Gastroenterological Surgery Research Articles

Indocyanine green dyed gauze-guided minimum invasive surgery for anatomical landmarks and preventing gauze remnants: a pilot study.

We aimed to develop a novel fluorescent surgical gauze dyed with indocyanine green (ICG) to guide surgeons to the target anatomical destination during surgery for real-time navigation and to prevent gauze remnants after surgery. Surgical gauze was dyed with an aqueous solution of ICG (5.0 × 10- 5 mol L- 1 for Steraze, 1.5 × 10- 4 mol L- 1 for BK-Opeze) at 132°C (inside pressure: 2.82atm, 286kPa) for 15min using an autoclave, followed by washing with distilled water, drying at room temperature, and sterilizing at 132°C for 8min before surgery. Fluorescence (FL) intensity was examined preclinically in the resected specimens using the SPY PHI (Stryker) system. Fourteen patients who underwent laparoscopic- and robotic-assisted gastroenterological surgery at Showa University Hospital were included. Fluorescent emission of ICG-dyed gauze was clearly observed through resected specimens with a thickness of approximately 10mm or more. In a clinical trial, the ICG-dyed gauze was detected earlier with near-infrared (near-IR) FL imaging than under white light during seven cases of laparoscopic and robotic surgery, which could become a precise marker for surgeons to locate the dissection site despite overlaying tissues and nearby disturbances. Additionally, no seepage of ICG from the gauze was observed in all surgical fields. We successfully developed ICG-dyed gauze exhibiting bright near-IR FL which can guide surgeons to the target anatomical destination and prevent gauze remnants during surgery. This invention would be a powerful support for real-time navigation surgery.

Successful staged surgery for advanced esophageal cancer after conversion pancreatoduodenectomy with pancreaticogastrostomy.

Complex surgery during initial cancer treatment can limit surgical options when planning management of a secondary malignancy. Subtotal esophagectomy and pancreatoduodenectomy are the most invasive and difficult procedures in gastroenterological surgery. Surgical cases in which subtotal esophagectomy was performed after pancreatoduodenectomy with pancreaticogastrostomy are extremely rare and challenging procedures due to the resulting complicated anatomical changes. A 60-year-old man with a history of conversion pancreatoduodenectomy with pancreaticogastrostomy for advanced pancreatic head cancer was diagnosed as having advanced thoracic esophageal squamous cell carcinoma. After neoadjuvant chemotherapy, we chose a two-staged surgery with thoracoscopic subtotal esophagectomy. Following percutaneous endoscopic gastrostomy, we performed subtotal esophagectomy, systematic lymph-node dissection, and esophagostomy as the first-stage operation. Fifty-six days later, we performed gastrointestinal reconstruction with pedicle jejunum and microvascular anastomosis by the percutaneous route as the second-stage operation. Postoperatively, the patient was relieved without major complications, and the tumors were amenable to curative pathologic resection. The greatest advantages of staged surgery are to reduce surgical invasiveness and to circumvent the lower rate of curability. Our procedure reported here may be recommended as an option for staged resection and reconstruction in patients with advanced esophageal cancer after pancreatoduodenectomy with pancreaticogastrostomy.

CT Angiography Assessment of Dorsal Pancreatic Artery and Intrapancreatic Arcade Anatomy: Impact on Whipple Surgery Outcomes

