Severe Postoperative Complications Research Articles

Observation on the efficacy of cataract surgery combined with ICL implantation in the contralateral eye for patients with high myopia complicated with monocular cataract

Objective: To assess the surgical outcomes of cataract surgery combined with phakic posterior chamber intraocular lens (ICL) implantation in the contralateral eye for patients with high myopia and monocular cataract. Methods: This is a retrospective case series study. Clinical data were collected from 10 patients (20 eyes) with high myopia and monocular cataract who underwent phacoemulsification cataract extraction and intraocular lens implantation in the cataract eye (cataract surgery eye), and implantable Collamer lens (ICL) implantation in the contralateral eye (ICL implantation eye) at the Ophthalmology Department of the Army Characteristic Medical Center from June 2021 to December 2023. Among them, there were 4 males and 6 females, with an average age of (35.60±7.62) years. Uncorrected visual acuity was measured using the international standard visual acuity chart, and spherical equivalent (SE) and best corrected visual acuity (BCVA) were obtained through comprehensive optometry. Visual acuity was recorded in the form of logarithm of the minimum angle of resolution (logMAR). Objective visual quality parameters were obtained using a visual quality analysis system, and subjective visual quality was obtained through questionnaire surveys. Postoperative accommodative function and defocus curve were also examined. Various indicators before and 5 months after surgery were compared between the two eyes. Results: The BCVA in the cataract surgery eye significantly improved postoperatively (P<0.05), while no significant change was observed in the ICL implantation eye (P>0.05). Postoperative UCVA for the cataract surgery eye was 0.12±0.12 for distance, 0.18±0.18 for intermediate, and 0.28±0.20 for near vision. For the ICL implantation eye, these values were 0.10±0.11, 0.00 (0.00, 0.03), and 0.01 (0.00, 0.06), respectively. Objective scatter indices postoperatively were 2.20±1.82 for the cataract surgery eye and 0.90 (0.48, 1.90) for the ICL implantation eye. All patients became spectacle-independent postoperatively, with 6 experiencing halo phenomena that did not affect their daily life. The average patient satisfaction score was 9.5. The ICL implantation eye showed better accommodative amplitude and facility than the cataract surgery eye, with statistically significant differences (both P<0.05). The defocus curve indicated good binocular visual acuity, and no severe intraoperative or postoperative complications were reported. Conclusions: For patients with high myopia and monocular cataract, the combination of cataract surgery and ICL implantation in the contralateral eye effectively enhances postoperative visual acuity and quality, preserves natural accommodation, establishes binocular vision balance, and facilitates spectacle independence. The procedure is safe, reliable, and improves the quality of life and work.

Barbed Versus Conventional Sutures in Laparoscopic-Assisted Colorectal Surgery: A Systematic Review and Meta-Analysis.

Background: Minimally invasive surgery is the preferred method for treating colorectal disease. Laparoscopic suturing is complex, and barbed sutures (BS) can improve the process by eliminating the need for surgical knots and constant traction on the suture line. This study compares intraoperative and postoperative outcomes in patients undergoing laparoscopic-assisted colorectal surgery (LCS) with anastomosis using BS and conventional sutures (CS). Methods: PubMed, Scopus and Cochrane Library were systematically searched for studies comparing BS to CS in patients undergoing LCS. Continuous outcomes were compared using mean differences (MDs), and odds ratios (ORs) were computed for binary endpoints with 95% confidence intervals (CIs). Heterogeneity was assessed with I2 statistics. Statistical analysis was performed using Software R, version 4.2.3. Results: A total of four studies comprising 285 patients were included, of whom 143 patients (50.17%) underwent BS. Compared with CS, BS significantly reduced the total operative time (MD -16.25 minutes; 95% CI: -25.94, -6.56; P < .01; I2 = 0%). However, there were no significant differences between groups in the occurrence of intraoperative complications (OR .74; 95% CI: .26-2.12; P = .58; I2=0%), anastomotic leakage (OR 1.00; 95% CI: .14-7.26; P = 1.00), and Clavien-Dindo ≥III complications (OR 1.80; 95% CI: .41-7.95; P = .44, I2 = 0%). Conclusion: In this meta-analysis, BS significantly reduced the operative time in the anastomotic closure compared to CS in LCS. Furthermore, there were no significant differences between the groups in anastomotic leakage, intraoperative complications, and severe postoperative complications.

