Clavien-Dindo Classification Research Articles

Comparative study of low-power versus high-power holmium laser enucleation of the prostate for large volume benign prostatic hyperplasia.

Benign prostatic hyperplasia (BPH) is a prevalent condition among the elderly male population, characterised by prostate enlargement and bothersome urinary symptoms. Holmium Laser Enucleation of the Prostate (HoLEP) is a minimally invasive surgical option that is preferred for larger prostates due to its precision and minimal complications. Although high-power HoLEP is an efficacious procedure, recent studies indicate that low-power settings may offer comparable benefits with diminished postoperative discomfort. This study compares the efficacy of low-power (LP) and high-power (HP) HoLEP in a prospective, multicentre, randomised controlled trial involving 102 men with prostates larger than 80ml. The participants were randomly assigned to either the LP or HP groups and were followed for a period of six months following the operation. The primary outcome measure was the international prostate symptom score (IPSS), with secondary outcomes including perioperative and postoperative parameters and Qmax, PVR, and Clavien-Dindo classification of complications at one, three, and six months post-surgery. Both LP and HP HoLEP resulted in significant improvements in IPSS, Qmax, and PVR compared to the baseline (p < 0.05). The LP group demonstrated a longer laser application time (p < 0.001) and required a greater volume of irrigation fluid (p < 0.001), yet exhibited a reduction in total energy usage (p = 0.01). Additionally, they reported significantly diminished postoperative pain at 24 and 48h (p < 0.05). No significant differences were observed between the groups with regard to the incidence of complications, the duration of catheterisation, or the length of hospital stay. The results demonstrate that LP-HoLEP is as efficacious as HP-HoLEP in improving urinary symptoms, with the additional benefit of reduced postoperative discomfort. These findings support the use of LP-HoLEP as a viable option for the treatment of large prostates, although further research is required to confirm long-term outcomes.

Preliminary Results of Microsurgical Sperm Retrieval in Azoospermic Patients: A Randomized Controlled Trial Comparing Operating Microscope vs. Surgical Loupes

Objectives: To compare surgical outcomes and sperm retrieval rates (SRRs) between conventional microsurgical-assisted testicular sperm extraction (m-TeSE—Group A) and testicular sperm extraction performed with surgical loupes (l-TeSE—Group B) in adult males with non-obstructive azoospermia (NOA). Methods: A multicentric prospective randomized trial (ethics committee no. 202/2022) in accordance with the CONSORT guidelines was conducted from March 2022 to April 2024. Adult males with NOA without genetic alterations who signed the informed consent were enrolled. SRRs, intra- and postoperative complications (according to the Clavien–Dindo classification), and hormonal profile changes were considered as outcomes during the follow-up period. Results: A total of 42 NOA patients were enrolled. The median age was 35 years (IQR: 33–49). The preoperative median FSH was 16.5 mIU/mL (IQR: 11.6–22.5) and the total testosterone was 4.6 (3.5–5.6). Overall, the SRR was 22.6%, with sperm retrieved from 19 testes. Histopathological findings reported Sertoli cell-only syndrome (SCOS) in 46.4% (39 cases), hypospermatogenesis in 26.2%, and germ cell arrest in 26.2% of the patients. No intraoperative complications were recorded. The postoperative complications were minimal (Clavien–Dindo grade I), but no significant differences were recorded in-between the two surgical approaches. Considering the operative time of the testicular exploration alone, Group B seemed to be faster than the m-TeSE, with a median time saving of 8 min (p &lt; 0.01). Conclusion: The use of surgical loupes was safe and comparable with m-TeSE in terms of the SRRs and complication rates. L-TeSE offered a reduction in the operative time compared with m-TeSE.

Experiencing Complications After Metabolic and Bariatric Surgeries is a Risk Factor for Postoperative Emergency Department Admissions: a Retrospective Cohort Study.

Emergency department admissions significantly burden hospital staff and countries' health system. Studies are encouraged for effective and correct utilization of emergency departments. Rational management of obesity-related medical problems and postoperative complications may reduce emergency department visits. This study aimed to determine the rates, characteristics, and antecedents of emergency room admissions after metabolic and bariatric surgeries (MBSs) performed in our hospital. According to our hypothesis, experiencing postoperative complications is the most common reason for emergency department admissions. The study was designed as a single-center, retrospective, cohort study. Metabolic and bariatric surgeries performed in our hospital between June 2021 and June 2023 were evaluated. Clavien Dindo Classification was used to classify complications. The reasons for emergency department admissions, re-hospitalization and surgical requirements, time relationships, and possible antecedents were examined in stages. A total of 153 patients were evaluated in the study. The average follow-up period was found to be 609.63 ± 222.89. The emergency department admission rate following MBSs was found to be 31%, and the admission rate within the first month was 7.8%. The major complication rate following MBSs was 4.6%. Experiencing complications was the most important antecedent for admissions 1month postoperatively. In patients with complications after MBS, the discharge decision should be provided with stricter controls, and outpatient clinic controls should be planned more frequently. Providing training to patients on managing complications should be considered as a strategy that may reduce the number of emergency department visits. ACTRN12624000810516.

