Case-matched Study Research Articles

Gut symptoms in diabetics correlate with components of the rectoanal inhibitory reflex, but not with pudendal nerve motor latencies or systemic autonomic neuropathy.

Fecal incontinence (FI) occurs in up to 20% of diabetes mellitus (DM) patients. Rectoanal inhibitory reflex (RAIR) is an enteric anorectal reflex that reflects the integrity of mechanisms in the physiology of FI. We aimed to investigate whether diabetic patients with FI, not constipation, had prolongation of RAIR and altered gut-specific autonomic tone. In this prospective case-matched study 31 type I DM (19 FI and 12 constipation) and 42 type II DM (26 FI and 16 constipation). Another 21 participants were included as controls. Patients underwent the following assessments: cardiovagal autonomic tone (Modified Mayo Clinic composite autonomic severity score), rectal mucosal blood flow (RMBF) (assessment of gut-specific autonomic tone) and RAIR. Three phases of RAIR and the amplitude of maximal reflex relaxation were compared between groups. All participants completed symptom scores for FI and constipation. RAIR recovery time back to resting pressure was slower in diabetic patients with FI than controls (8.7 s vs 3.6 s, P < 0.05) and was an independent variable correlating with symptoms of FI (P < 0.05). RAIR recovery time was correlated with RMBF (r = 0.58, P = 0.04). RAIR is correlated with anorectal symptoms of FI and was associated with gut-specific autonomic neuropathy.

Increased risks of mortality and atherosclerotic complications in incident hemodialysis patients subsequently with bone fractures: a nationwide case-matched cohort study.

BackgroundHemodialysis (HD) patients with bone fractures have an increased risk for death. However, the risks for mortality and atherosclerotic complications in incident HD patients subsequently with bone fractures are unknown.MethodsData derived from the Taiwan National Health Institute Research Database between January 1997 and December 2008 was analyzed. The enrolled patients included 3,008 incident HD patients subsequently with a single long bone fracture (LB Fx) and 2,070 incident HD patients subsequently with a single non-long bone fracture (NLB Fx). These patients were matched (1:5 ratio) for age, sex, and same duration of HD with incident HD patients who had no fractures and outcomes were measured over a 3-year follow-up.ResultsAfter demographic and co-morbidity adjustment, LB Fx increased the risk for overall mortality (HR = 1.59, p < 0.001) and stroke (HR = 1.09, p = 0.028) in incident HD patients. NLB Fx increased the risk for overall mortality (HR = 1.52, p < 0.001), stroke (HR = 1.19, p < 0.001), coronary artery disease (CAD), (HR = 1.13, p = 0.003), and peripheral arterial occlusive disease (PAOD), (HR = 1.41, p < 0.001) in incident HD patients. Moreover, incident patients subsequently with NLB Fx had significantly higher risks of CAD and PAOD than those subsequently with LB Fx.ConclusionsThe rates of mortality and stroke were significantly higher in incident HD patients subsequently with bone fractures than in matched patients without bone fractures. Incident HD patients subsequently with NLB Fx had significantly higher risks of CAD and PAOD than those subsequently with LB Fx and without bone fractures. Thus, incident HD patients subsequently with bone fractures should be closely followed for a higher mortality and possible development of atherosclerotic complications.

Laparoscopic versus open liver resection for hepatocellular carcinoma: Case-matched study with propensity score matching