Out-of-Hours Laparoscopic Appendectomy: A Risk Factor for Postoperative Complications in Acute Appendicitis?

Background: The surgical environment can influence the clinical outcomes of procedures and patient conditions. This retrospective study aimed to evaluate how surgical timing affects short-term outcomes in emergency laparoscopic appendectomy for acute appendicitis. Methods: A total of 647 patients with acute appendicitis who underwent emergency laparoscopic appendectomy at Chuncheon Sacred Heart Hospital between January 2018 and June 2021 were included in this study. The study cohort was divided into the following two groups based on the timing of surgery: work hours and out-of-hours (weekends, holidays, or weekday nights). Clinical outcomes were then compared between the groups. Results: Work-hour and out-of-hours appendectomies were performed in 282 and 365 patients, respectively. Baseline characteristics and types of appendicitis were similar between the groups (complicated appendicitis: 26.6% in the work-hours group versus 30.4% in the out-of-hours group, P = .288). Operation times were comparable (35.10 minutes versus 34.33 minutes, P = .620), with no cases requiring conversion to open appendectomy in either group. The overall rate of 30-day postoperative complications did not differ significantly between the groups (7.8% versus 10.4%, P = .849). The severity of postoperative complications, categorized by the modified Clavien-Dindo classification, did not show significant differences between the groups (P = .849). In addition, the time to functional recovery was similar in both groups. Conclusions: The clinical outcomes of out-of-hours laparoscopic appendectomy were similar to those of procedures performed during working hours. Therefore, scheduling emergency surgery can be determined based on the patient's condition and the hospital's capacity to manage acute appendicitis.

The cumulative risk and severity of postoperative complications in patients with frailty undergoing major emergency abdominal surgery-A prospective cohort study.

Major emergency abdominal surgery (MEAS) has high morbidity and mortality rates. With an aging and frail population, understanding the impact of frailty on postoperative complications is crucial. This prospective cohort study was conducted at a major university hospital in Denmark from October 1, 2020, to January 1, 2024. A total of 733 patients undergoing MEAS were assessed for frailty using the clinical frailty scale (CFS) at admission and grouped into low (CFS 1-3), moderate (CFS 4-6), and high (CFS 7-9) frailty categories. Postoperative complications were classified by the Clavien-Dindo score and comprehensive complication index (CCI) until discharge. Patients with CFS one to three had 140 complications per 100 patients, CFS four to six had 267 complications per 100 patients, and CFS seven to nine had 297 complications per 100 patients (p<0.001). Increased frailty was associated with higher severity of complications (Clavien-Dindo score). Median CCI scores were 8.7 (CFS 1-3), 29.6 (CFS 4-6), and 38.2 (CFS 7-9) (p<0.001). The cumulative risk of complications was higher in patients with CFS four to six and seven to nine. Higher frailty scores correlate with an increased number and severity of complications as well as a greater overall burden of postoperative complications. The clinical frailty scale is effective for preoperative identification of high-risk patients. The study was approved by the Capital Region of Denmark (P-2020-1166 and R-21038079) and the Danish Data Protection Agency (P-2021-431).

Assessment of predictive factors in endoscopic internal urethrotomy for bulbar urethral strictures

IntroductionDirect vision internal urethrotomy (DVIU) is usually the first treatment offered to patients with bulbar urethral strictures (US). Advances in devices and surgical techniques have contributed to reducing associated complications. Despite the favorable success rate of DVIU, various factors predicting better outcomes have been studied, including patient characteristics, stricture features, and procedural aspects. The main aim of our study is to assess predictive factors for success. MethodsWe conducted a retrospective descriptive study of patients who underwent endoscopic internal urethrotomy at our hospital over a 30 year period. Out of 788 DVIU performed, we selected 491 (62.3%) conducted for bulbar US with a minimum follow-up of 12 months. We examined clinical outcomes obtained, and assessed the relationship between different patient characteristics, stricture-related factors and procedural aspects related with clinical success -considered as the avoidance of further interventions for stricture recurrence-. Descriptive statistics were calculated and parametrical and non-parametrical comparative tests were applied. Kaplan-Meier survival analysis was used for evaluating time until recurrence. ResultsMean stricture length was 1.2 cm (SD 0.5), with only 12 patients presenting with more than 1 US in the bulbar area during DVIU. After a median follow-up of 170 months, 67.4% of patients did not experience clinical recurrence. Severe postoperative complications appear in 0.4% of cases, and need for overnight admission was 4.5%. A positive association was observed between clinical recurrence and a history of prior pelvic radiotherapy (OR 2.8, 95%IC 1.3-22.2), active smoking (OR 2.1, 95%IC 1.6-2.4), infectious etiology of stricture (OR 2.3, 95%IC 1.6-8), history of previous urethroplasty (OR 2.5, 95%IC 1.7-3.2), and higher postoperative urinary catheter sizes (OR 1.8 95%IC 1.1-2.9). Median time until recurrence after the first DVIU was 65 months, after the second was 60 months, after the third was 32 months, and after the fourth was 6 months. ConclusionsBulbar US could be safely managed with DVIU. The best clinical success is achieved in non-irradiated, non-smoker patients, without prior urethroplasties. The repetition of the procedure is significantly associated with a shorter time to clinical recurrence.

