Abdominal Surgery Research Articles

Impact of American College of Surgeons Geriatric Surgery Verification Program in Patients Undergoing Major Abdominal Oncologic Operation at a Cancer Center.

Patients older than 65 years have unique needs and treatment outcomes goals. The objective of this study was to evaluate the impact of Geriatric Surgery Verification (GSV) initiative in oncology patients ≥65 years undergoing major abdominal surgeries. We implemented the American College of Surgeons' GSV program protocols for patients 65 and older starting in 2022. A retrospective review was conducted of patients undergoing major abdominal oncologic surgeries from January 2021 through December 2022 to create pre-GSV and post-GSV initiative cohorts. Main outcomes variables were postoperative institutionalization and change in the patient's primary residence disposition (measured as primary residence score, PRS, as a proxy for loss of independence). 57 patients in the control group and 43 patients in the intervention group met inclusion criteria. The average age was 76.5 and 75 years, respectively. Patients were well matched for clinical and sociodemographic characteristics. The intervention group had a shorter mean length of stay (LOS) 4.4 ± 2.5 days vs 6.5 ± 3.6 days in control group (p<.01) and were less likely to be newly discharged to an institution (7.3% vs 24.1%, p=0.03). The GSV initiative was associated with 72% lower odds of increased PRS (i.e. care needs) at time of discharge (OR 0.28, 95% CI 0.1 - 0.81). The GSV initiative intervention in geriatric oncology patients undergoing major abdominal surgeries was associated with reducing postoperative institutionalization and change in primary residence disposition. Further studies to explore different mechanisms within GSV that lead to improved outcomes in geriatric oncologic population will be informative.

Does Prior Lower Abdominal Surgery Prevent Laparoscopic Hernia Repair (Totally Extraperitoneal or Transabdominal Preperitoneal)? A Prospective Observational Study.

Objective: Totally extraperitoneal (TEP) surgeries were considered contraindicated in patients who underwent lower abdominal surgery until recently. However, in recent surgeries, it has been reported that they can be performed safely in those cases. Our aim in this study is to investigate the effectiveness of laparoscopic hernia repair methods in patients who have and have not had lower abdominal surgery before. Patients and Method: This study was a prospective observational study between May 2018 and May 2023. Two hundred eighty-eight patients were included in the study. The operation was started with the TEP technique in all patients. Patients, classified in two groups who had not previously undergone abdominal surgery (n = 216) (Group I) and who had surgery (n = 72) (Group II). Demographic characteristics of patients, intraoperative and postoperative complications were determined. In addition to descriptive statistical methods (mean, standard deviation), Shapiro-Wilk normality test, independent t test, and chi-square test were used to evaluate the data. Logistic regression analysis was performed to determine the factors affecting the presence of Previous Surgery and Peritoneal Tear. Results were evaluated at the significance level of P < .05. Results: Two hundred fifty-nine patients were operated with TEP method. TEP method was converted to transabdominal preperitoneal (TAPP) in 9 patients from Group I and 20 patients from Group II. Intraoperative and postoperative complications were recorded. Conclusion: With increasing experience in laparoscopic hernia surgery, it is now possible to perform hernia surgeries with preperitoneal (TEP) and abdominal approaches (TAPP) in patients who have previously undergone lower abdominal surgery.

Post Operative Epidural Analgesia in Pediatric Abdominal Surgery: Comparison of Clonidine and Dexmedetomidine as an Adjuvant