Laparoscopic liver resection has gained wide acceptance and is established as a safe alternative to open liver resection. Until now, there is no prospective randomized comparative study between laparoscopic and open liver resection. Previous comparative studies reported minor resections for peripheral tumors, and enrolled small numbers of patients. Moreover, few reported the long term outcomes. The aim of this study is to compare perioperative and long term outcomes of laparoscopic versus open liver resection for hepatocellular carcinoma between two matched groups. 389 patients underwent liver resection for hepatocellular carcinoma during the period between 2004 and 2013. To overcome selection bias, we performed 1:1 match using propensity score matching between laparoscopic and open liver resection. After propensity score matching, 88 patients were included in each group. Laparoscopic group had shorter hospital stay (8 vs. 10 days, p⩽0.001), and lower postoperative morbidity (12.5% vs. 20.4%, p=0.042). The 1-, 3- and 5-year overall survivals were 91.6%, 87.5%, and 76.4%, for laparoscopic group, and were 93.1%, 87.8%, and 73.2%, for open group (p=0.944). The 1-, 3- and 5-year disease free survivals were 69.7%, 52%, and 44.2%, for laparoscopic group, and 74.7%, 49.5%, 41.2%, for open group (p=0.944). Our study showed comparative perioperative and long term outcomes between both groups, providing evidence regarding the safety and efficacy of laparoscopic liver resection for hepatocellular carcinoma.

Mo1624 Comparative Analysis of Single Incision Colorectal Surgery in Obese and Non-Obese Patients: A Case-Matched Study

S A T A b st ra ct s therapy to treat LRRC remains controversial. Therefore, we retrospectively analyzed patients who underwent surgical treatment for LRRC, to evaluate the perioperative outcome and the prognosis. Methods: Forty-five patients (male-female ratio, 25:20), who underwent surgical treatment for LRRC in a single institution between 1990 and 2014, were clinicopathologically analyzed. Results: The mean age at surgical treatment for LRRC was 60 years old (range 36-87). Thirty-four patients (76%) were diagnosed as LRRC within three years after surgery for the primary tumor. Total pelvic exenteration, abdominoperineal resection or low anterior resection, and simple tumor excision were performed in 7, 27, and 11 patients, respectively. The median operative time, blood loss and hospital stay were 530 min, 2213 ml and 53 days, respectively. Out of 45 patients, 32 patients (71%) had curative (R0) resection and 13 patients (29%) had non-curative resection. The complications, such as intrapelvic abscess, urinary tract dysfunction, wound infection, and intestinal obstruction, were observed in 35 patients (75%) after surgical treatment for LRRC. There was no surgery-related death. Threeyear survival rate of all 45 patients and 35 patients with R0 resection were 53% and 73%, respectively. No three-year survivors were observed in the patients with non-curative resection. Conclusions: Although surgical treatment for LRRC is highly invasive, curative (R0) resection improves the outcome of the patients with LRRC.

Effects of antenatal magnesium exposure on intestinal blood flow and outcome in preterm neonates.

This study aims to investigate the effects of antenatal magnesium sulfate on intestinal blood flow in preterm neonates. In this prospective case-match study, 25 preterm neonates exposed to magnesium sulfate antenatally were included (study group). Overall, 25 gestational age-matched neonates who had no exposure to magnesium constituted the control group. Serial daily Doppler flow measurements of superior mesenteric artery (SMA) were performed. The time to reach full feeds, first meconium passage were assessed. Presence of feeding intolerance or necrotizing enterocolitis was recorded. Blood flow velocities of SMA were not different between the groups during the first five postnatal days. However, SMA blood flow showed an increasing trend in the control group unlike the study group (control group, p < 0.001; study group, p = 0.29). There was no significant difference between the two groups regarding the time to reach full feeds or first meconium passage and presence of feeding intolerance. No case of necrotizing enterocolitis was seen. Antenatal magnesium does not significantly affect intestinal blood flow, but it seems to attenuate the increasing trend of the intestinal blood flow in the early postnatal days. However, this study failed to show any impact of this finding on clinical outcomes.

Cost Analysis of Early versus Delayed Loop Ileostomy Closure: A Case-Matched Study