Laparoscopic Retroperitoneal Lymph Node Dissection After Chemotherapy for Nonseminomatous Testicular Germ-Cell Tumor at a Single Center.

This study investigated the perioperative and oncological outcomes of laparoscopic retroperitoneal lymph node dissection (RPLND) procedures for post-chemotherapy patients with nonseminomatous testicular germ-cell tumor at a single center. This study included patients with nonseminomatous testicular cancer who underwent RPLND after chemotherapy at the Kyushu University Hospital between 2016 and 2024. The preoperative clinicopathological characteristics, perioperative outcomes, and oncological outcomes were investigated. A total of 13 patients underwent laparoscopic RPLND. Median maximum retroperitoneal tumor size at post-chemotherapy before RPLND was 11 mm (range, 2-30 mm). RPLND template was one side and both sides in nine and four patients. Median operative time was 272 min (range, 129-490 min), and median estimated blood loss was 27 mL (range, 0-100 mL). Median time from operation to discharge was 8 days (range, 5-15 days). There was no severe perioperative and postoperative complication. Residual cancer and teratoma were detected in one and seven patients. During median follow-up of 18.6 months (range, 1.0-95.7 months), no case presented recurrence. Laparoscopic RPLND presented safety in perioperative outcomes and favorable oncological outcomes. Thus, it was confirmed that laparoscopic RPLND is a feasible minimally invasive procedure for selected cases.

An initial exploratory clinical study and outcome assessment of gastrointestinal surgeries using advanced robotic-assisted techniques.

In addition to the Da Vinci surgical robot, domestic surgical robots are being developed rapidly. Chinese Toumai® laparoscopic surgical robot was approved for urological surgery in 2022.This study aims to systematically evaluate the safety and efficacy of the Toumai® robotic surgical system in performing complex gastrointestinal surgeries. This prospective, single-center, single-arm exploratory study was conducted at Gansu Provincial Hospital between June 2022 and October 2023, enrolling 12 patients undergoing gastrectomyand 9 patients undergoing colorectal resection. The primary endpoints are oncological outcomes and surgical success rates, while secondary endpoints encompassed intraoperative blood loss, operative duration, complication rates, system performance metrics, length of hospital stay, and postoperative pain levels. All patients successfully underwent robotic-assisted surgery with adequate oncological resection and favorable postoperative outcomes. There were no conversions to open or laparoscopic surgery, resulting in a 100% procedural success rate. The median docking time for radical gastrectomy was 17.50 (14.25, 21.50) minutes, with a median master-slave control time of 121.50 (105.50, 172.00) minutes, median intraoperative blood loss of 100.00 (50.00, 275.00) mL, and a median postoperative hospital stay of 9.00 (7.25, 10.75) days. For radical colorectal surgery, the median docking time was 22 (17.50, 30.50) minutes, the median master-slave control time was 68 (56.50, 119.00) minutes, with a median blood loss of 50 (50.00, 150.00) mL, and a median postoperative hospital stay of 7 (7.00, 10.00) days. No intraoperative organ injury, mortality, system failure, or severe postoperative complications were reported. These preliminary findings provide compelling evidence supporting the safety and efficacy of the Toumai® laparoscopic surgical robotic system in performing gastric and colorectal surgeries.

Preoperative Radiation Therapy is Not Associated with Postoperative Complications in Patients with Retroperitoneal Sarcoma.