Background: A Caudal epidural block is considered as one of the most common regional techniques in pediatric anesthesia. The latest addition to the group of adjuvants for caudal analgesia is α2 agonists namely Clonidine and Dexmedetomidine. This study includes a comparison of clonidine and dexmedetomidine as an adjuvant to bupivacaine in caudal epidural anesthesia for postoperative pain relief in the pediatric population. Methods: This study was performed on 60 children, aged 1 year to 6 years, of ASA physical status I and II, undergoing elective infra-umbilical surgeries under general anesthesia. The patients were assigned randomly into two groups of 30 patients each, caudal epidural was given in all patients according to their group, after giving general anaesthesia. Group A (n=30) - patient received 0.125% bupivacaine (1ml/kg) with 0.5mcg/kg Dexmedetomidine. Group B (n=30)- patient received 0.125% bupivacaine (1ml/kg) with 0.5mcg/kg Clonidine. The patients were observed postoperatively for the duration and effect of caudal analgesia, (using the CHEOPS Score - Children’s Hospital of Eastern Ontario Pain Scale), frequency and total dose of supplementary analgesic required, sedative effect (Modified Ramsay Sedation Score), perioperative hemodynamic parameters, and complications. Results: The duration of Caudal analgesia without the need of supplementary analgesic is significantly higher in dexmedetomidine group (743 ± 73.6 min) than clonidine group (181.7 ± 53.60 min) and the total dose of supplementary analgesic (Inj. Paracetamol 15mg/kg i.v) required is significantly higher in clonidine group (491.5 ± 134.55 mg) as compared to dexmedetomidine group (236.5 ± 113.68 mg). Conclusion: Addition of dexmedetomidine (0.5 mcg/kg) to caudal 0.125% bupivacaine (1ml/kg) produces a significantly longer duration of postoperative analgesia, less frequency, and dose of rescue analgesic required for postoperative analgesia in children, aged between 1 to 6 yrs as compared to a similar dose of clonidine used in caudal epidural for infra umbilical surgeries.

Outcomes of a delirium prevention program after major abdominal emergency surgery: An interventional study.

Postoperative delirium is a common complication after emergency surgery. Delirium is associated with increased morbidity and mortality. Clinical approach varies and pharmacological treatment is ineffective. We aimed to investigate if a structured non-pharmacological multidisciplinary intervention could reduce postoperative delirium. An interventional study including all patients aged 65years or older undergoing major abdominal emergency surgery in an 8month period. The intervention consisted of improved screening, staff, patient, and family education, ward modifications and nurse-led daily motor and sensory stimulation. Data was obtained from medical records. Results were compared to an unmatched historic cohort. Primary outcome was occurrence of delirium, secondary outcomes were mortality, postoperative complications, and length of stay. 312 patients were included, 81 in the study group and 231 in the control group. Delirium occurred in 6.2% of the interventional group compared to 15.2% in the historic cohort (p=0.038). In a multivariate regression analysis, the rate of delirium was significantly reduced in the interventional group; OR 0.185 95% CI (0.04-0.81), p=0.026. The 90day mortality was 14.8% in the interventional group and 8.7% in the historic cohort (p=0.116). The rate of overall medical complications was significantly lower in the study group (37% vs. 63%, p<0.001). Median length of stay was 6days in both groups. A structured cluster intervention may prevent the occurrence of postoperative delirium. The intervention did not reduce mortality or length of stay, but the need for supplementary nursing staff was eliminated.

Engineered Lubricative Lecithin-Based Electrospun Nanofibers for the Prevention of Postoperative Abdominal Adhesion

Background: Postoperative abdominal adhesion is a prevalent complication following abdominal surgery, with the incidence of adhesion reaching up to 90%, which may precipitate a range of adverse outcomes. Although fibrous membranes loaded with various anti-inflammatory or other drugs have been proposed for anti-adhesion, most of them suffer from drug-induced adverse effects. Methods: In this study, a lecithin-based electrospun polylactic acid (PLA) nanofibrous membrane (L/P-NM) was developed for the prevention of postoperative abdominal adhesion, utilizing the hydration lubrication theory. The loaded zwitterionic lecithin allows the nanofiber surface to strongly bind water molecules to create a hydration lubrication interface. Results: As the TGA results show, the content of bound water in the nanofibers increased significantly with the increase in the lecithin content. Tribological test results show that L/P-NM reached a minimum coefficient of friction (COF) of about 0.112. Additionally, the developed nanofibrous membranes possess favorable tensile property and biocompatibility. Rat postoperative abdominal adhesion model evaluation results demonstrated that L/P-NM possesses significant anti-adhesive performance, with an adhesion score of only 1. Conclusions: Therefore, this study offers a promising strategy for efficiently preventing abdominal adhesion.