Background/Objectives: The aim was to investigate the association between variations in the dorsal pancreatic artery (DPA) and intrapancreatic arcade anatomy with Whipple procedure outcomes and postoperative complications. Methods: This retrospective study was conducted with 362 patients who underwent a Whipple procedure at the Department of Gastroenterological Surgery of Adana City Training and Research Hospital between January 2018 and April 2024. All data collected from medical records were compared and statistically analyzed according to the patients’ survival status and arcade subtypes. Results: After excluding cases that did not meet the study criteria, a total of 284 patients were included in the study. DPA was visualized in 55.98% (159/284) of patients, while the intrapancreatic arcade was observed in 25% (71/284). The most common origin of the DPA was the splenic artery in 69.2% (n = 110) of patients, followed by the superior mesenteric artery in 17.6% (n = 28). The frequency of intrapancreatic arcade anatomy variations was as follows: type 1: 28.2% (n = 20), type 2: 49.3% (n = 35) and type 3: 22.5% (n = 16). Arcade type 4 anatomy was not detected. Postoperative pancreatic fistula (POPF) complication was found to be statistically significantly higher in patients with type 3 anatomy (p = 0.042). The 90-day mortality and long-term mortality rates did not differ among the groups based on the variations in both DPA and intrapancreatic arcade anatomy types. Conclusions: Patients with intrapancreatic arcade type 3 anatomy had a higher risk of POPF complications. Determination of preoperative arcade type by computed tomography (CT) angiography may help to predict the risk of POPF.

Differences in emergency hospitalization trauma patients during and after the COVID-19 pandemic.

The spread of COVID-19 has a huge impact on the medical system, affecting the normal order of routine patients, especially obvious effect on the Shenzhen Third People's Hospital as the designated hospital for COVID-19 patients. After the epidemic was loosened in early December 2022, the normal medical order gradually restored in China. How much was the impact on the admission and treatment of emergency trauma patients during and after the epidemic? This study aims to compare the differences between trauma patients admitted to the emergency department during and after the COVID-19 pandemic. The study included all trauma patients admitted through the emergency department from January 2020 to March 2024. Clinical data were collected, and a retrospective comparative analysis was performed on the characteristics of the two groups of trauma patients during and after the pandemic, including gender, age, average length of hospital stay, proportions of admissions to various departments, proportions of severe cases, proportions of surgical patients, and mortality rates, using statistical methods for analysis. The proportion of male patients during the pandemic (69.98%) was higher than after the pandemic (67.01%). The proportion of patients under 60 years of age during the pandemic was higher than that after the pandemic. There was no significant difference in the average hospital stay between patients during and after the pandemic (P>0.05). Comparisons between the two groups in terms of admissions to departments such as otolaryngology, hepatobiliary surgery, hepatic surgery, orthopedics, urology, neurosurgery, gastroenterology surgery, thoracic surgery, ophthalmology and intensive care unit showed no significant differences (P>0.05). The proportion of surgical patients during the pandemic (75.09%) was higher than after the pandemic (69.53%). The mortality rate during the pandemic (0.13%) was lower than after the pandemic (2.45%). The COVID-19 pandemic has impacted trauma patients admitted through the emergency department, with increases in the proportion of male and younger patients, surgical cases, and a decrease in mortality rates during the pandemic.

Prevalence and Incidence of Peutz-Jeghers Syndrome and Juvenile Polyposis Syndrome in Japan: A Nationwide Epidemiological Survey in 2022.

Peutz-Jeghers syndrome (PJS) and juvenile polyposis syndrome (JPS) are autosomal dominant diseases associated with high cancer risk. In Japan, knowledge about the prevalence and incidence of PJS and JPS is lacking despite being crucial for providing appropriate medical support. We aimed to determine the prevalence and incidence of these diseases. In 2022, a nationwide questionnaire survey was conducted to determine the number of patients with PJS or JPS by sex and the number of newly confirmed cases from 2019 to 2021. The target facilities included gastroenterology, pediatrics, and pediatric surgery departments, which were stratified into seven classes on the basis of the total number of beds. We randomly selected target facilities using different extraction rates in each class, resulting in 1748/2912 facilities (extraction rate: 60%) as the final sample. We calculated the estimated number of patients using the response and extraction rates. A total of 1077 facilities responded to the survey. The estimated numbers of patients with PJS and JPS were 701 (95% confidence interval [CI]: 581-820) and 188 (95% CI: 147-230), respectively. The 3-year period prevalences of PJS and JPS were 0.6/100000 and 0.15/100000, whereas the incidences in 2021 were 0.07/100000 and 0.02/100000, respectively. Male patients constituted 53.5% and 59.6% in the PJS and JPS groups, respectively. We determined the prevalence and incidence of PJS and JPS in Japan for the first time. Further research is needed to obtain more detailed information, including the clinical differences and outcomes in Japan.