Background/Aims: The optimal timing for the closure of loop ileostomies remains controversial. The aim of the current study was to investigate whether early ileostomy closure (EC) (<2 weeks post-formation) results in significant healthcare savings as against late closure (LC). Methods: Patients with available cost data that underwent EC between January 2008 and December 2012 were compared against matched patients undergoing LC during the same period. Direct hospital costs for the two groups were compared. Results: There were 42 EC patients and 61 LC patients. EC patients had significantly less ileostomy-related complications (p < 0.001) and hospital readmissions (p < 0.001). Operative time (p < 0.001) and operative cost (p = 0.002) were also both significantly less in the EC group. Community nursing costs favoured the LC group (p = 0.047). The EC group had an increased post-closure wound infection rate (p = 0.02). The mean total direct cost per patient was NZD 13,724 (SD NZD 3,736) for EC and NZD 16,728 (SD NZD 8,028) for LC. Representing an average costs saving of NZD 3,004 per patient favouring EC (p = 0.012). Conclusion: Although EC increases the post-closure wound infection rate, EC reduces ileostomy complications, hospital readmissions and operative costs resulting in significant healthcare savings. In order to improve patient outcomes and make EC even more cost effective, efforts should be taken to reduce wound infections.

Preoperative Risk Factors and Radiographic Findings Predictive of Laparoscopic Conversion to Open Procedures in Crohn’s Disease

IntroductionLaparoscopy is accepted as a standard surgical approach for Crohn’s disease. However, the rate of conversion is high, ranging from 15 to 70 % depending on the population. There are also concerns that conversion results in worsened outcomes versus an initial open procedure. MethodsThis study evaluated preoperative radiographic findings to determine who is at increased risk of conversion and may therefore benefit from an initial open approach. A case-matched study included patients from 2004 to 2013 with preoperative CTE/MRE who underwent laparoscopic surgery converted to an open approach, and compared them to laparoscopically completed controls with similar age, same surgeon, and number of previous abdominal operations. Studies were reviewed by two blinded radiologists. Variables included abdominal AP diameter, amount of subcutaneous fat, peritoneal versus pelvic location of disease (greater or lesser hemipelvis or abdomen), intestinal location of disease (colon, TI, ileum, jejunum), and presence, length, and location of strictures, simple or complex fistula, phlegmon, or abscess. Conditional logistic regression evaluated relationships between radiographic variables and conversion. Twenty-seven patients meeting study criteria were compared with 81 controls. ResultsA negative association between conversion and disease in the left lesser pelvis was found (p = 0.019) and neared significance for left abdomen (p = 0.08). Positive correlations were found with pelvic fistulas (p = 0.003), complex fistulas (p = 0.017), and pelvic abscesses (p = 0.009) and neared significance for Society of Abdominal Radiology classification (p = 0.058). ConclusionPreoperative imaging in patients with Crohn’s disease can help in selecting the most suitable cases to approach laparoscopically and reduce conversion rates and should be evaluated in conjunction with other preoperative factors.

3D visualization reduces operating time when compared to high-definition 2D in laparoscopic liver resection: a case-matched study.

To evaluate the effect of three-dimensional (3D) visualization on operative performance during elective laparoscopic liver resection (LLR). Major limitations of conventional laparoscopy are lack of depth perception and tactile feedback. Introduction of robotic technology, which employs 3D imaging, has removed only one of these technical obstacles. Despite the significant advantages claimed, 3D systems have not been widely accepted. In this single institutional study, 20 patients undergoing LLR by high-definition 3D laparoscope between April 2014 and August 2014 were matched to a retrospective control group of patients who underwent LLR by two-dimensional (2D) laparoscope. The number of patients who underwent major liver resection was 5 (25%) in the 3D group and 10 (25%) in the 2D group. There was no significant difference in contralateral wedge resection or combined resections between the 3D and 2D groups. There was no difference in the proportion of patients undergoing previous abdominal surgery (70 vs. 77%, p = 0.523) or previous hepatectomy (20 vs. 27.5%, p = 0.75). The operative time was significantly shorter in the 3D group when compared to 2D (225 ± 109 vs. 284 ± 71 min, p = 0.03). There was no significant difference in blood loss in the 3D group when compared to 2D group (204 ± 226 in 3D vs. 252 ± 349 ml in 2D group, p = 0.291). The major complication rates were similar, 5% (1/20) and 7.5% (3/40), respectively, (p ≥ 0.99). 3D visualization may reduce the operating time compared to high-definition 2D. Further large studies, preferably prospective randomized control trials are required to confirm this.