Preoperative skin asepsis in bovine surgery: an outcome-blinded 3-arm randomized clinical trial under non-sterile operating room conditions

BackgroundSurgical site infections (SSI) following clean abdominal surgery in cattle pose significant economic and welfare concerns. Preoperative skin asepsis aims to minimize microbial load over the surgical field before and throughout surgery to minimize its risk. While chlorhexidine (CHX) and povidone-iodine (PVI) are commonly used antiseptics for this purpose, our study introduces the so far unexplored use of octenidine (OCT) in veterinary surgery.MethodsWe compared in a single-center, prospective, randomized, outcome-blinded, 3-arm trial the effectiveness of an OCT-based protocol to CHX- and PVI-based protocols. Cattle aged 2 years or older, needing a clean standing flank laparotomy (e.g., exploratory laparotomy, right flank omentopexy, left flank abomasopexy), were eligible. Exclusion criteria comprised skin abnormalities, recent antibiotic use, or debilitating conditions with systemic involvement or distant site infections. Patients were randomized 1:1:1 with concealed allocation using unique identifiers. Skin bacterial reduction (immediate [IRF] and delayed [DRF] reduction factors), SSI rate, and wound scores were evaluated. Wound scores were rated on a 0 to 6 scale, considering the presence and severity of discharge and swelling.ResultsOut of 373 assessed cattle, 126 were included and randomized: PVI (n = 42), CHX (n = 41), OCT (n = 43). All protocols significantly reduced bacterial counts, with PVI exhibiting lower IRF. No significant differences were observed in DRF. The summer season and duration of surgical procedures had a negative impact on IRF and DRF in all groups, respectively. Nine of 118 patients (7.6%) with complete follow-up developed SSI. Higher wound scores were associated with development of SSI. Wound scores ≥3 at day 10 postoperatively predicted SSI with high sensitivity and specificity. Microbial flora in SSI included typical skin bacteria and opportunistic pathogens.ConclusionAll protocols met minimum FDA standards in reducing bacterial colonization. While limited by sample size and single-center design, this study confirms the OCT-based protocol as a valuable option for preoperative skin asepsis in clean abdominal bovine surgery.

Study on the role of postoperative rehabilitation based on the ERAS concept for patients undergoing pancreaticoduodenectomy: Protocol for a randomized controlled clinical trial.

Pancreaticoduodenectomy (PD), an abdominal surgery, is known for its complexity, cost and inherent risks. Recently, there has been increasing interest in enhanced recovery after surgery (ERAS) as a therapeutic approach. However, the mechanisms underlying postoperative functional recovery remain uncertain, and there are limited data on the efficacy of ERAS in postoperative physiotherapy following complex PD. This study aims to examine the feasibility and effectiveness of conducting a large powered randomized controlled trial (RCT) to evaluate a 2-week postoperative rehabilitation program based on the ERAS concept for patients undergoing pancreaticoduodenectomy. This study is a RCT with a single treatment group. From June 2022 to June 2024, 28 PD patients will participate in the trial. Patients will be randomly assigned to either a control group receiving standard clinical care or an intervention group undergoing a 2-week postoperative rehabilitation program. Cardiopulmonary function will be assessed using the 6-minute walk test (6MWT), and gastrointestinal (GI) recovery will be evaluated using the Intake, Feeling nausea, Emesis, physical Exam, and Duration of symptoms (I-FEED) scoring system. Secondary outcomes, including changes in recovery quality post-surgery, will be evaluated using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30) and the Quality of Recovery Questionnaire (QOR-40). Additional recorded items will include time to first flatus and feces, daily volume of stomach fluid, time to gastric tube removal, length of hospital stay (LOS), and postoperative complications. The study will utilize the I-FEED score, a novel tool for assessing GI function, to monitor the impact of a 2-week postoperative rehabilitation exercise program on patients. The primary outcome will focus on improvements in cardiopulmonary capacity following postoperative rehabilitation activities.