Nationwide medical database study for postoperative nutritional management in patients undergoing gastroenterological cancer surgery

Nationwide medical database study for postoperative nutritional management in patients undergoing gastroenterological cancer surgery

Analysis of surgical volume and short‐term outcomes for upper gastrointestinal cancer post‐COVID‐19: Evidence from a nationwide Japanese database

AbstractAimPrevious studies indicated that short‐term outcomes for gastroenterological surgeries did not worsen during the COVID‐19 pandemic. However, it remains unclear whether surgical volumes and medical resource use have recovered postpandemic. This study examines pre‐ and postpandemic trends in upper gastrointestinal surgeries, including esophagectomy and gastrectomy, and their short‐term outcomes.MethodsData from the Japan's National Clinical Database (NCD) were analyzed for patients who underwent esophagectomy for esophageal cancer and gastrectomy for gastric cancer between January 2018 and December 2023. We evaluated changes in surgical volume, intensive care unit (ICU) use, morbidity, mortality rates, and the standardized morbidity and mortality ratio (SMR)—a comparison of observed versus expected outcomes using an NCD‐established risk calculator. Key metrics included 30d mortality, surgical mortality, and four major morbidities like pneumonia and anastomotic leakage.ResultsEsophagectomy volumes remained stable from 2018 to 2023, while gastrectomy volumes decreased notably over the past 6 y. The proportion of patients over 70 increased significantly in both surgery types. Morbidity and mortality rates showed no significant deterioration postpandemic, as indicated by SMR values.ConclusionsThis study analyzed changes in surgical volume and short‐term outcomes for upper gastrointestinal cancer in the post‐COVID‐19 era using a Japanese nationwide database. It found that surgical treatments for gastrectomy and esophagectomy remained safe even after the pandemic.

EGS SO17 - Foreign body management - Time for improvement

Abstract Background The management of foreign bodies (FBs) in clinical practice presents significant challenges across various medical specialties. FBs can be ingested, inhaled, inserted, or result from trauma, necessitating a comprehensive understanding of their management to prevent complications. The prevalence of FB incidents varies by age, with children being particularly susceptible to ingestion and inhalation, while adults often encounter FBs through trauma or occupational hazards. Effective management strategies are crucial to minimize morbidity and mortality associated with FB incidents. Method This study retrospectively reviewed cases of FB management over eight years (2015-2023), encompassing various specialties including gastroenterology, upper gastrointestinal and colorectal surgery. Data were collected on patient demographics, type and location of FB, method of removal, complications, and outcomes. Imaging techniques, such as X-rays, CT scans, and endoscopic evaluations, were analysed for their efficacy in FB detection. Different removal techniques, including endoscopic, surgical, and non-invasive methods, were evaluated for success rates and associated complications. Results Of the 153 FB incidents,47% involved male patients and 53% involved female patients.The paediatric group accounted for 36% of incidents.Non-invasive management was successful in 62% of cases,while 37% required invasive procedures.Among invasive interventions,70% required operative intervention,10% endoscopic intervention and 20% other minimally invasive options.The time to intervention for invasive procedures varied with more than 50% taking place after 24 hours.For operative interventions,64% occurred over 24 hours after presentation,21% within less than 24 hours, and 14% within 12 hours.All endoscopic interventions were performed within 12 hours.Outcomes showed that 96% of cases were managed without further complications.There were no reported mortalities. Conclusion Effective management of FBs requires a timely and appropriate intervention strategy tailored to the patient’s age and the type of FB. Non-invasive methods successfully managed most cases, while invasive procedures were necessary for a significant proportion. Prompt intervention, particularly endoscopic and other minimally invasive techniques, was associated with favorable outcomes and minimal complications. No mortalities were reported, underscoring the efficacy of current management protocols. Further research is needed to optimize these protocols and improve outcomes across diverse patient populations.

