Leakage Rate Research Articles

Leak rates in pancreatico-duodenectomy procedures in pancreatic NETs compared to pancreatic ductal adenocarcinoma resections

Leak rates in pancreatico-duodenectomy procedures in pancreatic NETs compared to pancreatic ductal adenocarcinoma resections

Comparison of robotic assisted and laparoscopic radical resection for rectal cancer with or without left colic artery preservation.

The preservation of the left colic artery (LCA) during rectal cancer resection remains a topic of controversy, and there is a notable absence of robust evidence regarding the outcomes associated with LCA preservation. And the advantages of robotic-assisted laparoscopy (RAL) surgery in rectal resection remain uncertain. The objective of this study was to assess the influence of LCA preservation surgery and RAL surgery on intraoperative and postoperative complications of rectal cancer resection. Patients who underwent laparoscopic (LSC) or RAL with or without LCA preservation resection for rectal cancer between April 2020 and May 2023 were retrospectively assessed. The patients were categorized into two groups: low ligation (LL) which with preservation of LCA and high ligation (HL) which without preservation of LCA. A one-to-one propensity score-matched analysis was performed to decrease confounding. The primary outcome was operative findings, operative morbidity, and postoperative genitourinary function. A total of 612 patients were eligible for this study, and propensity score matching yielded 139 patients in each group. The blood loss of the LL group was significantly less than that of the HL group (54.42 ± 12.99 mL vs. 65.71 ± 7.37 mL, p<0.001). The urinary catheter withdrawal time in the LL group was significantly shorter than that in the HL group (4.87 ± 2.04 d vs. 6.06 ± 2.43d, p<0.001). Anastomotic leakage in the LL group was significantly lower than that in HL group (1.44% vs. 7.91%, p = 0.011). The rate of urinary dysfunction and sexual dysfunction in LL group is both significantly lower than HL group. Blood loss and number of harvested lymph nodes (LNs) of both RAL subgroups in LL and HL groups were significantly more than that in LSC subgroups. The anastomotic leakage in the RAL subgroup of HL group was significantly lower than that in LSC subgroup (0% vs. 14.89%, p = 0.018). LCA preservation surgery for rectal cancer may help reduce the blood loss, urinary catheter withdrawal time, the rate of anastomotic leakage and ileus, and postoperative genitourinary function outcomes. RAL can reduce the probability of blood loss and improve harvest LNs in patients with rectal cancer.

Unilateral-access vs. bilateral-access in transfemoral transcatheter aortic valve replacement: A slim fit approach.

Vascular complications remain prevalent on transfemoral transcatheter aortic valve replacement (TF-TAVR) with a significant proportion related to the secondary arterial access. We hypothesized that placing the second sheath ipsilateral and distal to the delivery sheath could reduce vascular complications with similar safety and efficacy. Comparing vascular complications and clinical outcomes when placing the secondary arterial sheath in the ipsilateral (unilateral-access) versus in the contralateral (bilateral-access) femoral artery during TF-TAVR. Patients who underwent TF-TAVR using unilateral-access as first-choice approach were retrospectively compared with a contemporaneous bilateral-access group. The primary endpoint was the incidence of vascular complications related to femoral access according to the VARC-3 criteria. A propensity-score analysis was performed accounting for the differences in clinical, vascular, and procedural characteristics. A total of 217 patients were included, of whom 150 (69.1 %) underwent TF-TAVR through bilateral- and 67 (30.9 %) through unilateral-access. Vascular complications occurred in 16.0 % of the bilateral-access group and 10.4 % of the unilateral-access group (p = 0.280). The unilateral-access group achieved high procedural success with normalization of peak aortic velocity and low rates of paravalvular leaks, valve migration and pacemaker requirement. After propensity-score matching, the overall complications rate was superior in the bilateral-access group (54.4 % vs 35.1 %, p = 0.038) due to a trend of higher vascular complications (26.3 % vs 12.3 %, p = 0.058) and a significant higher occurrence of bleeding complications (17.5 % vs 1.8 %, p = 0.008). Unilateral-access TF-TAVR is feasible, safe, and potentially enhances procedural efficiency and patient satisfaction while maintaining the capacity for bailout interventions in managing vascular complications.