A "Janus" Zwitterionic Hydrogel Patch for Tissue Repair and Prevention of Post-Operative Adhesions.

Anti-peritoneal adhesions (PA) are very important after abdominal surgery for that PA often leads to other medical problems and imposes a huge financial burden on the national healthcare system. In this work, a "Janus" zwitterionic hydrogel patch where one side can adhere firmly to the tissue, while the other side has anti-fouling properties and has little interaction with the surrounding tissue has been developed. The "Janus" hydrogel patch is prepared by in situ formation of a bonding polymer layer poly(acrylic-co-N-hydroxysuccinimide acrylate) on one side of zwitterionic hydrogel. The mechanical, swelling, adhesion, biodegradability and biocompatibility tests are performed to study the function of "Janus" hydrogel patch to prevent wound adhesion and rapid repair. It is found that the adhesive side of the hydrogel patch has stable adhesion to tissues, avoiding the slippage faced by many commercial anti-adhesion gels in the body. The other zwitterionic side can resist proteins and fibroblasts and prevent external interactions or adhesion with other tissues. This convenient and effective method provides a new idea for the design of postoperative anti-adhesion materials and broadens the application of hydrogels in the biomedical field.

Urinary incontinence in elite female powerlifters aged 20-30: correlating musculoskeletal exam data with incontinence severity index and survey data.

Urinary incontinence (UI) in the powerlifting community has been a hot topic due to its noticeability during competition and the burden it places on female athletes who experience it. UI is even experienced in those we least expect: young, high-performing, females with no history of pregnancy. Current studies have utilized primarily survey methodology, thus there is a lack of clinical information on this topic. Furthermore, the top athletes are underrepresentedbecause previous surveys were open to anyone reporting themselves as a powerlifter, regardless of competition level. The objectives of this study were to determine whether UI in elite female powerlifters is correlated with any musculoskeletal diagnoses and to further evaluate potentially contributing factors for UI within this group. Subjects underwent an osteopathic structural examination and then completed two surveys: the Incontinence Severity Index (ISI/Sandvik Test for Urinary Incontinence) and the Study Questionnaire. In total, there were 31 female participants, all of whom were in the top 2 % of powerlifters in the world between the ages of 20 and 30 years old (as of May 21, 2023) and reside in the United States. The survey results displayed a moderately positive relationship between age (rho=0.449, where rho refers to Spearman's rho), history of pelvic floor examination (rho=0.413), and self-care practice with ISI (rho=0.340). Other survey information such as weight class, height, best total in competition, number of years training, average duration of training day, confidence in ability to contract pelvic floor muscles, history of abdominal or pelvic surgery, history of urinary tract infection (UTI), and sexual activity status all had rho values less than 0.300. With atlantoaxial (AA) rotation to the right, there was an increase in ISI score (p=0.009). Similarly, with AA rotation to the left, there was a decrease in ISI score (p=0.030). All patients with severe ISI had nonphysiologic sacral dysfunctions (p=0.051). Severe ISI-scored participants were more likely to yield a dysfunctional clavicle upon screening (p=0.027). There was a strong correlation between increasing severity of UI and findings of a restricted right clavicle and/or AA rotation to the right (p=0.010). In addition, there were only two individuals with both a restricted right clavicle and AA rotation to the right, and these two individuals both scored severe on the ISI (p=0.012). A pelvic diaphragm dysfunction was present in 74.2 % of the participants. Extension diagnoses of the lumbar spine were found in those with mild UI over those with severe UI (p=0.012). Most other diagnoses were largely unremarkable due to a wide distribution across all ISI scores. Our study revealed a relationship between UI and somatic dysfunctions in this population. These findings may help providers, especially in the fields of primary care, sports medicine, and urogynecology, to expand treatment options for UI in this group in the future. Survey results yielded a positive relationship of moderate strength between age, history of pelvic floor exination, and engaging in leakage prevention practices with ISI. No survey category was found to have a relationship of high strength with ISI. These findings contribute to our knowledge on factors that do (or do not) contribute to incontinence severity.