The outcomes of robotic-assisted enucleation for tumors located in uncinate process of pancreas in 16 cases

Objective: To summarize the experience of robot-assisted enucleation of tumors located in uncinate process of pancreas. Methods: This is a retrospective case series study. The clinical data of patients with robot-assisted enucleation of tumors located in the uncinate process of pancreas at the Department of Gastroenterology and Pancreatic Surgery,Zhejiang Provincial People's Hospital from June 2019 to December 2023 were retrospectively analyzed. A total of 16 cases were enrolled,including 10 males and 6 females,with an age(M(IQR)) of 56(21)years (range: 28 to 77 years),and body mass index of 22.4(2.3)kg/m2 (range:19.8 to 25.6 kg/m2). Follow-up was asked every 6 to 12 months after the first 3-month postoperative follow-up through out-patient service or via telephone. Results: In total 16 cases,there were 11 cases with pancreatic enucleation,and 5 cases with resection of the uninate process. The operation time was 70(60) minutes (range: 40 to 165 minutes),and the blood loss was 30(13)ml (range: 10 to 80 ml). The rate of pancreatic fistula was 5/16. The length of stay was 8(6)days (range: 5 to 33 days). The pathological finding included non-functional neuroendocrine tumor(n=3),insulinoma(n=2),introductal papillary mucinous neoplasm (n=5),solid pseudopapillary neoplasm (n=2),mucinous cystadenoma (n=1),serous cystadenoma (n=2),pseudocyst (n=1). Follow-up as of March 12, 2024, the follow-up time was 16(12)months (range: 3 to 41 months). All patients had no new onset diabetes and no dyspepsia. Conclusion: Robot-assisted surgical system can be used for local resection of uncinate process tumors of pancreas,and the quality of life of patients can be improved.

258. SHORT-TERM OUTCOMES AFTER ESOPHAGECTOMY ANALYZED USING NATIONAL CLINICAL DATABASE IN JAPAN

Abstract Esophagectomy for esophageal cancer is a highly invasive procedure in gastrointestinal surgery. The National Clinical Database (NCD) of Japan starting data collection in 2011 has accumulated real world data of esophagectomy, one of the main nine gastroenterological surgeries for which detailed input items have been required for the evaluation of surgical mortality and postoperative complications. We herein reviewed the short-term outcomes after esophagectomy analyzed by Japanese nationwide big database. Many studies on esophagectomy, including investigations of quality indicators, feasibility of minimally invasive surgery, and various patients’ conditions, have been conducted using NCD. The validation of certification systems by the Japanese Society of Gastroenterological Surgery (JSGS) and the Japan Esophageal Society (JES) revealed that the institute’s certification had greater influence on short-term surgical outcomes than the operating surgeon’s certification. Minimally invasive esophagectomy (MIE) can replace open esophagectomy (OE). MIE performed with no preoperative treatment was associated with significantly less incidence of any pulmonary morbidities, prolonged ventilation 48hours, unplanned intubation, surgical site infection, and sepsis. The total surgery-related mortality rates of MIE and OE were 1.7% and 2.4%, respectively (P < 0.001). The operative mortality in the elderly group with residual tumors increased to more than twice than that in the non-elderly groups (15.9 vs. 5.5 or 6.5%) and was much higher than that in elderly patients without residual tumors (15.9 vs. 4.6%). Careful selection is important for the treatment of elderly patients with highly advanced tumors to avoid unfavorable short-term outcomes. Thus, the NCD has contributed to quality assessment and improvement of surgery by feedback of accurate data in Japan.