A phase I/II clinical trial of preoperative docetaxel/oxaliplatin/S-1 (DOS) combination therapy for esophagogastric junction adenocarcinoma.

429 Background: Esophagogastric junction (EGJ) cancer is difficult to cure with surgery alone, necessitating adjuvant chemotherapy. However, administering aggressive adjuvant chemotherapy after invasive surgery is difficult. Neoadjuvant chemotherapy, on the other hand, is expected to enhance compliance, increase the rate of curative resection, and reduce recurrence. Methods: We conducted a single center Phase I/II study to evaluate the safety and efficacy of neoadjuvant chemotherapy using docetaxel, oxaliplatin, and S-1 (DOS), followed by adjuvant chemotherapy with S-1 in patients with cT3-4aN0-3M0 adenocarcinoma of the EGJ. In Phase I, we estimated the maximum tolerated dose and dose-limiting toxicity of neoadjuvant DOS therapy and determined the recommended dose (RD). In Phase II, we assessed the safety and efficacy of the RD established in Phase I. The primary endpoint was the curative resection rate, with secondary endpoints including the 3-year overall survival rate, 3-year recurrence-free survival rate, treatment completion rate, response rate to neoadjuvant chemotherapy, pathological response, and adverse events. Neoadjuvant DOS chemotherapy was administered in three 3-week cycles. The starting dose of docetaxel was 50 mg/m², with plans to escalate it to 60 mg/m². Docetaxel and oxaliplatin (100 mg/m²) were administered on day 1, while S-1 (120 mg/body) was given orally on days 1-14. Postoperative adjuvant chemotherapy consisted of S-1 (120 mg/body), administered for 4 weeks followed by a 2-week rest period, repeated for 8 cycles. Results: Based on the 6 patients enrolled in Phase I, the RD of docetaxel was determined to be 60 mg/m². A total of 40 eligible patients, including 3 from Phase I, were enrolled in the study. Two patients discontinued protocol treatment during neoadjuvant chemotherapy due to adverse events and 1 patient discontinued due to positive peritoneal cytology. The R0 resection rate was 87.5% (35/40). Surgical procedures included esophagectomy in 18 patients, total gastrectomy in 15, and proximal gastrectomy in 4. Postoperative complications of Grade III or higher, as per the Clavien-Dindo classification, occurred in 15.0% of patients, with no surgery-related deaths. The response rates to neoadjuvant chemotherapy were 12.5% for PR, 2.5% for PD, and 85.0% for non-CR/non-PD. Pathological response rates were: Grade III in 8.1%, Grade II in 35.1% and Grade I in 56.8%. During neoadjuvant chemotherapy, Grade 3 or higher adverse events were observed, including neutropenia (82.5%), nausea (5%) and diarrhea (5%). The neoadjuvant chemotherapy completion rate was 92.5%, although 59.5% of patients required dose reductions. Conclusions: Neoadjuvant DOS therapy for esophagogastric junction cancer shows promise, achieving a high R0 resection rate and substantial pathological efficacy, with acceptable levels of adverse events. Clinical trial information: UMIN000022210.

Impact of Perioperative Rehabilitation on Postoperative Length of Hospital Stay for Patients With Gastric Cancer.

Perioperative rehabilitation is effective in preventing postoperative complications and is associated with a shorter length of hospital stay after gastrectomy. However, its impact on short-term outcomes in patients without post-gastrectomy complications has not yet been clarified. This study aimed to evaluate the usefulness of perioperative rehabilitation beyond preventing postoperative complications. Of the 142 patients who underwent surgery for gastric cancer at our hospital between November 2017 and December 2022 and were treated according to the Enhanced Recovery After Surgery (ERAS) protocol during the perioperative period, 106 patients who were discharged without postoperative complications (with Clavien-Dindo classification < Grade 1) and did not undergo readmission within 30 days after surgery were included in the study. Perioperative rehabilitation was provided from August 2020. Patients were divided into the following two groups: Group A (with cancer rehabilitation; n=55) and Group B (without cancer rehabilitation; n=51), and their clinicopathological characteristics and short-term results were compared. Risk factor analysis was performed based on the number of days of postoperative hospitalization. The number of days of postoperative hospitalization in Group A (average 8.6 days) was significantly shorter than that in group B (average 9.9 days) (p=0.032). Multivariate analysis of postoperative hospital stay revealed that older age (p=0.003), female sex (p=0.043), heavy bleeding (p=0.026), and no rehabilitation (p=0.004) were independent risk factors. Even in patients without postoperative complications, perioperative rehabilitation for gastric cancer could be effective in shortening the postoperative hospital stay.

Surgical treatment in patients with advanced gastrointestinal stromal tumours (GISTs) in second-line and later stages: A single-centre cohort study.