Comparison of erector spinae plane block and transverse abdominis plane block in postoperative recovery after laparoscopic colorectal surgery: a randomized, double-blind, controlled trial

BackgroundPatients experience significant postoperative pain after laparoscopic resection of colorectal cancer. Transversus abdominis plane block (TAPB) provides effective analgesia, and recent studies have also shown that erector spinae plane block (ESPB) can be used for postoperative analgesia in abdominal surgery. However, there is a lack of comparison between the two methods regarding recovery quality following laparoscopic colorectal surgery.MethodsSixty patients scheduled for laparoscopic radical resection of colorectal cancer were randomly assigned to receive either a ESPB with TAPB (n = 30). Both groups received a single injection of 20 mL of 0.25% ropivacaine bilaterally. The primary outcome was the quality of recovery (QoR) at 24 h postoperatively, using the quality of recovery-15 (QoR-15) scale. Secondary outcomes included the QoR at 48 h postoperatively, visual analogue scale (VAS) pain scores during the first 48 h postoperatively in both resting and active states, requirements for rescue analgesia, cumulative postoperative opioid consumption, patient satisfaction, incidence of postoperative nausea and vomiting (PONV), time to first flatus and ambulation, the Comprehensive Complication Index (CCI) score, and postoperative hospital stay.ResultsAt 24 h postoperatively, the QoR-15 score (mean ± standard deviation) was significantly higher in the ESPB group (109.2 ± 8.7) compared to the TAPB group (101 ± 10.1) (p = 0.001). Similarly, at 48 h postoperatively, the QoR-15 score remained higher in the ESPB group (118.5 ± 8.8) than in the TAPB group (113.8 ± 8.1) (p = 0.035). Patients in the ESPB group reported lower visual analog scale (VAS) pain scores during the first 24 h postoperatively (all p < 0.05) compared to those in the TAPB group. The sufentanil consumption median (interquartile range) in the ESPB group at 24 h postoperatively was lower (62, 61–65 μg) compared to the TAPB group (66, 63–70 μg) (p < 0.001). Hospital stay median was 7 (6–9) days for the ESPB group and 8 (7–10) days for the TAPB group (p = 0.037).ConclusionsPatients who received ESPB showed better recovery quality, improved analgesic effects, and higher postoperative satisfaction compared to those who underwent preoperative TAPB.Trial registrationhttps://www.chictr.org.cn (ChiCTR2400081157); date of registration: February 24, 2024. The first participant was enrolled on February 27, 2024.

Troponin T and Frailty in Emergency Abdominal Surgery: Methodological Questions.

Troponin T and Frailty in Emergency Abdominal Surgery: Methodological Questions.

A right colectomy case study: transitioning to the Hugo RAS system with a novel 3-ports technique in experienced robotic colorectal practice.

Advancements in robotic technology have revolutionized general surgery, with new platforms and continuous improvements enhancing surgical procedures. Our unit adopted the Da Vinci Si model in 2012 and later the X model for various abdominal surgeries. In early 2023, we integrated the Hugo RAS system by Medtronic into our practice following comprehensive training. This study examines the transition of experienced robotic surgeons from the Da Vinci platform to the Hugo RAS system, focusing on robotic right hemicolectomy. We conducted a retrospective analysis of consecutive adult patients who underwent robotic right hemicolectomy using the Da Vinci X and Hugo RAS systems. Outcomes from the latest seven cases with the Da Vinci X system were compared to the initial seven cases with the Hugo RAS system. The baseline characteristics of the two groups were comparable, with no significant differences in age, sex, comorbidities, ASA score, or BMI. Operative times showed a trend towards being shorter with the Da Vinci X (127 ± 30min) compared to the Hugo RAS (163 ± 43min), but this was not statistically significant (p = 0.2). Other measures, including blood loss, anastomotic configuration, and length of hospital stay, were similar. Two non-surgical postoperative complications occurred in the Hugo RAS group, with no complications in the Da Vinci X group. There were no 30-day readmissions or reoperations in either group. Experienced robotic surgeons can seamlessly transition to the Hugo RAS system for right hemicolectomy, achieving comparable outcomes to the Da Vinci system.