563. CURRENT AND PROPOSED TREATMENT STRATEGIES FOR LOCALLY ADVANCED ESOPHAGEAL ADENOCARCINOMA OF THE ESOPHAGOGASTRIC JUNCTION

Abstract Background The optimal treatment strategy for locally advanced esophageal adenocarcinoma of the esophagogastric junction (AEG) is still unclear, and no consensus exists whether to treat it as an esophageal cancer or as a gastric cancer, which would include adjuvant therapy. The purpose of this study was to determine the optimal lymph node dissection, considering lymph node metastases and to develop a strategy for treatment that includes adjuvant therapy to improve the survival rate. Methods The patients were selected from a retrospective study by the Department of Surgery, Institute of Gastroenterological Surgery, Tokyo Women’s Medical University, that was conducted from 1990 to 2019. We studied 88 cases of advanced AEG in patients who underwent surgery with lymph node dissection. We retrospectively investigated the patient characteristics, pathological findings, surgical procedures, optimum extent of lymph node dissection, location of metastatic lymph nodes, recurrence pattern, and survival curves. Results Positivity for H. pylori was 29.8%. Barrett esophagus was found in 33%. Barrett esophagus was low. The calculated index for each nodal station was in stations 1, 2, 3, 7, 11 and 110 for 3-year survival and in stations 1, 2, 3 and 7 for 5-year survival. The proportion with undifferentiated histological type was high. The surgical approach underwent lower esophagectomy + proximal gastrectomy. Double-tract reconstruction was performed in 45%. Adjuvant (postoperative) chemotherapy was given to 51% patients. Preoperative (neoadjuvant) chemoradiotherapy was 17%. The 5-year overall survival rates were 24%. Conclusion We found that the optimal lymph node resection consists of the inferior mediastinum (No. 110), the lesser curvature (Nos. 1, 3, 7), No. 2, and No 11. When esophageal involvement was > 40 mm, we performed esophagectomy including upper thoracic lymph nodes. We were not satisfied with the result of surgical treatment including lymph node dissection alone in advanced AEG. We will recommend nab-paclitaxel combined with radiotherapy for advanced AEG to improve the survival rate.

Delayed diagnosis, disease and secondary prevention, especially in young patients with colorectal cancer.

<b>Introduction:</b> Colorectal cancer (CRC) is the third most common cancer worldwide and the second cause of death. Its incidence rate decreased by about 3% per year between 2011 and 2015, and mortality by 35% between 1990 and 2007. This improvement is a result of cancer prevention and early detection strategies through screening. The decline in cancer rates may have been due to a growing awareness of colorectal cancer in the Polish population. There was a discernible improvement in the quality of surgical treatment with time.<b>Aim:</b> The aim of the study was to determine the relationship between colonoscopy and the incidence of CRC, the incidence and family history of cancer and other intestinal diseases, as well as between the stage and time from first symptoms to the start of treatment.<b>Materials and methods:</b> A retrospective analysis of the records of patients with CRC treated surgically between 1995 and 2005 at the Department of General, Oncological, and Gastroenterological Surgery in Krakow and a diagnostic survey method were used.<b>Results:</b> There was a statistically significant relationship between the performance of colonoscopy and the incidence of CRC (P<0.001). There was no correlation between CRC and the incidence of cancer and other bowel diseases in the family, or between the stage and the time from first symptoms to the start of treatment. The length of time was long, usually up to 6 months, 1-3 years, and in some cases longer than 6 years.<b>Discussion:</b> Unfortunately, the incidence of CRC in young people under 50 years (EOCRC) has increased. Screening is of proven importance in reducing the incidence and mortality of CRC and every effort should be made to carry out as many of these screenings as possible. The time between diagnosis and treatment should also be kept as short as possible. Recommendations for the timeframe from diagnosis to treatment of cancer exist in many countries. In Australia, guidelines for an optimal care pathway suggest a timeframe of up to 7-9 weeks, similar to the National Health Service UK guidelines in the UK. Timeliness of treatment is an important factor in cancer care, to assess the consequences of delays and disruptions in oncology care.<b>Conclusions:</b> The incidence of CRC was lowest among those who had prophylactic examinations - colonoscopies. Studies on secondary prevention have confirmed that there was poor diagnosis in this area, even though there were cases of CRC in the immediate family, so it is worth educating the public and encouraging them to have colonoscopies and take care of their health. The long time between the appearance of the first clinical symptoms and the start of treatment, which was presented in the study, is unfortunately associated with a worse prognosis, as any delay in starting treatment for oncology patients is unfavorable.<b>Significance of the research for the development of the field:</b> The role of secondary prevention in the prevention of CRC and the need to educate the public to catch the first worrying signs of cancer and to consult a doctor are emphasized.