OGC SO45 - Effect of anastomotic technique on leak rates in two-stage robotic-assisted subtotal oesophagectomy

Abstract Background Introduction of new surgical techniques requires constant monitoring and real time audit. In our unit the introduction of the thoracic component of our robotic oesophagectomy program resulted in an increase in the anastomotic leak rate which was recognised in real time. This prompted a decision to change from a circular to a linear stapled technique. The aim of this study was to evaluate the impact of this change in technique on the anastomotic leak rate. Method A database was used to identify all cases of patients undergoing two stage subtotal oesophagectomy where the thoracic phase was performed robotically-assisted. Demographic, operative, pathological and complications data were extracted. An anastomotic leak was defined as radiological or endoscopic disruption of the oesophagogastric anastomosis or where a clinician had documented the presence of a leak in the clinical notes. Leaks were then graded by severity according to the classification by Low et al into type 1: localised defect treated with medical therapy or observation; Type 2: localised defect requiring intervention but not surgery, and; Type 3: localised defects requiring surgery. Results Fifty-seven patients were identified. The first 25 cases were reconstructed with a circular-stapled and the subsequent 32 with a linear-stapled anastomosis. There were no differences in baseline demographics. There were no differences in thoracic operating time nor blood loss, intraoperative complications and pathological variables such as lymph node yield. Overall, 11/57 patients (19%) had an anastomotic leak, of which 7 (28%) had a circular stapled anastomosis and 4 (12%) had a linear stapled anastomosis. This difference was not statistically significant (p=0.2384). However, CUSUM analysis after the change in anastomotic technique showed an ongoing and diminished anastomotic leak rate. Conclusion In our unit changing from a circular to a linear stapled anastomotic technique resulted in a reduction in the anastomotic leak rate from 24% to 12%. While this was not statistically significant, this is a clinically appreciable result and this benefit was confirmed on CUSUM analysis.

BN SO53 - Thoracotomy for the Repair of Giant Paraesophageal and Hiatal Hernias: A Systematic Review

Abstract Background The utilisation of transthoracic approaches for the repair of large hiatus hernias remains a topic of clinical debate. This study aims to evaluate and compare the efficacy, safety, and recovery metrics for transthoracic hiatal hernia repair and comparisons to the laparoscopic approach. Method A literature search was conducted using the key terms "hiatus hernia," "thoracotomy," "thoracic approach," and "Belsey Mark IV." The databases searched included MEDLINE, EMBASE, and Web of Science, covering the period from 2000 to June 2024. Extracted data included patient demographics, study design characteristics, length of stay, complication rate and mortality rate. Results A total of 5 citations were selected comprising a total of 560 patients of which 164 were male (29.3%) with an overall mean age was 64.9 (pooled SD = 1.93) and weighted mean follow-up length was 56.4 months (pooled SD = 39.1 months). The weighted overall mean length of stay was 14.5 days (Pooled SD = 7.42). The overall rate of minor complications was 19% (95% CI [6%, 31%]). The overall rate of major complications was 13% (95% CI [6%, 21%]). There were 4 reported mortalities in total and an overall leak rate of 1% (95% CI [0%, 2%]). Conclusion Both thoracotomy and laparoscopy have unique benefits and risks in the context of hiatal hernia surgery. Access via thoracotomy is associated with a higher incidence of complications. However, for large or emergent paraesophageal hernias, the transthoracic approach may represent a viable option in select patients.

OGC SO46 - Improving outcomes after oesophagectomy: The benefits of full robotic-assisted minimally invasive oesophagectomy (RAMIO) demonstrated in the first 100 cases, at a high-volume UK unit