Minimally invasive versus open total mesorectal excision for rectal cancer: Long-term results from a case-matched study of 633 patients

This study compared the long-term oncologic outcomes of patients with rectal cancer who underwent either laparoscopic or robotic total mesorectal excision (TME) via minimally invasive surgery (MIS) to those patient who underwent open TME. This study was a retrospective, case-control study; patients in the 2 groups were matched according to age, sex, MIS vs open operation, body mass index, tumor location, pathologic TNM stage (ie, tumor-node-metastasis), neoadjuvant treatment, and adjuvant treatment. A total of 633 patients (MIS, n = 211; open, n = 422) were assessed. The median follow-up period was 64 (2-124) months. Patient characteristics did not differ between the groups. Overall postoperative complication rates did not differ between the groups (16.0% [MIS]; 17.0% [open]; P = .76). Rates of the involvement of the circumferential resection margin did not differ between the groups (4.0% [MIS]; 5.0% [open]; P = .84). The 5-year overall survival, disease-specific survival, disease-free survival, and local recurrence rates were not different between the MIS and open groups (overall survival = 88.4% vs 85.3%, P = .23; disease-specific survival = 88.8% vs 87.4%, P = .53, disease-free survival = 80.7% vs 78.4%, P = .74; local recurrence = 5.7% vs 5.1%, P = .95). In subgroup analysis, no differences were found in terms of the long-term, oncologic outcomes, oncologic adequacy, and postoperative complications among 3 groups. We found no differences in the oncologic outcomes between MIS and open surgery, suggesting that MIS for rectal cancer is a safe option for rectal cancer that does not increase the risk of serious complications.

The Safety of Laparoscopic Sleeve Gastrectomy in Patients Receiving Chronic Anticoagulation Therapy: A Case-Matched Study.

Obesity is linked to cardiac disorders with a relative risk of atrial fibrillation of 1.5 (requiring the use of chronic anticoagulation therapy, CAT). However, CAT is a known risk factor for postoperative bleeding after elective surgery. The primary objective of the present study was to evaluate the short- and long-term complications of laparoscopic sleeve gastrectomy (LSG) in patients receiving CAT. This is a retrospective analysis of a prospective database of CAT patients undergoing LSG between March 2004 and December 2012. This LSG-CAT group was matched 1:2 on preoperative data with patients not receiving CAT (LSG-control group). Primary efficacy criterion was the frequency of CAT-related complications. Secondary efficacy criteria were the major postoperative complications, frequency of revisional surgery, long-term CAT-related complications, and a change in the dose level of oral anticoagulants. The LSG-CAT group consisted of 15 patients with a median age of 54 years (32-65). The LSG-control group consisted of 30 patients. Median operating time was 75 min in both groups (p = 0.33). Major complication rates in the LSG-CAT and LSG-control groups were 13.3 and 3.3 %, respectively (p = 0.20), with one case of postoperative bleeding in each group (6.7 and 3.3 %, p = 0.6); incidence of revisional surgery was 13.3 and 3.3 % (p = 0.2). There were no postoperative mortalities. After a median follow-up of 14 months (9-43), no changes in the dose level of oral anticoagulants were reported. LSG in patients receiving CAT is not associated with CAT-specific complications. This surgical procedure enables good weight loss and does not require change in the dose level of oral anticoagulants.

An association between abnormal bone turnover, systemic inflammation, and osteoporosis in patients with chronic pancreatitis: a case-matched study.