Outcome research on esophagectomy analyzed using nationwide databases in Japan: evidences generated from real-world data.

Esophagectomy for esophageal cancer is a highly invasive gastrointestinal surgical procedure. The National Clinical Database (NCD) of Japan, initiated in 2011, has compiled real-world data on esophagectomy, one of nine major gastroenterological surgeries. This review examines outcomes after esophagectomy analyzed using the Japanese big databases. Certification systems by the Japanese Society of Gastroenterological Surgery (JSGS) and the Japan Esophageal Society (JES) have shown that institutional certification has a greater impact on short-term surgical outcomes than surgeon certification. Minimally invasive esophagectomy has emerged as a viable alternative to open esophagectomy, although careful patient selection is crucial, especially for elderly patients with advanced tumors. The NCD has significantly contributed to the assessment and enhancement of surgical quality and short-term outcomes, while studies based on Comprehensive Registry of Esophageal Cancer in Japan (CRECJ) have provided data on patient characteristics, treatments, and long-term outcomes. The JES has conducted various questionnaire-based retrospective clinical reviews in collaboration with authorized institutions certified by JES. The Diagnosis Procedure Combination (DPC) database provides administrative claims data including itemized prices for surgical, pharmaceutical, laboratory, and other inpatient services. Analyzing these nationwide databases can offer precise insights into surgical quality for esophageal cancer, potentially leading to improved treatment outcomes.

Complete Mesogastric Excision with D2 Lymphadenectomy for Gastric Cancer: Short-Term Results.

To compare the short-term results of complete mesogastric excision with the conventional surgical technique. An experimental study. Place and Duration of the Study: Department of Gastroenterological Surgery, Health Sciences University, Basaksehir City Hospital, Istanbul, Turkiye, from April to December 2023. Comparison of short-term results of open total gastrectomy + mesogastrectomy with standard total gastrectomy + D2 lymph node dissection at a tertiary centre in terms of peroperative results, histopathological findings, and postoperative short-term outcomes prospectively, with review of the literature. A total of 37 patients were included in the study. The groups involved 26 male and 11 female patients. The study group included 14 patients while the control group involved 23 patients. The mean blood loss (mL) was significantly lower and number of metastatic lymph nodes was significantly higher in the study group. Total mesogastric excision is a safe technique which has advantages over conventional D2 gastrectomy in terms of not only peroperative and short-term outcomes, but also disease-free survival. This is the first study from a different population of the world and initial results can contribute to the literature for universalisation. Complete mesogastrium excision, D2 lymphadenectomy, Gastric cancer, Gastrectomy, Mesogastrectomy.

Endoscopic pancreatogastric anastomosis in the treatment of symptoms associated with inflammatory diseases of the pancreas.