818 Background: Gastrointestinal stromal tumour (GIST) after imatinib treatment failure usually progresses rapidly with limited overall survival. Previous studies have suggested that surgery is beneficial for advanced GISTs in disease control to imatinib, but the role of surgery in &gt; = 2 line patients remains unclear. Methods: Imatinib-resistant patients with advanced GIST between May 2009 and Nov. 2023 were included. Surgical treatments included tumour reduction, radiofrequency ablation and TACE. The primary endpoint was overall survival (OS) and secondary endpoints were time to second-line treatment failure (TTF) and postoperative morbidity. To balance clinicopathological characteristics, 1:1 propensity score matching (PSM) was used. Results: A total of 242 patients with advanced GIST treated with 2nd-line or later drugs were included, including 125 in the surgical group and 117 in the non-surgical group. The median follow-up was 30.3 months. OS was significantly better in the surgical group than in the non-surgical group (pre-PSM: 51.7m vs 35.9m , p = 0.001; post-PSM: 50.8m vs 38.8m, p = 0.043). Univariate analysis showed that surgical treatment (HR 0.487, 95% CI 0.320-0.740, p = 0.001), age ≤60 years (HR 0.640, 95% CI 0.411-0.997, p = 0.049) and low tumour burden (HR 0.491, 95% CI 0.293-0.822, p = 0.007) were associated with prolonged OS. Multivariate analysis indicated that surgical treatment (HR 0.541, 95% CI 0.348-0.843, p = 0.007) and low tumour burden (HR 0.510, 95% CI 0.300-0.865, p = 0.012) were significantly associated with OS benefit. Patients (n = 84) who had surgical treatment during second-line treatment had longer TTF compared to patients (n = 158) who had TKI only (14.2m vs 8.1m , p = 0.003). There were 29 (14.8%) postoperative complications with Clavien-Dindo classification ≥3, including 5 deaths. Conclusions: Surgical treatment can provide a survival benefit for patients with second-line and later advanced GIST, but further studies are needed for a more detailed indication of the surgical population.

Neoadjuvant chemoradiotherapy with ipilimumab and nivolumab in rectal cancer (CHINOREC): A prospective randomized, open-label, multicenter, phase II clinical trial.

139 Background: Immune checkpoint inhibitors (ICIs) seem only effective in a primed tumor immune microenvironment (TIME). Neoadjuvant radiotherapy (RT) has been shown to induce an immunogenic cell death (ICD) and thereby restores the susceptibility to ICI. This study evaluates the safety of neoadjuvant chemoradiotherapy (CRT) with concomitant ipilimumab (IPI) and nivolumab (NIVO) in curative rectal cancer (RC) patients. Methods: The CHINOREC study (ClinicalTrials.gov identifier NCT04124601) is a prospective, randomized (ratio 50:30), open-label, multicenter, phase II investigator-initiated trial (IIT). Patients with RC received neoadjuvant CRT (50 Gy in 2 Gy fractions with concurrent capecitabine 1650 mg/m 2 /d) alone or in combination with IPI (1 mg/kg IV at day 7), following 3 cycles of NIVO (3 mg/kg IV Q2W, starting on day 14). Surgical resection was performed 10-12 weeks post CRT. The primary endpoint was surgical safety and feasibility (Clavien-Dindo Classification) of neoadjuvant CRT with sequential IPI and NIVO following surgical resection. Secondary outcome was complete response rate (clinical and pathological). Results: Between June 2020 and November 2023, 145 patients were screened and 80 randomly assigned to CRT (n=30) or CRT+IPI/NIVO (n=50). The primary endpoint (any surgical complication) did not differ between the 2 groups (78% vs. 77%). The reoperation rate (≥Grade IIIb) was comparable low in both groups (8% vs. 7%). No new safety signals were identified. The rate of major pathological response (MPR) and complete response (CR) was also comparable high in both arms (38% vs. 37% and 30% vs. 22%, respectively). Conclusions: Neoadjuvant IPI/NIVO can be safely applied concomitant with CRT in patients with RC, as it does not increase the rate of reoperation or surgical complications. The validity of the encouraging CR rate needs to be elucidated over time. Further translational analyses will elucidate mechanistic insight regarding improved fraction, dosing and timing of CRT and ICI. Clinical trial information: NCT04124601 .

A multicenter prospective study to evaluate the efficacy of resection for initially unresectable hepatocellular carcinoma after atezolizumab combined with bevacizumab (the RACB study): Short-term outcomes.