Abstract Background There is a rapid movement towards adoption of robotically assisted minimally invasive oesophagectomy (RAMIO) in the United Kingdom. Transition from an open or laparoscopic oesophagectomy to a RAMIO programme, which carries considerable financial and training cost, must ensure parity of oncological and perioperative outcomes. We sought to compare our centre’s results of the three standard approaches to two-phase oesophagectomy: Open/Open (Open); laparoscopic/robotic abdomen with open chest (Hybrid); and RAMIO. Method This prospective cohort study investigated the experience of five surgeons in a single high-volume UK institution. We analysed consecutive patients undergoing two-phase transthoracic oesophagectomy for oncological reasons between 2018 and 2024. The study period was divided into three cohorts: Open (2018-2020, n=61), Hybrid (2020-2023, n=82) and RAMIO (2023-2024, n=100). Patient demographics, tumour characteristics, perioperative outcomes, and oncological data were compared. Data were analysed using Kruskal-Wallis and Chi-squared statistical tests. Results No significant differences were observed in patient demographics or tumour stage between the groups. Comparison of Open vs. Hybrid vs. RAMIO demonstrated a significant reduction in major complications (Clavien-Dindo ≥III), 34.4% vs. 23.2% vs. 14% (p=0.0014); pulmonary complications, 36.1% vs. 25.4% vs. 13% (p=0.0004); anastomotic leak rate, 11.5% vs. 2.4% vs. 4.0%, (p=0.0370); median length of stay, 14 vs. 12 vs. 8 days (p=0.0001); and mortality, 4.9% vs. 1.2% vs. 0% (p=0.0133) all favouring the RAMIO group in sub-group analysis. Median lymph node yields were comparable across groups, 49 vs. 43 vs. 43 (p=0.0876). Conclusion This single-institution study demonstrates potential benefits of transitioning from open or hybrid to RAMIO for oesophagectomy. RAMIO was associated with significantly reduced pulmonary complications, major complications and a shorter length of hospital stay. Oncological outcomes were maintained across all 3 techniques. These findings have important patient, financial, and resource implications, and support the continued adoption of RAMIO in the UK.

Abstract 4122080: Outcomes of Left Atrial Appendage Occlusion With and Without Concurrent Catheter Ablation for Patients at High Bleeding Risk: A Systematic Review and Meta-analysis

Introduction: The prevalence of non-valvular atrial fibrillation (NVAF) and stroke-related morbidity is rising. First-line therapy remains rate or rhythm control with anticoagulation, with catheter ablation (CA) also considered in suitable candidates. Left atrial appendage closure (LAAC) is increasingly used due to mounting evidence of non-inferiority compared to anticoagulation. Despite improved pre-procedural planning and patient selection reducing complications, adverse outcomes such as pericardial effusion and device-related thrombus occur in about 5% of patients. This study evaluates the outcomes of LAAC with CA versus standalone LAAC in NVAF patients with contraindications to anticoagulation. Methods: We searched PubMed, EMBASE, and Cochrane databases for all cohort studies comparing LAAC with CA to LAAC alone in patients with NVAF. Case series, reviews, and non-English language studies were excluded. The assessed outcomes included device compression rate at implant, device-related thrombosis, pericardial effusion, need for pericardiocentesis, and peri-device leak at 6 weeks. Statistical analysis was performed using Review Manager 5.1.7. Heterogeneity was assessed with I 2 statistics. Results: We included 6 studies with 51,545 patients, of whom 1,221 (2.3%) underwent both procedures. LAAC with CA and standalone LAAC cohorts had similar baseline demographics including age (68, 69 years), percentage of women (48%, 46%), CHA2DS2-VASc score (3.6, 3.7), and HAS-BLED score (3.1, 3.2). LAAC with CA was associated with a reduced incidence of device-related thrombosis (OR=0.18; 95% CI= 0.04-0.89; p=0.04) without an increase in pericardial effusion rates (OR=0.85; 95% CI= 0.48-1.51; p=0.59). There were no significant differences in device compression rates at implant (MD=0.34; 95% CI= -0.77-1.45; p=0.55), the need for pericardiocentesis (OR=1.01; 95% CI= 0.30-3.48; p=0.98), or rates of peri-device leak at 6 weeks (OR=0.61; 95% CI= 0.21-1.78; p=0.37). Conclusion: Concomitant LAAC with CA may reduce rates of device-related thrombosis compared to standalone LAAC without increasing the risk of pericardial effusion or peri-device leak at 6 weeks. These findings support the consideration of combining these procedures in the management of high-risk NVAF patients unable to tolerate anticoagulation.

Ghost-ileostomy versus conventional loop ileostomy in patients undergoing low anterior resection for rectal cancer: results of a randomised controlled multicentre pilot trial (DRKS00013997).