The outflow of pancreatic juice into the duodenum is often impaired in pancreatic inflammatory diseases. The basis of interventional treatment in these cases is anatomical transpapillary access of the main pancreatic duct during endoscopic retrograde cholangiopancreatography (ERCP), which ensures the physiological outflow of pancreatic juice into the lumen of the digestive tract. However, in some patients, anatomical changes prevent transpapillary drainage of the main pancreatic duct. Surgery is the treatment of choice in such cases. To evaluate the effectiveness and safety of endoscopic pancreaticogastrostomy under endoscopic ultrasound (EUS) guidance. Retrospective analysis of treatment outcomes of all patients with acute or chronic pancreatitis who underwent endoscopic pancreatogastric anastomosis under EUS guidance in 2018-2023 at the Department of General, Gastroenterological and Oncological Surgery, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Poland. In 9 patients [7 men, 2 women; mean age 53.45 (36-66) years], endoscopic pancreatogastric anastomosis under EUS guidance was performed because of the lack of transpapillary access during ERCP. Narrowing of the main pancreatic duct at the head of the pancreas was observed in 4/9 patients (44.44%). Pancreatic fragmentation (disconnected pancreatic duct syndrome) was diagnosed in 3/9 patients (33.33%). In 2/9 patients (22.22%), narrowing of the pancreatoenteric anastomosis was observed after pancreaticoduodenectomy. Technical success of endoscopic pancreaticogastrostomy was observed in 8/9 patients (88.89%). Endotherapeutic complications were observed in 2/9 patients (22.22%). Clinical success was achieved in 8/9 patients (88.89%). The mean follow-up period was 451 (42-988) d. Long-term success of endoscopic pancreatogastric anastomosis was achieved in 7/9 patients (77.78%). Endoscopic pancreaticogastrostomy under EUS guidance is an effective and safe treatment method, especially in the absence of transpapillary access to the main pancreatic duct.

Contrasting seasonality of the incidence of incisional surgical site infection after general and gastroenterological surgery: an analysis of 8436 patients in a single institute

BackgroundWhile seasonality of hospital-acquired infections, including incisional SSI after orthopaedic surgery, is recognized, the seasonality of incisional SSI after general and gastroenterological surgeries remains unclear. Study DesignThis retrospective single-institute observational study analysed the seasonality and risk factors of incisional SSI after general and gastroenterological surgeries using univariate and multivariable analyses. The evaluated variables included age, sex, surgical approach, surgical urgency, operation time, wound classification, and the American Society of Anesthesiologists physical status (ASA-PS). Results8,436 patients were enrolled. General surgeries (n=2,241) showed a pronounced SSI incidence in summer (3.9%; odds ratio [OR] 1.87; 95% confidence interval [CI] 1.05-3.27; p=0.025) compared to other seasons (2.1%). Conversely, gastroenterological surgeries (n=6,195) showed a higher incidence in winter (8.3%; OR 1.38; 95% CI 1.10-1.73; p=0.005) than in other seasons (6.1%). Summer for general surgery (OR 1.90; 95% CI 1.12-3.24; p=0.018) and winter for gastroenterological surgery (OR 1.46; 95% CI 1.17-1.82; p=0.001) emerged as independent risk factors for incisional SSI. Open surgery (OR, 2.72; 95% CI 1.73-4.29, p<0.001) and an ASA-PS score ≥3 (OR, 1.64; 95% CI 1.08-2.50, p=0.021) were independent risk factors for incisional SSI in patients undergoing gastroenterological surgery during winter. ConclusionSeasonality exists in the incisional SSI incidence following general and gastroenterological surgeries. Recognizing these trends may help enhance preventive strategies, highlighting the elevated risk in summer for general surgery and in winter for gastroenterological surgery.