Because of deteriorating exocrine function, malabsorption renders chronic pancreatitis (CP) patients at risk of osteoporosis and fracture. However, the pathogenesis of low bone mineral density (BMD) has not been characterized. We hypothesized that bone turnover is elevated in CP, and we sought to investigate an association between bone metabolism and systemic inflammation. Twenty-nine CP patients and twenty-nine matched controls were recruited. Bone-turnover markers procollagen 1 amino-terminal propeptide (P1NP), OC (osteocalcin; bone formation markers), and carboxy-terminal telopeptide of type I collagen (CTX-I; bone resorption marker) were measured along with vitamin D (25-hydroxyvitamin D, 25OHD), parathyroid hormone (PTH), interleukin 6 (IL-6), high-sensitivity (hs) C-reactive protein (CRP), and sex/thyroid hormones. BMD was measured by dual-energy X-ray absorptiometry. Smoking status was noted. Of the CP patients, 31% had osteoporosis and 44.8% osteopenia (controls: 6.9 and 51.7%, respectively; P=0.019). BMD was lower for patients at the lumbar spine (P=0.014) and femoral neck (P=0.029). Patients had elevated bone formation (P1NP (P=0.0068), OC (P=0.033)) and bone resportion (CTX-I (P=0.016)) compared with controls. Patients had lower 25OHD compared with controls (P=0.0126) and higher inflammatory markers (hsCRP, P=0.0013). Sex and thyroid hormone levels were similar. Patients with lowest 25OHD levels had highest P1NP. In a multivariable model, age, PTH, and smoking were predictive of 25OHD. Patients with osteoporosis had higher P1NP, PTH, and IL-6 and lower 25OHD. Using analysis of variance, inflammation (hsCRP) was highest in those with lowest 25OHD and lowest BMD. For the first time, bone turnover was shown to be abnormal in CP, and importantly, an association between low 25-OHD, smoking, and systematic inflammation was identified. Moreover, those with osteoporosis had the highest systemic inflammation. Together these factors provide an avenue for potential modification of risk factors, which may ultimately reduce bone loss and avert fractures in this group.

Survival rate after D3-lymphadenectomy for right-sided colic cancer: case-match study

The aim of the study was to compare the effectiveness of D3-lymphadenectomy in compliance with «no-touch» principle and mesocolectomy with traditional hemicolectomy in patients with right-sided colon cancer. It is retrospective-prospective comparative case-match study. From prospectively collected database patients with right-sided colon cancer stage I-III treated in 2009-2013 without adjuvant chemotherapy were selected. Patients who underwent conventional right-sided hemicolectomy with D2-lymphadenectomy in the regional oncologic dispensary formed the first group. The second group included patients after right-sided hemicolectomy with D3-lymphadenectomy, «no-touch» principle and mesocolectomy performed in academic hospital of the third level. From both groups 'case-match' patients by gender, age, stage and location of primary tumor were selected. Each group consisted of 50 patients. Overall and cancer-related 5-year survival was significantly higher in the second group - 80.9% vs. 56.0% (p=0.01) and 93.4% vs. 59.8% (p=0.01), respectively. D3-lymphadenectomy and mesocolectomy for right-sided colon cancer stage I-III without adjuvant chemotherapy provides significantly better overall and cancer-related 5-year survival compared with conventional right-sided hemicolectomy. Thus, D3-lymphadenectomy and mesocolectomy in compliance with «no-touch» principle for right-sided colon cancer is reproducible and effective in Russian conditions.

Hand-Sewn Running Barbed Suture versus Endoscopic Stapler Closure of the Mesenteric Defects in Retrocolic and Retrogastric RYGB: A Comparative Case-Matched Study

