full textPURPOSE: Ipsilateral central compartment node dissection has been proposed to reduce the morbidity of prophylactic bilateral central compartment node dissection in papillary thyroid carcinoma (PTC), but it carries the risk of contralateral metastases being overlooked in approximately 25 % of patients. We aimed to verify if frozen section examination (FSE) can identify patients who could benefit from bilateral central compartment node dissection.
METHODS: All the consenting patients with clinically unifocal PTC, without any preoperative evidence of lymph node involvement, observed between September 2010 and September 2011 underwent total thyroidectomy plus bilateral central compartment node dissection. Ipsilateral central compartment nodes were sent for FSE.
RESULTS: Forty-eight patients were included. Mean number of removed nodes was 13.2 ± 6.8. Final histology showed lymph node metastases in 21 patients: ipsilateral in 15, bilateral in 6. FSE accurately predicted lymph node status in 43 patients (27 node negative, 16 node positive). Five node metastases were not detected at FSE: three were micrometastases (≤2 mm). Sensitivity, specificity and overall accuracy of FSE in definition of N status status were 80.7, 100, and 90 %, respectively.
CONCLUSIONS: FSE is accurate in predicting node metastases in clinically unifocal node negative PTC and can be useful in determining the extension of central compartment node dissection. False-negative results are reported mainly in case of micrometastases, which usually have limited clinical implications
Open versus laparoscopic colorectal surgery in the era of multimodality treatment of cancer.
No full textAIM:
To compares the efficacy and safety of laparoscopic surgery (LS) and open surgery (OS). To analyze early results of a single institution experience using adjuvant intraoperative radiation therapy (IORT) presacral boost in locally advanced cancer.
MATERIAL OF STUDY:
264 patients with curable colorectal cancer undergoing laparoscopic (97) or open colorectal resection (167). In 41 patients (31 open and 10 laparoscopic resection) with locally advanced rectal cancer we performed IORT. Primary endpoints were the evaluation of postoperative clinical and oncologic results.
RESULTS:
Twenty (21%) patients underwent conversion from laparoscopic to open surgery. The overall morbidity rates were 17.5% in the LS group and 20.9% in the OS group (P= 0.5). Average operative time was shorter in the OS than in the LS series (P= 0.01). Use of parenteral narcotics was shorter in LS than in OS group (P <0.001), but there were more stoma creations in LS group than in OS group (P= 0.001). All patients are alive at different followup periods.
DISCUSSION:
Colorectal cancer is the second leading cause of death from malignancy in the industrialized world. The risk of local recurrence after treatment increases with tumor stage. The roles of radiochemotherapy and surgical procedures have been investigated extensively in the last decades, especially in locally advanced rectal cancer.
CONCLUSIONS:
Laparoscopic techniques can be applied to colorectal malignancies without sacrificing oncologic results. Multimodality treatment with LS and IORT is safe and feasibl
Barbed vs conventional sutures in bariatric surgery: a propensity score analysis from a high-volume center
No full textThe use of barbed sutures for constructing an anastomosis is favoured by a few bariatric surgeons as compared to conventional sutures. The aim of this study is to assess safety and efficacy of barbed sutures to close the gastric pouch–jejunal anastomosis (GPJA) in laparoscopic gastric bypass (Roux-en-Y gastric bypass—RYGB, and One-Anastomosis gastric bypass—OAGB) using propensity score-matching (PSM) analysis. A retrospective analysis of patients who underwent primary laparoscopic gastric bypasses between January 2012 and December 2017 was performed. Patients were divided into two different groups (RYGB-G and OAGB-G). PSM analysis was performed to minimize patient selection bias between the two types of sutures (barbed—BS and conventional—CS) in each group. A total of 808 patients were reviewed. After PSM, 488 (244 BS vs 244 CS) patients in RYGB-G and 48 in OAGB-G (24 BS vs 24 CS) patients were compared. Median operative time was significantly shorter (p < 0.001) for BS in RYGB-G. In OAGB-G, BS were associated with a shorter operative time, although no significant difference was observed (p = 0.183). Post-operative hospital stay was significantly shorter for BS in both the groups (p < 0.001). Post-operative 30th-day complications were comparable: no leakage or bleeding of GPJA was observed in BS groups. At median follow-up of 28.78 months, no late complications were observed. Barbed sutures appear to be effective to close GPJA during gastric bypass and as safe as conventional suture. Further studies are necessary to draw definitive conclusions
Role of CT imaging in discriminating internal hernia from aspecific abdominal pain following Roux-en-Y gastric bypass: a single high-volume centre experience
No full textInternal hernia (IH) represents a delayed complication of the laparoscopic Roux-en-Y gastric bypass (LRYGB) and it is historically difficult to identify preoperatively. Numerous CT signs were considered suggestive of IH but none of them is pathognomonic. In this study, we aim to evaluate the accuracy of CT in diagnosing IH, differentiating from non-specific abdominal pain. This can lead to a way of personalized medicine and improve the outcome of anti-obesity treatments. We retrospectively reviewed CT scans of 50 patients previously subjected to LRYGB procedure, with a clinical suspicion of IH. 3 groups of patients were identified: IH group (21 patients with a surgical confirmed IH), negative group (12 patients in whom IH was not confirmed at surgery), and control group (17 patients who were not surgically explored because of low/no suspicion of IH). We divided CT signs into three groups: "bowel loop signs", "vessel signs", and "venous congestion/stasis signs". The accuracy of CT in detecting IH was tested by comparing each sign, either individually or in combination, with the surgical findings. Statistical analysis showed that "vessel signs" (swirl sign, superior mesenteric vein beaking, mesenteric arteries, and veins branches inversion) present the highest distribution in patients with IH demonstrated at surgery, with a higher accuracy in case of simultaneous presence of two or three signs. CT imaging is highly accurate in diagnosing IH. Despite no single sign being pathognomonic, the combination of two or more signs, especially among the "vessels signs", can suggest the IH, even in pauci-symptomatic patients
- …