The role of preoperative radiation therapy (RT) in the management of retroperitoneal sarcomas (RPS) remains controversial. A legitimate concern is the potential for worse outcomes after surgery for RPS with preoperative RT. The purpose of this study was to evaluate the impact of preoperative (± intraoperative) RT on postoperative complications in patients undergoing surgery for RPS. A total of 99 patients who underwent curative-intent surgery for primary RPS of any histology after preoperative RT from 2003 to 2021 were analyzed. Univariate and multivariate logistic regression analyses were performed to identify factors associated with postoperative morbidity and mortality. The median preoperative RT dose was 57.4Gy, and 17 patients received intraoperative RT to a median dose of 10Gy. The median number of organs resected was two. Postoperative complications within 30 days of surgery occurred in 47% of patients, including severe complications (Clavien-Dindo grades ≥IIIa) in 20% of patients. The 90-day mortality rate was 2%. On multivariate analysis, concomitant vascular resection was the only significant predictor of severe postoperative complications (odds ratio 8.76; p=0.0069). Despite increasing median preoperative RT doses from 50.4Gy in 2003-2012 to 63Gy (on a clinical trial) in 2013-2021, severe postoperative morbidity rates actually decreased from 26.3% to 16.1% (p=0.303). The administration of preoperative (± intraoperative) RT to patients with RPS resulted in similar postoperative complications as reported after surgery alone. Continuous advances in surgical and radiotherapeutic expertise resulted in lower complication rates over time despite increasing radiation doses.

The Perioperative NonaGEnaRIan And cenTenarian suRgICal (GERIATRIC) Risk Stratification Tool

Objective: To develop age-appropriate nonaGEnaRIan And cenTenarian suRgICal (GERIATRIC) risk tool for classifying patients who may or may not develop postoperative complications or die within their index hospital admission. Background: There are no validated perioperative risk stratification tools for use in nonagenarian and centenarian patients—people aged 90 to 99 years and &gt;100 years. Methods: In this retrospective observational study, nonagenarians and centenarians undergoing any surgical procedure were profiled. Surgery severity was stratified, and the incidence and grade of postoperative complications were recorded. Multivariable logistic regression analysis was performed on a training cohort, followed by calibration on a validation cohort, followed by performance evaluation on a testing cohort. The discriminative accuracy was compared to that of the age-adjusted Charlson Comorbidity Index for each outcome. The primary outcome was the ability of the risk stratification tool to effectively classify patients into those who may or may not experience a postoperative complications or mortality within their index hospital stay. Results: A total of 3085 patients were enrolled. The GERIATRIC risk tool had good discriminative accuracy for any postoperative complication [area under the receiver operating characteristic curves (AUROC), 0.857; 95% CI = 0.824–0.890] and any severe postoperative complication (AUROC, 0.833; 95% CI = 0.793–0.874), and fair discriminative accuracy for in-hospital mortality (AUROC, 0.780; 95% CI = 0.668–0.893). Conclusions: Compared to the age-adjusted Charlson Comorbidity Index, The GERIATRIC risk tool was accurate in classifying patients into those who may or may not experience severe complications or die during their index admission. The tool can be used to assist perioperative clinicians with shared decision-making and short-term prognostication.

Combined laparoscopic nephroureterectomy with transurethral approach to the ureter in renal tuberculosis treatment

BACKGROUND: Tuberculosis of the genitourinary system is a common cause of organ removal surgeries. Despite the improvement of medical technologies, kidney and urinary tract surgeries for urogenital tuberculosis are traditionally performed using the open method. AIM: To assess the findings of laparoscopic and open combined nephroureterectomy with transurethral resection of the distal ureter in patients with renal tuberculosis. MATERIALS AND METHODS: The findings of 61 nephroureterectomies with transurethral resection of the distal ureter performed for destructive renal tuberculosis were analyzed. Open nephroureterectomy was performed in 31 patients, and laparoscopic approach was used in 30 patients. Patients in both groups were comparable by gender and age. RESULTS: The surgery duration, volume of intraoperative blood loss, rate and severity of postoperative complications were lower in patients who had laparoscopic interventions. When examined 1 month after surgery, patients in both groups showed the improvement of clinical parameters. The following changes were reported: a significant decrease in the nighttime urination rate, a decrease in IPSS scores, and an increase in the functional bladder capacity without significant differences depending on the surgical approach. After the surgery, a significant improvement in the quality of patients’ life was observed. In patients who had laparoscopic surgery, improvements were detected in all the SF-36 questionnaire domains. However, in patients after open surgery with a positive effect on most of assessed parameters no significant improvement of parameters in section “General Physical Health” was found. CONCLUSIONS: Irrespective of the selected approach, combined nephroureterectomy with transurethral resection of the distal ureter is an effective method of surgical treatment of patients with destructive renal tuberculosis. Moreover, the laparoscopic technique has shown a number of significant advantages over open surgery.