The objective of the current pilot trial was to evaluate whether ghost ileostomy is a safe alternative to the current standard of care in terms of a conventional loop ileostomy in patients undergoing low anterior resection with total mesorectal excision (LAR/TME) for rectal cancer. This randomized controlled pilot trial included patients undergoing LAR/TME, randomly assigning them to ghost ileostomy or conventional loop ileostomy intraoperatively. Follow-up spanned 6months, evaluating the following endpoints: comprehensive complication index (CCI), postoperative morbidity, transformation of ghost ileostomy, presence of ostomy at 6months, Wexner score, and quality of life (EORTC QLQ-C30 & CR29). Exploratory statistical analysis based on the intention-to-treat principle was conducted. Recruiting 30 patients from May 2018 to September 2022, the trial was prematurely stopped due to slow recruitment. The mean CCI was comparable between groups at any point of time (at 6months: 30.7 vs. 29.7, p = 0.889). There was no mortality and no need for creation of a terminal ostomy. Anastomotic leakage rates were similar in ghost ileostomy and loop ileostomy groups (p > 0.99). The ghost ileostomy was converted into a conventional loop ileostomy in 6 of 15 (40.0%) patients. Neither postoperative function, nor the overall quality of life showed significant differences. Ghost ileostomy appears as a viable and safe option for selectively deciding ileostomy creation in LAR/TME for rectal cancer. However, challenges in patient selection, excluding those at high risk for anastomotic leakage, limit widespread application and call for optimization in future research. German Clinical Trials Register ( https://drks.de/ ): DRKS00013997; date of registration: April 9th 2018.

Experimental investigation of natural gas leakage and dispersion characteristics in utility tunnels under the effects of real facility layout and forced ventilation

Natural gas leakage occurring in underground utility tunnels usually poses a significant threat to public safety. In order to prevent unexpected fires and explosions, the evolution mechanism of natural gas leakage and dispersion in utility tunnels is urgently needed. In this study, an experimental apparatus was built to facilitate the understanding of leakage and dispersion dynamics in utility tunnels. Methane with a purity of 99.9% is used as a surrogate for natural gas. A schlieren imaging system with a Z-shaped optical path was designed to visualize the high-speed gas jet. The concentration distribution, alarm time, dilution efficiency, and gas jet image were analyzed under the effect of various facility layouts, ventilation, and leakage rates. The results show that the gas leakage and dispersion process can be divided into three zones: upwind zone, leak zone, and downwind zone, characterized by complicated airflow collision, high-speed get jets, and stable dilution dispersion respectively. Scenario analysis highlights the significance of key facilities, such as cable brackets, in experimental and numerical modeling due to their impact on dispersion trajectories. Higher ventilation rates prove beneficial in reducing peak concentration, hazardous areas, and enhancing purge efficiency. Conversely, higher leakage rates exacerbate the likelihood and severity of gas explosions. Alarm time exhibits a V-shaped distribution relative to the leak point, while purge time correlates positively with sensor positions. These findings are of practical importance in enhancing quantitative risk assessment and designing mitigation strategies for gas leakage accidents, which helps to improve the safety-risk-control capabilities of utility tunnels.

Managing esophageal squamous cell carcinoma after cervical radiotherapy for a head and neck cancer: esophagectomy remains a viable option.

Managing esophageal squamous cell carcinoma (ESCC) in patients with a history of cervical radiotherapy for a head and neck cancer (HNC) often requires a careful evaluation of esophagectomy due to concerns regarding complications and prognosis. This study evaluates the periesophagectomy and oncological outcomes of such patients. Patients diagnosed with ESCC between January 2010 and August 2023 and who had undergone esophagectomy with cervical anastomosis were retrospectively reviewed. Patients were categorized into two groups based on the presence (group 1) or absence (group 2) of a history of radiotherapy for as HNC. After 1: 2 propensity score matching, the perioperative and oncological outcomes, including overall survival (OS) and recurrence-free survival (RFS), were evaluated. A total of 481 patients, 32 in group 1 and 449 in group 2, were included. After matching, group 1 patients and 64 patients in the group 2 were analyzed. All the patients in group 1 were males, and their mean age was 56years. The median radiation dose was 69Gy. The rates of anastomosis leakage, pneumonia, respiratory failure, and reoperation were comparable between the two groups. However, vocal cord palsy occurred more frequently in group 1, particularly in those with recurrent laryngeal nerve lymph node dissection (37.5%). The 3-year OS (69.6% vs. 75.2%; p = 0.26) and RFS (50.8% vs. 55.9%; p = 0.63) were similar between groups 1 and 2. In conclusion, perioperative and oncological outcomes were comparable between ESCC patients with and without prior HNC radiotherapy, supporting esophagectomy as a feasible option.