Background: Obesity is nowadays a major health concern in Western countries and the number of bariatric surgical procedures being performed worldwide is vertiginously rising. The Laparoscopic Roux-en-Y gastric bypass (LRYGB) has become the gold standard bariatric procedure. The retrocolic retrogastric approach is closer to normal anatomy and it is associated to a lower rate of anastomotic leak, a lower rate of gastrojejunal stricture and a lower rate of marginal ulcers; therefore the problem of small bowel obstruction due to internal hernia (IH) has to be faced. The meticulous closure of all possible mesenteric defects with running, non-absorbable sutures may reduce the rate of this complication, but it can be challenging for the surgeon and it rises the operating time (OT). This study has conducted in a context of optimization of our “Fast Track-type” recovery protocol and it aims to compare the rate of early IH and the OT difference when mesenteric defects are closed using running non-absorbable barbed suture or an endoscopic stapler. Materials and Methods: From December 2014 to February 2015 a single-surgeon consecutive series of 22 patients undergoing retrocolic restrogastric LRYBP in our high volume obesity centre has been retrospectively extrapolated from our prospective longitudinal database. We recorded the overall OT and relative rate of IH in patients who received a 15-cm non-absorbable V-LocTM1 (group A, 11 patients) or EndopathTM EMS, endoscopic multifeed stapler2 (group B, 11 patients) defect. Results: The mean OT was 77.36 minutes in the group A and 60.90 minutes in the group B (P value 0.066). 0 patients (0%) in the group A versus 4 patients (36.3%) in the group B developed IH within 30 days (two-tailed P value at chi-square test: 0.02). Conclusion: Early rate of small bowel obstruction due to IH is extremely higher with the use of an endoscopic stapler instead of non-absorbable barber suture and there is not significant difference in the OT; more prospective randomized trials observing bigger series of patients with longer follow-up are needed to validate our study.

Texture Analysis of Preoperative CT Images for Prediction of Postoperative Hepatic Insufficiency: A Preliminary Study

Texture analysis is a promising method of analyzing imaging data to potentially enhance diagnostic capability. This approach involves automated measurement of pixel intensity variation that may offer further insight into disease progression than do standard imaging techniques alone. We postulated that postoperative liver insufficiency, a major source of morbidity and mortality, correlates with preoperative heterogeneous parenchymal enhancement that can be quantified with texture analysis of cross-sectional imaging. A retrospective case-matched study (waiver of informed consent and HIPAA authorization, approved by the Institutional Review Board) was performed comparing patients who underwent major hepatic resection and developed liver insufficiency (n= 12) with a matched group of patients with no postoperative liver insufficiency (n= 24) by procedure, remnant volume, and year of procedure. Texture analysis (with gray-level co-occurrence matrices) was used to quantify the heterogeneity of liver parenchyma on preoperative CT scans. Statistical significance was evaluated using Wilcoxon's signed rank and Pearson's chi-square tests. No statistically significant differences were found between study groups for preoperative patient demographics and clinical characteristics, with the exception of sex (p < 0.05). Two texture features differed significantly between the groups: correlation (linear dependency of gray levels on neighboring pixels) and entropy (randomness of brightness variation) (p < 0.05). In this preliminary study, the texture of liver parenchyma on preoperative CT was significantly more varied, less symmetric, and less homogeneous in patients with postoperative liver insufficiency. Therefore, texture analysis has the potential to provide an additional means of preoperative risk stratification.

Contrast-associated AKI in the critically ill: relevant or irrelevant?

Iodinated contrast media are frequently administered in ICU patients. Recent studies challenge the relevance of contrast media toxicity in ICU patients and relate occurrence of acute kidney injury to baseline characteristics and severity of illness. Various findings in studies with kidney biomarkers indicate the causal relationship between contrast media exposure and kidney damage. Contrast media exposure not only causes direct tubular damage and renal hypoperfusion but also initiates the formation of reactive oxygen species in its turn causing tissue damage. The route of administration determines the incidence of contrast-induced acute kidney injury with a higher incidence when contrast media are administered by intra-arterial route versus intravenous route. The impact of contrast-associated acute kidney injury on hospital length of stay, the need for renal replacement therapy and survival remains a matter of debate because of discrepancies between observational versus case-matched studies and limitations of the individual studies. There are diverse pathophysiologic mechanisms explaining the causal relationship between the administration of contrast media and the development of acute kidney injury. Some studies challenge the relevance of contrast media toxicity in ICU patients. However, limitations of the available studies in ICU patients preclude firm conclusions. A precautionary approach in the administration of contrast media is justified.