A novel nomogram prediction model for postoperative atrial fibrillation in patients undergoing laparotomy

BackgroundPostoperative atrial fibrillation (POAF) is an ordinary complication of surgery, particularly cardiac surgery. It significantly increases in-hospital mortality and costs. This study aimed to establish a nomogram prediction model for POAF in patients undergoing laparotomy. The model is expected to identify individuals at a high risk of POAF before surgery in clinical practice.MethodsA retrospective observational case–control study involving 230 adult patients (60 patients with POAF, 120 patients in the control group, and 50 patients in the validation group) who underwent laparotomy was retrieved from two hospitals. Independent risk variables for POAF were investigated using logistic regression and the least absolute shrinkage and selection operator (LASSO) regression analysis. Subsequently, a nomogram model for POAF was constructed by multivariate logistic regression equations. The prediction model was internally validated by bootstrap method and externally validated with the validation group data. To assess the discriminative ability of the nomogram model, a receiver operating characteristic (ROC) curve was generated and a calibration curve was employed to assess the concentricity between the model’s probability curve and the ideal curve. Subsequently, decision curve analysis (DCA) was performed to assess the clinical effectiveness of the model.ResultsC-reactive protein (CRP), lymphocyte-to-monocyte ratio(LMR), blood urea nitrogen (BUN), and Macruz index were independent risk variables for POAF in patients who underwent laparotomy. A user-friendly and efficient prediction nomogram was visualized using R software. This nomogram exhibited strong discrimination, as evidenced by an area under the ROC curve (AUC) of 0.90 (95% CI 0.8509–0.9488) for the training set, 0.86 (95% CI 0.7142–1) for the test set, and 0.9792 (95% CI 0.9293–1) for the validation group data. The C-index of the bootstrap nomogram model was 0.8998. Furthermore, DCA revealed that this model displayed excellent fit and calibration, as well as positive net benefits.ConclusionsA nomogram prediction model was constructed for POAF in patients who underwent abdominal surgery. The nomogram prediction model is expected to identify individuals at high risk of POAF in clinical practice for prophylactic therapeutic intervention prior to surgery.

Gastrointestinal cancer surgery in the elderly: The effects of preoperative oral nutritional supplements - A retrospective study.

The current study aimed to explore the effect of nutritional prehabilitation on the clinical prognosis of elderly patients undergoing abdominal cancer surgery. A retrospective study was conducted, where participants were divided into two groups based on whether they received oral nutritional supplementation at the first outpatient visit. The nutritional prehabilitation group (n=41) adopted a nutritional prehabilitation mode (a standard energy intake of 25-30 kcal/kg· d was recommended). While the control group (n=55) received routine care. All patients underwent laparoscopic surgery according to the National Comprehensive Cancer Network (NCCN) guidelines. Changes in nutritional status, complications, psychological status, symptoms, hospitalization days, and expenditures were compared between the two groups. Both groups of patients experienced weight loss. However, the decline in body weight in the prehabilitation group was less than that in the control group (-1.88 vs. -2.56 kg, p < 0.001). In the comparison of nutritional prehabilitation group and control group, significant improvements were observed in the Hospital Anxiety Scale scores (5 vs. 5, p = 0.01) and MD Anderson Symptom Inventory scores (3 vs. 0, p < 0.001) respectively. The infection rate in the nutritional prehabilitation group was lower than that in the control group (17.1% vs. 36.4%, p = 0.04). Additionally, patients in the nutritional prehabilitation group had significantly fewer hospitalization days at discharge (14.3 vs. 17.1 days, p = 0.03). In elderly patients undergoing abdominal cancer surgery, a nutritional prehabilitation model may help maintain better physical and mental status, reduce infection rates, and shorten hospitalization days.