Experimental Characterization of a Bladeless Air Compressor

Abstract The Tesla compressor is an innovative technology that offers a unique approach to fluid compression. Unlike traditional compressors that use rotating blades, bladeless compressors utilize closely spaced disks to create compression. The purpose of this article is to design a prototype Tesla air compressor with optimal design parameters and investigate the performance and loss characteristics based on numerical analysis and experimental demonstration. The prototype model has been numerically investigated at different rotational speeds, and the results have been compared with those obtained in experiments. Computational fluid dynamics (CFD) simulations indicate that the rotor-only efficiency is greater than 90% at very low mass flowrates, while the coupling of the rotor and volute leads to a total-to-static efficiency of approximately 58% (without losses) at 14 g/s. At a nominal mass flow of 4 g/s, the highest total-to-static pressure ratio would be around 1.27. Experimental results indicate leakage losses greatly reduce net mass flow, while pressure ratio values are in good agreement with CFD predictions. During this experiment, a maximum isentropic efficiency of 32.4% is measured. Indeed, the prototype included ventilation and leakage losses, which were not modeled in the CFD analysis. It is remarkable that the compressor does not show any unstable behavior down to zero mass flow (closed valve test), where the CFD and the experiment show consistent pressure ratios. An estimation of the losses from end-wall friction and leakage flow is carried out using numerical simulations at different exit radial clearances. Increasing radial clearance results in an increase in leakage and end-wall power loss, the latter being driven mainly by the axial clearance with the casing, which remained unchanged. To minimize leakage, a Teflon ring has been used as a first measure. Numerical calculations have indicated that the leakage rate is approximately 6 g/s at design speed. A brush seal-type solution can improve the sealing system to reduce leakage.

Quantitative Characterization of Compressed Air Systems

In industrial production plants, leaks in the compressed air system (CAS) lead to significant energy losses. In view of rising global energy costs, increasing the efficiency of such systems represents considerable costcutting potential. When analyzing CASs, it is often not possible to quantify the basic consumption and leakages from the available data. For companies seeking to evaluate potential savings and enhance energy efficiency, it is crucial to quantitatively assess the efficiency of CASs in terms of leakage rate. Determining the quality is typically done at a pressure of 1 bar, which is insufficient due to the volume influence of different compressor-units used in production plants. This work focuses on the algorithmic identification of pressure drop intervals as well as the determination and graphical representation of a quantitative trend visualization for industrial pressure drop intervals over a broad pressure range. For the study, the pressures time series of four production sites were recorded within one year. Shutdown periods were identified from the raw data using four machine-learning (ML) clustering and classification methods. By segmenting the pressure drop intervals, the shutdown periods were parameterized, from which quantitative trend visualization for the pressure drop periods due to compressor shutdown could be calculated and interpreted in the context of a graphical representation. The classification methods were compared as part of this work. With an F1-score of up to 0.99 being reached, only the variance differed among the algorithms. From the temporal observation of the calculated trend visualizations, rapidly falling curves suggest an increasing system leakage.

The Current State of Robot-Assisted Minimally Invasive Esophagectomy (RAMIE): Outcomes from the Upper GI International Robotic Association (UGIRA) Esophageal Registry.