Endoscopic cardiac mucosal ligation: a novel minimally invasive procedure for gastroesophageal reflux disease

Background Our objective in this study was to evaluate the short-term clinical efficacy and safety of endoscopic cardiac mucosal ligation, a novel endoscopic procedure, in the treatment of gastroesophageal reflux disease (GERD). Methods Patients diagnosed with refractory GERD or recurrent patients due to drug withdrawal admitted to our hospital were recruited in this clinical trial. All GERD patients were treated with endoscopic cardiac mucosal ligation. Postoperatively, all patients received subsequent follow-ups for approximately four months to evaluate the efficacy and safety of this endoscopic procedure. Results A total of 13 GERD patients were enrolled. Endoscopic cardiac mucosal ligation was successfully performed in all cases. Postoperatively, relevant symptoms were significantly alleviated in 10 patients (76.9%). The average Gastroesophageal Reflux Disease Questionnaire (GERD-Q) score in all participants significantly decreased from preoperative 10.0 ± 3.5 to postoperative 7.8 ± 2.9 (p = .022). The average GERD symptom questionnaire score was 27.0 ± 12.0 prior to surgery, which significantly decreased to 18.3 ± 7.5 postoperatively (p = .032). No severe postoperative complications were observed during subsequent follow-ups. Conclusions Endoscopic cardiac mucosal ligation might be a novel effective and safe endoscopic procedure for GERD.

The Extent of Tumor in the Peritoneum and Liver Influences Outcomes After Surgery for Synchronous Liver and Peritoneal Colorectal Metastases: A Cohort Study

PurposeCytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRSH) or liver resection have led to increased survival in patients with peritoneal or liver metastases of colorectal cancer. Selected patients undergo concomitant CRSH and liver resection. Differences in survival and morbidity between patients who underwent concomitant surgery, CRSH or liver resection for peritoneal and/or liver metastases were compared.MethodsPatients who underwent liver resection and/or CRSH for colorectal liver and/or peritoneal metastases, 2006–2016, were included. Regression analysis was used to evaluate the associations between baseline characteristics and survival.ResultsOverall, 634 patients were studied. Twenty-eight patients had peritoneal and liver metastases, 121 patients had peritoneal metastases only, and 485 patients had isolated liver metastases. Median survival after concomitant treatment was 23.8 months (95% CI 12.8–43.8), after CRSH 34.5 months (95% CI 27.1–41.9), and after liver resection 54.2 months (95% CI 47.4–61.0) (p < 0.001). Increased hepatic tumor burden (HR 3.2, 95% CI 1.8–5.8) and high-volume peritoneal disease (HR 6.0, 95% CI 3.7–9.8) were associated with decreased survival in multivariate analysis. Postoperative complications according to a Clavien–Dindo score > 3a were observed in 11% in the liver resection group, 15% in the CRSH group, and 11% in the concomitant treatment group (p = 0.945).ConclusionsPatients treated with concomitant surgery for liver and peritoneal metastases experienced a shorter median overall survival than patients treated for metastases at an isolated site but had a similar rate of severe postoperative complications. The extent of peritoneal spread seemed to impact survival more than the tumor burden in the liver.

Development and validation of a risk prediction model for severe postoperative complications in elderly patients with hip fracture.