521 Background: The IMbrave150 study showed that atezolizumab plus bevacizumab (atezo+bev) is superior to sorafenib in progression-free survival and overall survival, making it the recommended first-line systemic therapy for unresectable hepatocellular carcinoma (HCC). The RACB study was scheduled to evaluate the efficacy of atezo+bev in achieving conversion surgery for initially unresectable HCC. This time, we report the short-term outcomes of the RACB study. Methods: This prospective, single-arm, multicenter Phase II trial evaluates atezo+bev to achieve conversion surgery in patients with technically or oncologically unresectable HCC. Eligible patients had unresectable HCC without prior systemic chemotherapy and at least one target lesion based on RECIST ver1.1. Patients received atezolizumab (1200 mg) plus bevacizumab (15 mg/kg) every three weeks. If resectable on radiological assessment at 12 weeks, atezolizumab monotherapy was given followed by surgery. The primary endpoint was the progression-free survival. The secondary endpoints included the overall response rate, overall survival, resection rate, curative resection rate, on-protocol resection rate, and ICG retention rate at 15 min after atezo+bev therapy. The study is registered with the Japan Registry of Clinical Trials (jRCTs051210148). Results: Between March 2022 and March 2024, 55 patients from 17 centers were enrolled. Four patients were excluded due to ineligible lesions or other reasons. A total of 50 patients were included in the efficacy evaluation set. Macrovascular invasion and extrahepatic metastases were observed in 38 (76.0%) and 6 patients (12.0%), respectively. Two patients (4.0%) had metachronous extrahepatic metastases without intrahepatic tumors. The complete and partial response rates were 0% and 13% based on RECIST, and 2.2% and 26.1% based on mRECIST. The overall resection rate was 48%, corresponding to 24 cases. R0, R1, and R2 resections were performed in 21 (87.5%), 1 (4.2%), and 2 (8.3%) patients, respectively. Complications ≥Grade III according to the Clavien-Dindo classification included 3 bile leakages, 2 infections, 1 anastomotic leakage, and 1 hemoptysis. There were no surgery-related deaths. Of the 51 patients included in the safety analysis set, adverse events occurred in 34 cases (66.7%), with 16 Grade 3 or higher instances with one Grade 4 upper gastrointestinal bleeding, 1 Grade 4 encephalopathy, and 1 unexpected death after 1 cycle of atezo+bev. Conclusions: The RACB study's short-term outcomes demonstrated the feasibility of conversion surgery after atezo+bev in patients with initially unresectable HCC. The response rate of atezo+bev, as measured by mRECIST, was similar to IMbrave150, with a 48% resection rate, though careful monitoring of severe adverse events is essential. Clinical trial information: 051210148.

Association between frailty, as measured by the FRAIL scale, and 1-year mortality in older patients undergoing hip fracture surgery

BackgroundThe FRAIL scale is a concise and user-friendly tool for frailty assessment. However, its effectiveness in predicting 1-year mortality among older patients undergoing hip fracture surgery remains unclear. This study explored the relationship between preoperative frailty, as measured by the FRAIL scale, and 1-year mortality after surgery in this population.MethodsThis retrospective analysis included 194 older patients (aged ≥ 75 years) with hip fractures who underwent surgical treatment in our departments from January 2019 to December 2022. Perioperative clinical data were collected, and all-cause mortality within 1 year after surgery was monitored. Patients were categorized into non-frail (n = 114) and frail (n = 80) groups based on their FRAIL scores. Postoperative complications and 1-year mortality rates were compared between these groups. The association of preoperative frailty with 1-year mortality and its predictive capability were assessed.ResultsAmong the 194 older hip fracture patients, 78 (40.2%) were male, with a mean (standard deviation [SD]) age of 84.4 (6.3) years. The overall incidence of 1-year mortality after surgery was 11.3% (22/194). Frail patients had a higher incidence of Clavien-Dindo (CD) classification of surgical complications ≥ II (31.3% vs. 12.3%, p = 0.00) and greater 1-year mortality (21.3% vs. 4.4%, p = 0.00) compared with non-frail patients. Cox regression analysis indicated that preoperative frailty was independently associated with 1-year mortality (adjusted hazard ratio: 3.88; 95% confidence interval [CI]: 1.28–11.77; p = 0.02). The FRAIL scale demonstrated acceptable discriminatory capacity for predicting 1-year mortality in these patients (area under the curve: 0.70; 95% CI: 0.59–0.81).ConclusionsFrailty, as measured by the FRAIL scale, was independently associated with 1-year mortality in older patients undergoing hip fracture surgery. The scale can be used to stratify risk and facilitate personalized perioperative treatment and management.

Enhanced patient recovery with early extensive surgical deb-ridement in Fournier's Gangrene: evaluation of perioperative outcomes in a multicentric experience.