Robot-assisted minimally invasive esophagectomy (RAMIE) is increasingly adopted in centers worldwide, with ongoing refinements to enhance results. This study aims to assess the current state of RAMIE worldwide and to identify potential areas for improvement. This descriptive study analyzed prospective data from esophageal cancer patients who underwent transthoracic RAMIE in Upper GI International Robotic Association (UGIRA) centers. Main endpoints included textbook outcome rate, surgical techniques, and perioperative outcomes. Analyses were performed separately for intrathoracic (Ivor-Lewis) and cervical anastomosis (McKeown), divided into three time cohorts (2016-2018, 2019-2020, 2021-2023). A sensitivity analysis was conducted with cases after the learning curve (> 70 cases). Across 28 UGIRA centers, 2012 Ivor-Lewis and 1180 McKeown procedures were performed. Over the time cohorts, textbook outcome rates were 39%, 48%, and 49% for Ivor-Lewis, and 49%, 63%, and 61% for McKeown procedures, respectively. Fully robotic procedures accounted for 66%, 51%, and 60% of Ivor-Lewis procedures, and 53%, 81%, and 66% of McKeown procedures. Lymph node yield showed 27, 30, and 30 nodes in Ivor-Lewis procedures, and 26, 26, and 34 nodes in McKeown procedures. Furthermore, high mediastinal lymphadenectomy was performed in 65%, 43%, and 37%, and 70%, 48%, and 64% of Ivor-Lewis and McKeown procedures, respectively. Anastomotic leakage rates were 22%, 22%, and 16% in Ivor-Lewis cases, and 14%, 12%, and 11% in McKeown cases. Hospital stay was 13, 14, and 13 days for Ivor-Lewis procedures, and 12, 9, and 11days for McKeown procedures. In Ivor-Lewis and McKeown, respectively, the sensitivity analysis revealed textbook outcome rates of 43%, 54%, and 51%, and 47%, 64%, and 64%; anastomotic leakage rates of 28%, 18%, and 15%, and 13%, 11%, and 10%; and hospital stay of 11, 12, and 12days, and 10, 9, and 9days. This study demonstrates favorable outcomes over time in achieving textbook outcome after RAMIE. Areas for improvement include a reduction of anastomotic leakage and shortening of hospital stay.

Design and Characterization of a New Quartz Smog Chamber System for Studying the Atmospheric Effects of Vehicle Emissions on Plateaus

Since the 1960s, smog chambers have been an important tool for studying air pollution, and many indoor and outdoor smog chambers have been developed both domestically and internationally. However, all of these chambers are located at altitudes below 1500 meters, only simulating atmospheric conditions in low-altitude plains. Moreover, most are made of polytetrafluoroethylene (PTFE), resulting in a higher wall deposition effect. To simulate the evolution of atmospheric pollution in high-altitude regions, we developed the world's highest-altitude quartz smog chamber, located in Kunming at an elevation of 1900 meters. The chamber is a 3.375m³ cube constructed from 5mm quartz glass and features controlled temperature (0°C to 40°C) and relative humidity (2%-95%). We conducted a comprehensive characterization of the chamber, including tests for temperature and humidity stability, mixing stability, pressure resistance and sealing, light intensity measurement and environmental light matching, and background pollutant and wall loss assessments. The characterization results indicate excellent performance in simulating sunlight and controlling background pollutants. The NO2 photolysis rate is adjustable, ranging from 2.03×10⁻³s⁻1 to 5.87×10⁻³s⁻1. Under dry conditions, after 6 hours of photooxidation, the detected O3 formation rate was approximately 1.05 ppb/h, with a particulate mass concentration around 0.12 μg/m³. The reactor withstands pressures exceeding 1.5 bar, and at this pressure, the leak rate was measured at 1.1‰. Validation using the toluene-NO₂ system showed that indoor mixing reached equilibrium in about four minutes. The wall loss rate for SWFU-HAP particles at 25°C and RH <10% was 0.066 h⁻1, which is 70% lower compared to other chambers, while at RH = 50%, the wall loss rate was 0.137 h⁻1. These results demonstrate the superior performance of our system, meeting the high standards required for high-altitude vehicle exhaust aerosol emissions research and the investigation of the formation mechanisms of vehicle exhaust in high-altitude atmospheric environments.