Is sleeve gastrectomy still contraindicated for patients aged≥60 years? A case-matched study with 24 months of follow-up

BackgroundCurrent guidelines consider that bariatric surgery is relatively contraindicated in elderly adults (aged≥60 years). The objective of this study was to evaluate obesity-related morbidity after sleeve gastrectomy (SG) according to whether patients were aged≥60 years or<60 years. MethodsForty-two patients aged≥60 years (the elderly group) were matched 1:2 with 84 patients aged<60 (the control group). The primary objective was to compare weight change and the remission rate of co-morbidities in the 2 groups after 24 months of follow-up. The secondary endpoints were short-term and midterm postoperative outcomes (operating time, the frequency of conversion to laparotomy, the length of hospital stay, postoperative complications, mortality, and the SG failure rate). ResultsNo significant differences were observed between the elderly and control groups in terms of the mean operating time (83 minutes in both groups; P = .90), length of stay (3.2 versus 3.4 days, respectively; P = .51), morbidity rate (4.7% versus 9.5%, P = .35), or mortality rate (0% in both groups). The mean excess weight loss was significantly lower in the elderly group than in the control group at 12 months (56.2% versus 71.4%, respectively; P<.01) and 24 months (51.8% versus 73.5%, P<.01). Similar statistically significant differences were observed between the elderly group and control group for remission of metabolic syndrome (95% versus 90%, respectively; P = .55), type 2 diabetes mellitus (87% versus 71%, respectively; P = .13), hypertension (81% versus 77%, respectively; P = .71), and dyslipidemia (94% versus 74%, respectively; P = .09) at 24 months after SG. ConclusionResults support the safety and efficacy of SG for morbid obesity in patients aged≥60 years. In contrast to weight loss, the long-term morbidity rate and remission of obesity-related co-morbidities were similar in the participants aged≥60 years and those aged<60 years.

Does somatostatin-14 have an impact on gastric fistula after laparoscopic sleeve gastrectomy?

The main complications following laparoscopic sleeve gastrectomy (LSG) is gastric fistula (GF). Gastric fistula is a rare but serious complication (affecting 2 % of LSGs). Somatostatin-14 and its analogs are mainly used in the prevention and curative treatment of digestive fistulas. These compounds inhibit secretions in the pancreas, stomach, and small intestine. Treatment with somatostatin-14 increases the spontaneous closure rate and reduces the closure time of postoperative digestive fistulas. However, the impact of somatostatin-14 on GF after LSG has not been studied. We report on a prospective, non-randomized, single-center, case-matched study of patients receiving somatostatin-14 after a post-LSG GF was discovered. Our results suggest that use of somatostatin-14 is associated with a shorter length of hospital stay and (perhaps) a shorter treatment period.

Traditional Growing Rods Versus Magnetically Controlled Growing Rods for the Surgical Treatment of Early-Onset Scoliosis: A Case-Matched 2-Year Study

IntroductionTraditional growing rod (TGR) surgery is a treatment technique commonly used for progressive early-onset scoliosis. Studies have shown that repeated TGR lengthenings can significantly increase the risk of complications. Magnetically controlled growing rods (MCGR) are currently available outside of the United States and early results have been promising. The purpose of this study was to compare the effectiveness of MCGR versus TGR for the treatment of early-onset scoliosis. MethodsMagnetically controlled growing rod patients were selected based on the following criteria: aged less than 10 years, major curve greater than 30°, thoracic height less than 22 cm, no previous spine surgery, and minimum 2-year follow-up. A total of 17 MCGR patients met the inclusion criteria, 12 of whom had complete data available for analysis. Each MCGR patient was matched with a TGR patient by etiology, gender, single versus dual rods, preoperative age, and preoperative major curve. ResultsMagnetically controlled growing rod patients had a mean age of 6.8 years and mean follow-up of 2.5 years. Mean follow-up was greater for TGR patients by 1.6 years. Major curve correction was similar between MCGR and TGR patients throughout treatment. The MCGR patients experienced an average of 8.1 mm/year increase in T1–S1 during the lengthening period, compared with 9.7 mm/year for TGR patients (p = .73). There was a mean increase in T1–T12 of 1.5 mm/year for MCGR patients and 2.3 mm/year for TGR patients (p = .83). The TGR patients had 73 open surgeries, 56 of which were lengthenings. The MCGR patients had 16 open surgeries and 137 noninvasive lengthenings. Three TGR patients underwent 5 unplanned revision surgeries whereas 3 MCGR patients underwent 4 unplanned revisions. ConclusionsMajor curve correction was similar between MCGR and TGR patients throughout treatment. Annual T1–S1 and T1–12 growth was also similar between groups. The MCGR patients had 57 fewer surgical procedures than TGR patients. Incidence of unplanned surgical revisions as a result of complications was similar between groups.