Fournier's gangrene (FG) is a rare, life-threatening necrotizing fasciitis primarily affecting the perineal, genital, and perianal regions. This rapidly progressing bacterial infection predominantly affects middleaged and elderly men. This multicenter study aims to describe the management in a wide cohort of Fournier's gangrene cases that presented to three tertiary centers with early extensive surgical debridement. We retrospectively collect data from patients with FG who were referred to the Urology Clinic of the Department of Medicine and Surgery (Perugia), the Urological Andrological Surgery and Minimally Invasive Techniques Unit (Terni) of the University of Perugia, and the Urology Unit of the Surgery Department of the Macerata Civic Hospital between January 2019 and March 2024 for onset of classic signs and symptoms of FG. Extensive surgical debridement was immediately performed under general anesthesia to reach normochromic and vascularized tissue in wide and depth extension, assuring vital and healthy margins. For all patients, intravenous daptomycin plus piperacillin/tazobactam were administered. 28 male patients with FG underwent early surgical debridement. In two cases, orchidectomy and partial penectomy were required during surgical debridement due to extensive necrosis. Colon diversion and urinary diversion were not necessary for any of the patients. 32.1% complications were recorded according to the Clavien Dindo classification; 6 patients died in the perioperative. Excluding death data, the average duration of antibiotic therapy was 22.0±9.1 days, and the average length of stay was 17.6±11.8 days. Fournier's gangrene has high mortality rates. It requires timely surgical debridement and antibiotic therapy to achieve positive outcomes. This study shows that a primary extensive debridement can help reduce the need for further intervention and shorten the hospital stay.

Factors Affecting the Prognosis after Primary Tumor Resection for Patients with Metastatic Colorectal Cancer with Synchronous Peritoneal Metastasis: A Multi-center, Prospective, Observational Study

To clarify the risk factors affecting prognosis after primary tumor resection (PTR) in patients with metastatic colorectal cancer with synchronous peritoneal metastasis (mCRC-SPM). Patients were enrolled prospectively in the JSCCR project "Grading of Peritoneal Seeding in Colorectal Cancer." Factors that may influence overall survival-age, sex, location of the primary tumor, lymph node metastasis, presence of liver metastasis, degree of peritoneal metastasis, peritoneal cancer index (PCI), cancer cure, and postoperative chemotherapy-in the PTR group were examined using multivariate analysis. Of the 133 enrolled patients with mCRC-SPM, 112 patients underwent PTR. Among them, 26 (23.2%) had mCRC-SPM of grade P1, 47 (42.0%) of P2, and 39 (34.8%) of P3. The median PCI was 4 (range, 1-28); no surgery-related deaths occurred. Postoperative complications of Clavien-Dindo classification ≥grade 2 were observed in 20 (17.9%) patients. R0 surgery became more difficult as the degree of dissemination increased, and the PTR group had a significantly better prognosis than the non-PTR group. In the multivariate analysis, age ≥75 years, rectal cancer, presence of liver metastasis, higher PCI, non-curative resection, and non-treatment with systemic chemotherapy were associated with poor prognosis in patients after PTR. In patients with mCRC-SPM, postoperative complications are infrequent for P1 with localized peritoneal dissemination, and PTR may be considered as aggressive treatment. Factors including age ≥75 years, rectal cancer, presence of liver metastasis, increased PCI, non-curative resection, and non-treatment with systemic chemotherapy are associated with a reduced survival benefit from PTR.

Robot-Assisted Radical Prostatectomy Using the KangDuo Surgical Robot-1500: A Prospective, Multicenter, Single-Arm Clinical Study.

Introduction: The KangDuo Surgical Robot-1500 (KD-SR-1500) is a newly developed surgical robot. We aim to evaluate the feasibility and efficiency of the KD-SR-1500 system for robot-assisted radical prostatectomy (RARP). Materials and Methods: This prospective, multicenter, single-arm clinical study was conducted among 18-75-year-old patients with suspected T1-2N0M0 prostate cancer scheduled for RARP. The perioperative and follow-up data were prospectively recorded. Early oncologic outcomes were assessed according to surgical margin status and prostate-specific antigen (PSA) at 6 weeks after surgery. Continence was defined as no more than one pad daily. Ergonomics were assessed with the National Aeronautics and Space Administration task load index (NASA-TLX). Perioperative complications were recorded according to the Clavien-Dindo classification. Results: A total of 31 patients were involved in the trial. One patient with severe abdominal adhesion withdrew from the trial. All surgeries were performed successfully without any conversion or secondary surgery due to surgical complications. The median docking time and console time were 3.8 (3.3-5.2) and 104.6 (80.0-145.6) minutes, with a median estimated blood loss of 50 (20-100) mL. Positive surgical margin was observed in 6 (20%) patients. One (3.4%) patient experienced PSA persistence at 6 weeks after surgery. The urinary continence rate was 75.9% (22/29) at 4 weeks after catheter removal. There were no major complications (grade ≥ III) or equipment-related adverse events. The mean NASA-TLX score was 23.9 ± 11.7. Conclusions: The KD-SR-1500 is feasible and effective for the management of T1-T2 prostate cancer.