This study aimed to investigate risk factors associated with severe postoperative complications following hip fracture surgery in elderly patients and to develop a nomogram-based risk prediction model for these complications. A total of 627 elderly patients with hip fractures treated at Yongchuan Hospital of Chongqing Medical University from January 2015 to April 2024 were collected. 439 patients were assigned to the training cohort for model development, and 188 to the validation cohort for model assessment. The training cohort was stratified based on the presence or absence of severe complications. We employed LASSO regression, as well as univariate and multivariate logistic regression analyses, to identify significant factors. A nomogram was constructed based on the outcomes of the multivariate regression. The model's discriminative ability was assessed using the area under the receiver operating characteristic curve (AUC), while calibration plots and decision curve analysis (DCA) evaluated its calibration and stability. Internal validation was performed using the validation cohort. Out of the 627 patients, 118 (18.82%) experienced severe postoperative complications. Both LASSO regression and multivariate logistic analysis identified the modified 5-item frailty index (mFI-5) and the preoperative C-reactive protein to albumin ratio (CAR) as significant predictors of severe complications. The nomogram model, derived from the multivariate analysis, exhibited strong discriminative ability, with an AUC of 0.963 (95% CI: 0.946-0.980) for the training cohort and 0.963 (95% CI: 0.938-0.988) for the validation cohort. Calibration plots demonstrated excellent agreement between the nomogram's predictions and actual outcomes. Decision curve analysis (DCA) indicated that the model provided clinical utility across all patient scenarios. These findings were consistent in the validation cohort. Both the mFI-5 and CAR are predictive factors for severe postoperative complications in elderly patients undergoing hip fracture surgery.

OGC O01 - Stomach Cancer Elective Surgery Morbidity and Mortality at 90-Days (HOLD Study): A Prospective, International Collaborative Cohort Study

Abstract Background Data on multinational 90-day mortality and morbidity rates after surgery for gastric cancer is limited in the literature. This study aimed to understand the 90-day mortality and morbidity outcomes according to GASTRODATA Registry for elective gastric cancer surgery patients and identify risk factors. Method We conducted an international prospective study on ≥18 years patients undergoing elective surgery for gastric cancer with curative intent from 01 April 2022 to 30 September 2022. Known metastatic disease, concurrent secondary cancers, gastrointestinal stromal tumour (GIST) and Siewert type I/II oesophagogastric junction malignancies were excluded. Univariate and multivariate logistic regression was used to identify variables associated to 90-day outcome. Results 380 collaborators from 47 countries submitted data on 1538 patients. Mean age was 64.2 years and 58.5% were males. 90-day morbidity rate was 38.2% (n=587) and mortality rate was 2.9% (n=45). Pre-operative higher CCI or ASA score, pre-operative weight loss &amp;gt;10%, and surgical determinants such as type of gastric resection, positive specimen margin, number of harvested lymph nodes, longer surgery duration and post operative pathological IV staging (p value&amp;lt;0.05) were identified as predictors of postoperative severe complications and mortality. Conclusion Elective gastric cancer surgery has a 90-day morbidity of 38.2% and 90-day mortality of 2.9%, globally. This study identified several factors associated with higher morbidity and exemplified the importance of a unified language on surgical morbidity, pre-habilitation and ongoing audits to enhance patient outcomes.

Updated risk prediction model for pancreaticoduodenectomy using data from the National Clinical Database in Japan

AbstractAimRisk prediction models for mortality, severe postoperative complications, and postoperative pancreatic fistula in patients undergoing pancreaticoduodenectomy were established using data from the National Clinical Database more than a decade ago, and the surgical outcomes of pancreaticoduodenectomy have improved over the years. The aim of this study is to update the risk prediction model for pancreaticoduodenectomy using National Clinical Database data.MethodsBetween 2019 and 2021, the data of 35 365 patients who underwent pancreaticoduodenectomy and who were registered in the National Clinical Database were retrospectively analyzed. According to the registration year, the patients were divided into two cohorts: the development cohort (2019–2020; n = 23 654) and the validation cohort (2021; n = 11 711). Logistic regression analyses were performed to create risk models for surgical mortality, severe postoperative complications, and grade C postoperative pancreatic fistula.ResultsOverall, the rates of surgical mortality, severe postoperative complications, and grade C postoperative pancreatic fistula were 1.8%, 2.2%, and 1.3%, respectively. Logistic regression analyses revealed 28, 28, and 14 risk factors for surgical mortality, severe postoperative complications, and grade C postoperative pancreatic fistula, respectively. The area under the receiver operating characteristic curve of the risk model in the development cohort was 0.759 for surgical mortality, 0.712 for severe complications, and 0.699 for postoperative pancreatic fistula, comparable to the validation cohort. The calibration plots were favorable in both cohorts.ConclusionThe updated risk model for pancreaticoduodenectomy will be useful to predict surgical mortality, severe postoperative complications, and grade C postoperative pancreatic fistula.

Diagnostics and Surgical Treatment of Deep Endometriosis-Real-World Data from a Large Endometriosis Center.