Associated factors with non[sbnd]operative management failure in bowel obstruction

BackgroundBowel obstruction caused by adhesion syndrome is a prevalent condition in emergency departments, presenting significant economic and morbidity challenges. While nonsurgical approaches succeed in 70–90% of cases, surgery becomes necessary for nonresponsive patients. This study aims to identify predictors of non-operative management failure in patients with bowel obstruction upon emergency room admission. MethodsA retrospective cross-sectional analytical study was conducted from 2015 to 2022 at Hospital Militar Central, focusing on patients with bowel obstruction secondary to adhesion syndrome. Comparative analysis of medical and surgical histories and admission laboratory values aimed to identify possibles factors associated with non-operative management failure and subsequent surgical intervention. ResultsAmong 354 patients with bowel obstruction, 130 met inclusion criteria, of whom 98 responded to non-operative treatment and 32 experienced treatment failure. Significant differences were found between groups, including age (p: 0.035), history of two or more abdominal surgeries (10.2% vs. 25%, p: 0.01), appendectomy (17% vs. 37%, p: 0.01), previous surgical intervention for bowel obstruction (22.5% vs. 9.38%, p: 0.008), and hospital stay duration (4.26 vs. 13.2 days, p: 0.001). In multivariate analysis using Poisson regression, age had a prevalence ratio (PR) of 1.01 [95% CI (1.00; 1.02), p < 0.04] for non-operative management failure, the history of peritonitis had a PR of 3.83 [95% CI (2.34; 6.26), p < 0.001], while each unit increase in lactate showed a PR increase of 1.24 [95% CI (0.99; 1.57), p 0.05]. ConclusionAge, history of peritonitis, and elevated lactate values upon emergency room admission are predictive factors for non-operative management failure in bowel obstruction in the population studied.

Correlation between colonoscopy difficulty and personality traits: study protocol for a prospective, observational, multicentre study

BackgroundColonoscopy is widely used for screening and treatment of early colonic lesions and is critical for the early diagnosis of colorectal cancer. However, due to its invasive nature, colonoscopy can...

Delayed breast reconstruction with the thoracodorsal flap and endoprosthesis after complex treatment of breast cancer

Breast reconstruction with a thoracodorsal flap (TDF) in combination with a tissue expander/implant is a wellestablished technique.The purpose of the study was to present current data on the results of delayed breast reconstruction with thoracodorsal flap and tissue expander after combined/complex treatment in patients with breast cancer.Material and methods. The search for relevant sources was carried out in the PubMed, Cochrane Library, E-library systems, publications from 2014 to 2022 were studied. Delayed breast reconstruction using TDF in combination with a tissue expander/implant is a reliable method of reconstruction for the group of patients who have previously undergone radical mastectomy or adjuvant external beam radiation therapy in terms of combined/complex treatment of breast cancer, allowing to achieve good and excellent aesthetic results with a low incidence of surgical complications.Results and discussion. The use of the latissimus dorsi flap is a reliable and universal method of breast reconstruction, it allows achieving good and excellent aesthetic results, high patient satisfaction. Patients with a low body mass index or obesity, a history of abdominal surgery, including abdominoplasty, are not candidates for reconstruction using anterior abdominal wall flaps, and therefore the only possible method of breast reconstruction for them is the method using the TDF. In addition, the use of the TDF may be most appropriate for women who are planning a pregnancy in the future and for whom the use of anterior abdominal wall flaps will not be an optimal method of reconstruction due to reduced abdominal wall compliance. Other reasons why the use of TDF is the method of choice for many surgeons are the possibility of closing the donor site regardless of the size of the skin flap taken, the possibility of closing such defects of the mammary gland as extrusions, protrusions, in case of insufficiency of the skin cover after skin-preserving mastectomies.Conclusion. The use of the latissimus dorsi flap is a reliable and universal method of breast reconstruction, it allows achieving good and excellent aesthetic results, a high degree of patient satisfaction.

Innovative strategies for the rapid restoration of intestinal function in patients undergoing abdominal surgery: use of probiotics. Pilot study of 15 patients.