Comparing simultaneous versus staged resection in patients with synchronous colorectal liver metastases: case match study

INTRODUCTION: There is no consensus on the optimal timing of liver resection in patients with synchronous colorectal liver metastasis. METHODS: Patients undergoing hepatic resections between 2004- 2013 for synchronous colorectal liver metastases were analyzed from a prospectively maintained and institutional review board approved database. Patients who underwent simultaneous resection of a colorectal primary and hepatic metastasis in a single operation (Group I) were case-matched 1:1with patients who underwent staged operation (Group II) according to age, sex, ASA classification, size of liver lesion and number of liver lesion. RESULTS: 66 patients (33 Group I, 33 Group II) were matched from a total cohort of 106 patients with synchronous colorectal liver metastasis. The patients’ characteristics of both groups were similar. 62% were male and the mean age was 55.511 years. Blood loss and duration of surgery did not differ between simultaneous resections and staged resection (p¼0.63; p¼0.14, respectively). Perioperative complication rate were similar in both groups (P¼0.70). There was no mortality. The median number of in-hospital days during the course of treatment was 9 (4-23) days in Group I and 6 (3-17) days in Group II (p <0.001). There was no difference in 2 years disease free survival and overall survival were found between Group I and Group II ( 30% and 34%, p¼ 0.58; 67% and 62%, p¼0.86 respectively). CONCLUSIONS: Simultaneous liver resections result in similar short and long eterm outcomes as in patients undergoing sequential resections for synchronous colorectal cancer with comparable metastatic disease burden.

Challenge of safety margin in laparoscopic liver resection for hepatocellular carcinoma

Background Advances in minimally invasive surgical techniques and instrumentation have facilitated their application in the management of hepatic tumors. However, determination of the optimal safety margin can be challenging for liver surgeons. The present study used a case-matched analysis to evaluate the surgical margins and survival rates in patients with liver cancer treated using either laparoscopic or traditional liver resection. Methods All of the enrolled patients were diagnosed with hepatocellular carcinoma (HCC) after surgical resection, which was performed according to clinical practice guidelines. The indications for laparoscopy included the detection of a tumor at the anterior peripheral region of Segments III, IV, V, and VI, with a diameter of < 5 cm. Of all the enrolled patients, 86 (63 men and 23 women) underwent laparoscopic liver resection (Group I), whereas the remaining 91 (67 men and 24 women) underwent traditional open resection (Group II) based on case-matched study. Results The resection margins were ≥ 10 mm, 5–9 mm, and ≤ 4 mm in 1 patient, 70 patients, and 15 patients in Group I and 3 patients, 41 patients, and 47 patients in Group II, respectively. The safety margin was ≥ 10 mm in 15 Group I patients (17.4%) and 47 Group II patients (51.6%), respectively, (p = 0.001). The feasibility of wide resection was probably limited by the location of the tumor based adjacent to the main vessels. Overall, in Group I, the 1-, 3-, and 5-year survival rates were 84.2%, 67.3%, and 57.7% for a 5–9-mm safety margin and 93.3%, 86.7%, and 78.0% for a ≥ 10-mm safety margin, respectively; however, these differences were not statistically significant (p = 0.139). Similarly, in Group II, no significant differences were observed regarding the survival rates for varying safety margins (5–9 mm and 10 mm; p = 0.57). Conclusion Securing an appropriate safety margin for laparoscopic liver resection while dissecting using laparoscopic instruments was challenging without any tactile sensation by the surgeon. Moreover, no significant differences were observed in the postoperative survival of both Group I or II patients with a safety margin of ≥ 5 mm.