Background: Deep endometriosis (DE) is a special form of endometriosis, one of the most common benign diseases in gynecology. In the specific case of DE, ectopic endometrium can be found not only in peritoneal but also in deeper tissue layers or even as parenchymal organ infiltration. Symptoms include dysmenorrhea, dyspareunia, dyschezia, and dysuria, as well as asymptomatic hydronephrosis or other organ dysfunctions. Due to a pathogenesis of the disease that has not been conclusively clarified to date, no causal therapy exists, which is why surgical resection of DE is still the gold standard for symptomatic cases. Methods: This article retrospectively describes the challenges in diagnosis and surgical treatment of DE at a German Level III Endometriosis Center, with a focus on diagnosis and surgical treatment, as well as the analysis of perioperative and postoperative complications. Results: The surgical treatment of DE is performed in most cases by minimally invasive laparoscopy (94.1%), whereas complex procedures such as ureterolysis, adhesiolysis, or preparation of the rectovaginal septum are considered standard procedures as well. The complexity of the procedures is further underlined by a high need for interdisciplinary operations (28%). Despite high complexity, severe postoperative complications occurred in only 3.1% of surgeries, with the complication rate being significantly higher whenever bowel surgery was necessary for DE resection. Conclusions: Our results emphasize the complexity and interdisciplinary nature of the disease. Therefore, treatment should preferably take place at an endometriosis center of the highest level with experienced, well-coordinated teams.

The Role of Robotic Cystectomy in the Salvage and Palliative Setting: A Retrospective, Single-Center, Cohort Study.

Introduction: This article compares surgical and survival outcomes of robot-assisted and open radical cystectomy with cutaneous ureterostomy for the treatment of frail bladder cancer patients with limited life expectancy. Methods: The institutional database was searched for cystectomy cases with cutaneous ureterostomy, from 1 June 2016 to 31 August 2022. The study population was split into two groups, according to the surgical approach. The baseline characteristics and surgical outcomes were compared. Logistic regression analyses identified predictors of major bleeding events (hemoglobin loss ≥ 3.5 g/dL or blood transfusion) and re-operation within 30 days from surgery. The Kaplan-Meier method estimated the impact of the robotic approach on overall survival and Cox regression analysis assessed its predictors. Results: A total of 145 patients were included: 30% (n = 43) underwent robotic cystectomy. Patients' characteristics and tumor stages distribution were comparable in the two groups but those receiving a minimally invasive treatment showed significantly reduced times to flatus, bowel and hospital discharge (all p < 0.001). Although operation times were longer in this cohort, major bleeding events (60% vs. 89%) and postoperative severe complications (0 vs. 8%) (both p < 0.001) were less frequent compared to the open approach. A logistic regression showed that robotic surgery independently predicted major bleeding events (OR: 0.26; 95%CI 0.09-0.72; p = 0.02) but not the need for re-intervention. A Kaplan-Meier analysis showed that robotic cystectomy was associated with a significant advantage in terms of overall survival (LogRank = 0.03), and this result was confirmed by Cox regression analysis (HR: 0.39; 95%CI 0.14-0.94; p = 0.04). Conclusions: Robotic cystectomy with cutaneous ureterostomy may represent a viable option to treat frail bladder cancer patients, as the minimally invasive approach reduces the risk of bleeding and serious complications and provides a prompt restoration of bowel function and a shorter hospital stay compared to open surgery.

Association Between Two Muscle-Related Parameters and Postoperative Complications in Patients Undergoing Colorectal Tumor Resection Surgery.