P0677 Population-Based Analysis of 30-Day Postoperative Course in Crohn’s Disease Patients Undergoing Primary Bowel Resection

Abstract Background Despite a growing array of medical treatment options, resection rates for Crohn’s disease (CD) have decreased over time, while re-resection rates have remained stable at approximately one-third in historical cohorts. This study aimed to assess 30-day postoperative outcomes and complication rates following primary bowel resection in CD patients. Methods This study encompassed all CD patients undergoing primary resection in Eastern Denmark from 2010 to 2020 (46% of the Danish population, n=2,730,000). Clinical characteristics, surgical procedures, and complications (Clavien-Dindo classification and Rahbari score) were collected 30 days postoperatively (Figure 1). We used nonparametric statistics (median, interquartile range (IQR), percentages) and assessed complication risk with chi-square tests and multivariate logistic regression. Results Primary resection was performed on 631 CD patients due to disease activity. The median age at resection was 35 years (IQR: 25-49) with disease duration of 2 years (IQR: 0-7), and 227 (36%) were smokers. A total of 76 patients (12%) underwent acute resection (&amp;lt;24 hours), while 380 (60%) underwent elective procedures, 349 (55%) had laparoscopic surgery, 479 (76%) received a primary anastomosis (PA), and 94 (15%) were re-admitted. In total, 164 patients (26%) experienced complications within 30 days. Twenty-two (3%) had a Rahbari score of grade C, and two (0.3%) had grade B, and none had grade A. The Clavien-Dindo classification showed grade I: 22 (3%), grade II: 42 (7%), grade III: 95 (15%), grade IV: 4 (0.6%), and only one death (0.2%). Active steroid use (OR 2.26, 95% CI: 1.47–3.45, p&amp;lt;0.001), open surgery (OR 1.60, 95% CI: 1.10–2.34, p=0.015), and resection length &amp;gt;10 cm (OR 2.82, 95% CI: 0.532–51.9, p=0.325) were associated with higher odds, while primary anastomosis reduced risk (OR 0.42, 95% CI: 0.281–0.633, p&amp;lt;0.001). Never received IBD medication (OR 0.76, 95% CI: 0.42–1.30, p=0.336) or being on therapeutic doses of biologics (OR 1.31, 95% CI: 0.87–1.96, p=0.191) was not significantly associated with the risk of 30-day complications, nor were symptom burden (HBI) or smoking status (p=0.670 and 0.250). Conclusion CD patients are often diagnosed and primary resected young, facing significant risks within 30 days postoperatively: 15% were readmitted, and one-fourth experienced complications requiring treatment. the Risk of complications was increased by open surgery, resection length &amp;gt;10 cm, and preoperative corticosteroid use, while primary anastomosis reduced the risk. Receiving biologic therapy did not increase the risk of complications.

P0991 Laparoscopic ileocecal resection in pediatric Crohn’s disease: effect of anastomotic configuration on postoperative outcomes in the era of biologic therapy

Abstract Background Postoperative complications and recurrence (POR) frequently follow Ileocecal resection (ICR) in pediatric Crohn’s disease (pCD) patients. Evidence addressing the effect of anastomosis type on complications and POR in children remains limited. We aimed to compare laparoscopic-assisted end-to-end (ETE), side-to-side (STS), and Kono-S anastomoses and evaluate their outcomes based on the followed parameters. Methods From April 2018 to December 2023, we prospectively collected data on anastomosis configuration, colonoscopy at 6 months post-surgery, perioperative and demographic parameters from all pediatric patients referred to ICR for pCD. Complications were classified according to the Clavien–Dindo classification (CDc). Logistic regression estimated odds ratios (OR) and 95% confidence intervals (CI) for endoscopic recurrence (ER), defined as Rutgeerts score &amp;gt;1. The ETE was set as the reference. Artificial Intelligence (AI) were not used in the production of this abstract. Results Thirty-eight patients (18 females, 47.4%) were included, 14 in ETE, 10 in STS, 14 in Kono-S. No preoperative differences were observed. Median surgery durations were 151 minutes for ETE, 142 for STS (p=0.78), and 169 for Kono-S (p=0.09). Complication rate did not significantly differ. Median hospitalisations were 6.5 days for ETE, 6 for STS (p=0.85), and 6 for Kono-S (p=0.70). Neither Kono-S nor STS showed a higher risk of ER compared to ETE, with OR=1.13 (95%CI=0.21-6.16) for STS and OR=0.41 (95%CI=0.09-1.87) for Kono-S. Conclusion Kono-S and STS anastomoses demonstrated comparable complication rates to ETE, without significantly prolonging hospitalization or operation duration. Neither type of anastomosis was associated with an increased risk of ER.