Evaluating the Impact of Elective Endotracheal Tube Replacement on Postoperative Outcomes in Esophageal Atresia: A STROBE-guided Study

ABSTRACT Background: Elective ventilation and paralysis have been shown to decrease the anastomosis-related complications following primary repair of esophageal atresia (EA). Repeated endotracheal tube (ETT) block and replacement can increase these complications. We evaluated the results of our strategy of electively changing the ETT just before shifting the patient to the postoperative ward for elective ventilation. Materials and Methods: A retrospective study was conducted using the case records of patients from July 2015 to February 2024 including all the patients of EA with tracheoesophageal fistula who underwent primary repair with end-to-end esophageal anastomosis. The patients were divided into two groups Group A: ETT was changed and Group B: ETT was not changed immediately before shifting. The groups were compared for anastomotic leak and ETT tube block in the first 48 h. Results: Ninety-one patients were included in the study, 36 in Group A and 55 in Group B. Elective replacement of ETT decreased the tube block rates in the first 48 h following surgery (P = 0.032). Tension in the anastomosis was associated with a higher leak rate. The leak was present in 58.3% and 3.6% in cases with and without tension in the anastomosis (P = 0.001). Overall, the anastomotic leak was similar in both groups. In the subgroup of patients with anastomosis under tension, the rate of anastomotic leak was higher in patients with ETT block (P = 0.028). Conclusion: Elective replacement of EET decreases the tube block rates and anastomotic leak rates in cases with anastomosis under tension.

Predictive value and model construction of preoperative nutritional indexes for postoperative leakage in gastric cancer

Objective: We aimed to explore the predictive significance of the nutritional indexes in the occurrence of postoperative leakage after gastrectomy, aiming to develop and validate a predictive nomogram for assessing the risk of these complications.Methods: Patients undergoing radical gastrectomy for gastric cancer were studied, using data from The Sixth Affiliated Hospital of Sun Yat-sen University (2019-2022, n=1075) for nomogram development and an external cohort from Sun Yat-sen University Cancer Center (2022, n=286) for validation. The model, focusing on postoperative leakage, was constructed through univariate and backward stepwise regression. The performance of nomogram was assessed using the receiver operating characteristic (ROC) curve, calibration plots, decision curve analysis (DCA), and clinical impact curves (CIC).Results: The incidence rates of postoperative leakage were 6.51% in the training cohort and 6.71% in the external validation cohort, respectively. The nomogram effectively identifies critical factors influencing postoperative leakage risk, including NRS-2002 score, SFMAI, VSR, blood loss, intraoperative time, type of reconstruction, and Lauren type. The areas under the curve (AUC) for the development and external validation cohorts were 0.763 and 0.761, respectively, demonstrating acceptable predictive accuracy. The validation study showed the nomogram's satisfactory calibration, and both DCA and CIC confirmed its significant clinical utility.Conclusions: The nomogram offers an efficient and precise tool for initial screening, effectively identifying individuals at elevated risk for postoperative leakage.

Analysis of 398 cases of intradural spinal tumor resection with primary dural closure: surgical outcomes based on the suture material.

Cerebrospinal fluid (CSF) leak after resection of intradural spinal tumors (IST) represents a significant postoperative challenge. Although various dura suture techniques and materials have been explored experimentally, direct clinical comparative studies are lacking. This study evaluated the effectiveness of specific suture materials in primary dural closure post-IST resection and identified associated risk factors for CSF leak. A retrospective review was conducted of patients who underwent IST resection surgery at a single institution from January 2012 to February 2021. Patients were categorized on the basis of the dura suture materials used. Eligibility for the study required a posterior midline surgical approach, primary dural closure after durotomy, and absence of closed-suction drainage. Of 398 patients who met the inclusion criteria, the overall CSF leak-related surgical complication rate was 4.27% (17/398). The sutures used were 6-0 Prolene for 163 patients and 5-0 silk for 235 patients. Significant differences were observed between the suture groups in the CSF leak rate (Prolene 1.8% vs silk 6.0%, p = 0.046), lumbar drainage insertion rate (Prolene 0.6% vs silk 4.3%, p = 0.031), and length of postoperative bed rest (Prolene 1.07 days vs silk 3.25 days, p < 0.001). Logistic regression analysis indicated a significant association of CSF leak with the use of 5-0 silk (OR 4.11, p = 0.006) and revision surgical procedures (OR 6.73, p = 0.001). Surgical complications related to CSF leaks were significantly lower with the use of 6-0 Prolene sutures compared to 5-0 silk sutures in primary dural closure after IST resection.