Rehabilitation Treatment in Perioperative Period of Gastroenterological Surgery

Rehabilitation Treatment in Perioperative Period of Gastroenterological Surgery

Incisional surgical site infections by subcutaneous soaking of wound with aqueous 0.05% chlorhexidine gluconate in gastroenterological surgery: A randomized controlled trial

BackgroundChlorhexidine gluconate solution is superior to povidone-iodine for prevention of surgical site infection. However, the overall efficacy of chlorhexidine gluconate for surgical site infection prevention in various types of gastroenterological surgery, as well as the optimal concentration of chlorhexidine gluconate, remain unclear. The aim of the present study was to clarify whether subcutaneous wound soaking with chlorhexidine gluconate would reduce the incidence of surgical site infection associated with gastroenterological surgery in patients with wound classes Ⅱ to Ⅳ. MethodsPatients were randomly assigned (1:1) to either wound soaking with chlorhexidine gluconate (chlorhexidine gluconate group) or no chlorhexidine gluconate soaking (control group). After closure of the abdominal fascia, gentle subcutaneous soaking of the wound was performed using gauze fully soaked in aqueous 0.05% chlorhexidine gluconate before skin closure. Incisional surgical site infection was diagnosed using the Centers for Disease Control and Prevention criteria. The primary end point was the occurrence of incisional surgical site infection. ResultsAmong 363 patients, 245 (67%) underwent laparoscopic surgery. All 363 patients were included—181 in the chlorhexidine gluconate group (49.9%) and 182 (50.1%) in the control group. There were no significant inter-group differences in patient background, the type of procedure, or wound classification. The incidence proportion of incisional surgical site infection was significantly lower in the chlorhexidine gluconate group than in the control group (9.4% vs 19.2%; P = .008). ConclusionSubcutaneous wound soaking with chlorhexidine gluconate reduces the incidence of incisional surgical site infection in patients undergoing gastroenterological surgery.

Value of zonulin as a diagnostic and prognostic marker in different degrees of nonalcoholic fatty liver disease

BackgroundNonalcoholic fatty liver disease (NAFLD) is a group of hepatic disorders ranging between simple form of accumulation of fat in hepatocytes (hepatic steatosis) and inflammation of liver internal tissues and injury of hepatocytes that is known as nonalcoholic steatohepatitis (NASH) with increasing levels of fibrosis and cirrhosis and hepatocellular carcinoma (HCC). The composition of one’s gut microbiota has a role in both the onset and progression of chronic liver disorders. One indicator of intestinal permeability is zonulin. In this study, we aimed to detect the value of zonulin as a diagnostic and prognostic marker in patients with different degrees of nonalcoholic fatty liver disease (steatosis, steatohepatitis, cirrhosis).This case–control study was conducted on 60 subjects in Gastroenterology and Bariatric Surgery Departments at Ain Shams University Hospitals who were divided into 3 groups: Group A: 20 patients underwent bariatric surgery and have mild NASH, Group B: 20 patients underwent bariatric surgery and have moderate-to-severe NASH, and Group C: 20 healthy controls, during a period 1 of year.ResultsThere was high statistically significant difference between the studied groups; as regard zonulin concentration, zonulin showed high diagnostic accuracy in diagnosis of NASH among hepatic patients with total accuracy of 81.7%, sensitivity of 72.5%, and specificity of 100.ConclusionSerum zonulin levels increase with steatosis severity in patients with NAFLD. This explains the high diagnostic accuracy of zonulin in diagnosis and prognosis of NASH among patients.

Abdominal aortic calcification among gastroenterological and transplant surgery.

This review discusses the increasing global trend towards an aging population, which has resulted in a growing number of surgeries being performed on elderly patients, particularly those living with cancer. The focus was on the implications of abdominal aortic calcification (AAC), an indicator of systemic atherosclerosis, in these patients. This comprehensive review provided evidence detailing the complex processes of atherosclerosis and vascular calcification and various approaches to assess this condition. The prevalence of AAC is related to multiple factors, including cardiovascular disease, inflammation, frailty in various types of gastroenterological surgery. Additionally, notable links were found between AAC, postoperative complications, and patient survival following gastroenterological surgery. This study highlights how AAC could negatively impact the health status of elderly patients and undermine treatment efficacy, stressing the need for more research in this domain to improve patient outcomes.