Rare but important gastrointestinal complications after laparoscopic inguinal hernia repair: a single-center experience

Transabdominal preperitoneal patch plasty (TAPP) versus total extraperitoneal patch plasty (TEP) are surgical techniques commonly used to treat inguinal hernia. However, studies indicate that both procedures may lead to significant complications, particularly gastrointestinal complications, some of which can be life-threatening. We statistically analyzed the complications caused by adult inguinal hernia patients admitted from 2018 to 2022. We focused on gastrointestinal complications and conducted a case-by-case analysis on their causes and treatment processes. A total of 1034 patients were included in the final analysis, with 783 patients receiving TAPP treatment and 251 patients undergoing TEP. The overall complication rate for the TAPP group was slightly higher at 4.72% compared to 3.58% in the TEP group, but the difference was not statistically significant (p = 0.446). The incidence of both common and gastrointestinal complications is similar between the two groups, with no significant difference observed. Five patients (0.48%) suffered gastrointestinal complications, one with gastric perforation after TEP surgery, and four during TAPP surgery. All five cases of gastrointestinal complications were Grade III or higher according to the Clavien-Dindo classification, and all required reoperation. Gastrointestinal complications, though rare in LIHR, often require readmission and reoperation. Attempting non-operative management of such complications may lead to disastrous consequences. The majority of these complications are attributed to improper use of surgical instruments, necessitating vigilance on the part of the surgical team in preventing them.

Feasibility of robotic surgery in elderly patients with rectal cancer: a meta-analysis.

Rectal cancer's prevalence increases with an aging population, disproportionately affecting the elderly. The suitability of surgical interventions for this demographic is contentious due to underrepresentation during surgery. This study examines the practicality of utilizing Da Vinci surgery for rectal cancer patients who are 70years and older. Information was gathered from PubMed, Embase, Scopus and the Cochrane Library, with a focus on English-language publications. Statistical analysis was performed using RevMan 5.4, presenting outcomes for categorical variables in risk ratios. Out of 890 patients across 5 studies, 240 were categorized as elderly, while 650 fell into the younger age group. Notable distinctions were noted in harvested lymph nodes, BMI, and postoperative outcomes, whereas factors like the length of hospital stay, Clavien-Dindo classification, and radial resection margin did not display significance. Although age increases postoperative risk, evidence emphasizes frailty, not age alone, as the primary determining factor.

Continuous Stitches Versus Simple Interrupted Stitches During Anterior Colporrhaphy: A Randomized Controlled Trial.

Background: The anterior vaginal wall is frequently affected by prolapse, which is frequently treated with anterior colporrhaphy. However, this repair has a high recurrence rate, and no standardized approach exists. Our study aimed to compare two suture techniques concerning postoperative outcomes. Methods: This randomized, single-center trial involved patients with symptomatic pelvic organ prolapse, assigned to either continuous or interrupted stitches during anterior repair. The primary outcome was subjective symptom improvement, assessed by the German pelvic floor questionnaire 6-12 months post-surgery. Secondary outcomes included anatomical results and surgery-related adverse events per Clavien-Dindo classification (CDC). A total of 42 patients were analyzed to achieve 80% study power. Results: No significant differences were found in the pelvic floor scores between the two groups, but both groups showed significant improvements in prolapse and all other domains assessed by the questionnaire. None of the patients reported a recurrence of symptoms or required re-treatment during the follow-up visits. In patients with continuous stitches, significantly more CDC 2 and fewer CDC 1 events were noticed. The baseline prolapse stage, prolapse domain scores, age, and the stitching technique did not significantly influence the treatment success. Conclusions: We were able to demonstrate that both suture techniques are comparable and effective in improving subjective symptoms after anterior colporrhaphy, with no significant difference in outcomes between the two methods. The choice of stitching technique did not impact the recurrence of symptoms or the need for reoperation.

Antibiotic treatment versus appendicectomy for acute appendicitis in adults: an individual patient data meta-analysis.