The clinical value of probiotics in patients undergoing abdominal surgery, particularly colorectal surgery, remains uncertain despite their well-documented health benefits. This pilot randomized controlled trial aimed to assess the effects of perioperative and postoperative oral administration of two probiotics, Clostridium butyricum CBM588® and Bifidobacterium longum ES1, on immune function, systemic inflammatory response, postoperative infections, and recovery after colorectal surgery. Fifteen adult patients underwent colorectal resection, with two groups receiving probiotics and one acting as a control. Blood and fecal samples were collected, and clinical parameters were assessed. Results showed the safety of probiotics, resistance to antibiotics and gastric acid, and potential benefits in reducing postoperative infections and intestinal inflammation. Future trials should provide more conclusive evidence on the efficacy and safety of perioperative probiotic administration in colorectal surgery, aiming for improved patient outcomes and reduced healthcare costs.

Aberrant Origin of Splenic Artery Detected by Computed Tomography Abdominal Angiogram: A Case Report

The splenic artery is one of the terminal arteries arising from the coeliac axis, supplying the spleen, pancreas and stomach. It courses along the superior border of the pancreas and travels into the splenorenal ligament and into the hilum of the spleen, accompanied by the splenic vein. The splenic vein joins with the superior mesenteric vein to form the portal vein. This is the most common anatomical pattern. Anatomical variations of the coeliac axis and splenic artery have been documented in the literature, but variations in the origin of the splenic artery are unusual and rare occurrences. This variation is important in the case of abdominal surgeries, like liver transplantation and pancreatic surgery. A 45-year-old male patient with cirrhosis of the liver underwent a Computed Tomography (CT) abdominal angiogram and Contrast-Enhanced Computed Tomography (CECT) abdomen as part of the assessment for liver conditions, portal hypertension, portosystemic collaterals and to rule out any hepatic neoplastic complications, like Hepatocellular carcinoma. In this patient, the splenic artery, instead of arising from the coeliac axis, was observed to originate from the superior mesenteric artery. Knowing this variation before surgery could prevent potentially lifethreatening complications like as intraoperative or postoperative intra-abdominal bleeding.

Joint Models Inform the Longitudinal Assessment of Patient-Reported Outcomes in Clinical Trials: A Simulation Study and Secondary Analysis of the Restrictive versus Liberal Fluid Therapy for Major Abdominal Surgery (RELIEF) Randomized Controlled Trial

Evaluate the utility of a joint model when analysing a patient-reported endpoint as part of a randomized controlled trial in which censoring occurs when patients die during follow-up. The present study comprises two parts: first we re-analyzed data from a previously published randomized controlled trial comparing two fluid regimens in the first 24 hours of major abdomino-pelvic surgery ('RELIEF' trial). In this trial, patient-reported disability was measured at multiple timepoints before and after surgery. Next, we conducted a simulation study to jointly emulate patient-reported disability and survival, similar to the RELIEF trial, under nine treatment-outcome scenarios. In both parts, we compared a joint model analysis to a linear mixed effect model combined with one of several traditional methods of handling longitudinal missingness: available data analysis, complete case analysis, last observation carried forward, and worst-case assumption. In part one, the joint model revealed no between-group differences in patient-reported disability at one, three, six, and 12 months after surgery. The worst-case approach consistently resulted in the largest deviation from the joint model estimates, although in this particular setting none of the approaches materially changed the study's conclusions. In part two, the simulations revealed that across all treatment-outcome scenarios, the joint model expectedly produced unbiased estimates of patient-reported disability. Similarly, employing an approach based on all available data (i.e., relying on the maximum likelihood estimator for handling missingness) yielded disability estimates close to the simulated values, albeit with slight bias across some scenarios. The last observation carried forward approach mirrored the joint model's estimates except when the treatment had a non-null effect on patient-reported disability. The worst case analysis resulted in high bias, which was particularly evident when the treatment had a large effect on survival. The complete case analysis resulted in high bias across all scenarios. In randomized trials that employ a patient-reported outcome as one of their endpoints, a joint model can address bias arising from informative missingness related to death. Methods for handling missingness based on all available data appear to be a reasonable alternative to joint models, with only slight bias across some simulated scenarios.