Comparing surgical outcomes of powered versus manual surgical staplers: a systematic review and meta-analysis.

The growing use of staplers, manual and powered, especially in minimally invasive surgeries, necessitates evaluating their efficacy in gastrointestinal and thoracic surgeries. Parameters analysed include anastomotic and air leakage rates, bleeding, infection, cost, and operative duration. We searched Cochrane Library, CINAHL, EMBASE, PubMed, and Web of Science using terms like "surgical staplers," "manual staplers," "automatic staplers," and "powered staplers." We assessed study quality using the Joanna Briggs Institute (JBI) Critical Appraisal tools and conducted meta-analysis using Review Manager software. A total of 43,104 patients with a mean age of 60.8 were involved in the studies. The meta-analysis revealed a significant reduction in anastomotic leaks in GI surgery patients (OR 0.31, p = 0.0001) and a significant decrease in postoperative air leakage in thoracic surgery patients (OR 0.65, p = 0.05) when powered staplers were employed. Additionally, we observed a significant decline in hemostasis-related complications for both thoracic and GI surgeries (OR 0.48, p = 0.002) with the use of powered staplers. Although individually costlier than manual staplers, powered staplers significantly decreased total hospitalisation costs (MD -1725.82, p < 0.00001) amoungst the thoracic surgeries, due to the cost saved on remedying the lower rate of complications compared to manual staplers. It also decreased the average operative times in thoracic and GI surgeries, although not significant (p = 0.06, p = 0.07 respectively). Powered staplers surpass manual staplers by reducing operative duration, total hospital costs, and complications like anastomotic leaks and bleeding. Hence, they are poised to become the preferred alternative in future surgeries.

Structure Equation Model for Costs and Benefits of Distribution Pipe Rehabilitation in Reactive Maintenance

Some water distribution pipe networks were constructed several decades ago and have been damaged. The old pipe network has experienced many leaks and should be rehabilitated. In old cities like Jakarta, with high leak rates (1.6 leaks/km/year), pipeline network managers must frequently repair leaks or perform reactive maintenance. Far too many pipes need to be rehabilitated compared to the available budget. This research will develop an optimization model for selecting rehabilitated pipes under reactive maintenance conditions, which has never been performed before. The selection of pipe segments to be rehabilitated must be optimal to obtain maximum benefits using minimum costs. The variables that influence rehabilitation costs and benefits and the relationship between these variables need to be known to optimize the selection. The influencing variables and their model structure were obtained from literature reviews and surveys of respondents with sufficient experience in water pipe network management. These influential variables have varying characteristics. Data processing and analysis uses the confirmatory factor analysis (CFA) method with a formative–formative measurement model. In total, 22 variables were found to be valid and significantly influenced the cost and benefits of rehabilitation. The analysis results are a structural model of the relationship between variables that influence the costs and benefits of rehabilitation in reactive maintenance with a limited budget, which can be used to optimize rehabilitation models.

Optimization of aloe vera‐sodium alginate composite coating using L16 orthogonal design for extension of shelf life of mushroom

AbstractWhite button mushrooms are highly nutritive, rich in various macro and micro nutrients, however, have a short shelf life with weight loss (WL), enzymatic browning, and loss in firmness as the major quality defects. The present study was carried out to investigate the effect of aloe vera‐sodium alginate (AV‐SA) composite coating on the quality attributes of mushroom. The development of coating formulations containing 2% sodium alginate along with varying concentration of aloe vera gel 20%–80% and storage time 4–16 days was planned using a 2‐factor 4‐level orthogonal array (L16) design of Taguchi technique. The influence of both the process parameters on the WL, total soluble solids (TSS), respiration rate (RR), browning index (BI), firmness, electrolyte leakage rate (EL), malondialdehyde (MDA), ascorbic acid (AA), total phenolic content (TPC), enzymes activity (polyphenol oxidase and peroxidase), and yeast and mold count (YMC) were evaluated and the optimized level of parameters was determined on the basis of the highest S/N ratios of the responses. The results indicated that 60% AV‐SA composite coating could extend the shelf life of white button mushrooms for up to 8 days with retarded loss in weight, firmness, AA, and TPC and reduced increase in TSS, BI, EL, MDA with controlled enzymatic activity, RR, and YMC.