Randomised controlled trials (RCTs) have found antibiotics to be a feasible and safe alternative to appendicectomy in adults with imaging-confirmed acute appendicitis. However, patient inclusion criteria and outcome definitions vary greatly between RCTs. We aimed to compare antibiotics with appendicectomy for the treatment of acute appendicitis using individual patient data and uniform outcome definitions. In this individual patient data meta-analysis, we searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials without language restrictions between database inception and June 6, 2023, for RCTs comparing appendicectomy with antibiotics for the treatment of adults (≥18 years) with imaging-confirmed acute appendicitis. Studies without 1-year follow-up data on complications were excluded, as were patients. Corresponding authors of eligible studies were contacted and invited to share data; individual patient data were merged after validation. One-stage meta-analyses were conducted using a generalised, mixed-effects linear regression model, accounting for clustering of patients within studies. The primary outcome was the complication rate at 1-year follow-up, uniformly harmonised across trials using the Clavien-Dindo classification. Complications were further divided into minor (grade 1-2 or equivalent) and major (grade 3-5 or equivalent) complications. Appendicectomy rate during 1 year was a key secondary outcome but not considered a complication for the antibiotics group. Outcomes were described separately for patients with and without an appendicolith. This study is registered with PROSPERO, CRD42023391676. Of 887 potentially relevant articles, eight were eligible for inclusion, of which six RCTs could provide data for 2101 eligible patients (1050 assigned to antibiotics and 1051 assigned to appendicectomy; 830 [39·5%] women and 1271 [60·5%] men). All studies raised some bias concerns due to absence of blinding. One study was judged to have a high risk of bias due to the exclusion of eligible patients after randomisation, but these patients were eligible for inclusion in our meta-analysis. At 1 year, 57 (5·4%) of 1050 patients randomly assigned to antibiotics had a complication compared with 87 (8·3%) of 1051 patients randomly assigned to appendicectomy (odds ratio [OR] 0·49 [95% CI 0·20 to 1·20]; risk difference -4·5 percentage points [95% CI -11·6 to 2·6]). At 1 year, 1025 (97·5%) patients in the appendicectomy group had undergone appendicectomy compared with 356 (33·9%) patients in the antibiotics group. In patients with an appendicolith at pre-interventional imaging, there were more complications at 1 year among patients who received antibiotic treatment than among those who underwent appendicectomy (29 [15·0%] of 193 patients vs 12 [6·3%] of 190 patients; OR 2·82 [95% CI 1·11 to 7·18]; risk difference 13·2 percentage points [95% CI 2·3 to 24·2]). In the antibiotics group, 94 (48·7%) of 193 patients with an appendicolith underwent appendicectomy within 1 year versus 262 (30·6%) of 857 patients without an appendicolith. This meta-analysis showed that antibiotic treatment in adults with imaging-confirmed acute appendicitis was a safe alternative to surgery and resulted in around two-thirds of patients avoiding appendicectomy during the first year. In patients with an appendicolith, initial antibiotic treatment increased the risk of complications compared with appendicectomy, and around half of these patients assigned to antibiotics underwent step-up appendicectomy within 1 year. These data should be key components in shared decision making. None.

Performance of an Algorithm Grading Surgery-Related Adverse Events According to the Clavien-Dindo Classification.

To assess performance of an algorithm for automated grading of surgery-related adverse events (AEs) according to Clavien-Dindo (C-D) classification. Surgery-related AEs are common, lead to increased morbidity for patients, and raise healthcare costs. Resource-intensive manual chart review is still standard and to our knowledge algorithms using electronic health record (EHR) data to grade AEs according to C-D classification have not been explored. The algorithm was developed in a research database containing all EHR data of Karolinska University Hospital Stockholm and returns a C-D grade for each AE within 30 days. This raw score was used to grade postoperative recovery of 1,379 elective colorectal procedures according to C-D classification and Comprehensive Complication Index® (CCI). Agreement with manual annotation of colorectal surgeon (gold standard) and research nurse (current practice) was assessed in a random sample of 399 procedures. For the C-D classification, kappa was 0.77 (95%CI 0.71-0.84) for algorithm vs surgeon and 0.74 (95%CI 0.67-0.82) for algorithm vs nurse. The kappa value increased to 0.89 (95%CI 0.84-0.95) after correction of misclassified annotations of surgeon. The intraclass correlation for CCI between algorithm and surgeon was 0.89 (95%CI 0.87-0.91) after correction and 0.76 (95%CI 0.71-0.80) for algorithm vs nurse. The performance of the algorithm motivates in our opinion implementation to real-time data under continuous scientific evaluation of the impact on AEs in different types of surgery. In the future, local EHR data could be used to enhance risk prediction with machine learning techniques.

Transperitoneal robot-assisted partial nephrectomy: a comparison of operative and oncological outcomes between posterior and anterolateral tumours.

To compare operative and oncological outcomes, as well as the risk of postoperative complications in patients who underwent transperitoneal robot-assisted partial nephrectomy (RAPN) for renal tumours located either posteriorly or anterolaterally. Retrospective, consecutive study including 451 patients who underwent transperitoneal RAPN for non-metastatic, localised renal tumours from May 2016 to April 2023. Operative data included duration of the procedure, warm ischaemia time, and blood loss; oncological data included surgical margins and recurrence; and 90-day postoperative complications were classified according to the Clavien-Dindo classification. In total, 140 (31%) patients had tumours with a posterior location. The median follow-up was 3.3 (IQR 1.8-5.0) years. There were no differences in operative outcomes or length of hospital stay between the two groups. Positive surgical margins were recorded in 9% of the patients with posterior tumours compared to 7% of patients with anterolateral tumours, p = 0.60. The estimated probability of recurrence-free survival at 5years was 95.2% (95% CI 87.4-98.2) for patients with posterior tumours and 96.7% (95% CI 92.3-98.6) for patients with anterolateral tumours, p = 0.4. Patients with posterior tumours had a similar risk of any complication (OR 1.24 [95% CI 0.80-1.91]) and CD ≥ III (OR 0.73 [95% CI 0.28-1.67]) compared to patients with anterolateral tumours. This study found that patients with posterior tumours had longer operating times and hospital stays following transperitoneal RAPN compared to those with anterolateral tumours but without increased complications or poorer oncological outcomes.