This study aimed to investigate the associations of 2 preoperative muscle-related parameters, the third lumbar vertebra skeletal muscle index (L3 SMI) for muscle mass and the Hounsfield unit average calculation (HUAC) for muscle density, with the occurrence of postoperative complications among patients undergoing colorectal tumor resection surgery under general anesthesia. We hypothesized that muscle-related parameters are associated with the occurrence of postoperative complications. This was a single-center, retrospective observational study. Adult patients who underwent colorectal tumor resection surgery under general anesthesia between 2018.09.01 and 2021.09.01 were enrolled. The last abdominal computed tomography (CT) scan images obtained within 3 months before surgery were used to calculate the L3 SMI and HUAC. The primary outcome was defined as the occurrence of any postoperative complications corresponding to Clavien-Dindo classification before discharge. The secondary outcome was defined as the occurrence of any severe postoperative complications (Clavien-Dindo grade ≥3) before discharge. Multivariable logistic regression analyses were used to estimate the association between muscle-related parameters and incidence of postoperative complications. Patients' baseline demographics, past medical history and intraoperative parameters were adjusted in the multivariable logistic regression analysis. A total of 317 patients with a median age of 66 (58-72) years were included. Sarcopenia (muscle mass reduction) patients in our cohort and myosteatosis (muscle density decline) were present in 254 (80.1 %) and 79 (24.9%) patients, respectively. A total of 135 patients (42.6 %) developed postoperative complications. According to the multivariable logistic regression, myosteatosis (odds ratio [OR], 1.8, 95% confidence interval [CI], 1.0-3.3, P = .039) was significantly associated with postoperative complications. A significant association was observed between myosteatosis and postoperative complications (corresponding to Clavien-Dindo classification before discharge), especially severe postoperative complications (Clavien-Dindo grade ≥3) in patients undergoing colorectal tumor resection. Screening for myosteatosis with HUAC using the CT before surgery may help clinicians identify high-risk perioperative patients early.

Evaluación de los factores predictivos tras uretrotomía interna endoscópica para estenosis de uretra bulbar

Introduction: Direct vision internal urethrotomy (DVIU) is usually the first treatment offered to patients with bulbar urethral strictures (US). Advances in devices and surgical techniques have contributed to reducing associated complications. Despite the favorable success rate of DVIU, various factors predicting better outcomes have been studied, including patient characteristics, stricture features, and procedural aspects. The main aim of our study is to assess predictive factors for success.Methods: We conducted a retrospective descriptive study of patients who underwent endoscopic internal urethrotomy at our hospital over a 30 year period. Out of 788 DVIU performed, we selected 491 (62.3%) conducted for bulbar US with a minimum follow-up of 12 months. We examined clinical outcomes obtained, and assessed the relationship between different patient characteristics, stricture-related factors and procedural aspects related with clinical success -considered as the avoidance of further interventions for stricture recurrence-. Descriptive statistics were calculated and parametrical and non-parametrical comparative tests were applied. Kaplan-Meier survival analysis was used for evaluating time until recurrence.Results: Mean stricture length was 1.2 cm (SD 0.5), with only 12 patients presenting with more than 1 US in the bulbar area during DVIU. After a median follow-up of 170 months, 67.4% of patients did not experience clinical recurrence. Severe postoperative complications appear in 0.4% of cases, and need for overnight admission was 4.5%. A positive association was observed between clinical recurrence and a history of prior pelvic radiotherapy (OR 2.8, 95%IC 1.3-22.2), active smoking (OR 2.1, 95%IC 1.6-2.4), infectious etiology of stricture (OR 2.3, 95%IC 1.6-8), history of previous urethroplasty (OR 2.5, 95%IC 1.7-3.2), and higher postoperative urinary catheter sizes (OR 1.8 95%IC 1.1-2.9). Median time until recurrence after the first DVIU was 65 months, after the second was 60 months, after the third was 32 months, and after the fourth was 6 months.Conclusions: Bulbar US could be safely managed with DVIU. The best clinical success is achieved in non-irradiated, non-smoker patients, without prior urethroplasties. The repetition of the procedure is significantly associated with a shorter time to clinical recurrence.

Effects of Ketamine 0.5 mg/kgBW administration as preemptive analgesia on analgesia duration and the need for Fentanyl following hysterectomy surgery: a randomized controlled trial

INTRODUCTION: Hysterectomy is a surgical procedure with a high number of moderate to severe postoperative pain complications. Preemptive analgesia prevents central sensitization before surgery, hampering postoperative hyperesthesia. Ketamine is one of several preemptive analgesia available. This study aims to study the effects of ketamine 0.5 mg/kgBW administration as preemptive analgesia on analgesia duration and the need for fentanyl following hysterectomy surgery. MATHERIALS AND METHODS: This study is a double-blind randomized controlled trial experiment on two groups: the treatment group (n = 20) was given ketamine 0.5 mg/kgBW and the control group (n = 20). The duration was measured starting from surgery completion up to the need for additional fentanyl 25 µg analgesia through Patient Controlled Analgesia (PCA) within 24-hour periods following surgery. Numerical data statistical analysis was done using unpaired T-test and Mann—Whitney for normally distributed data and non-normally distributed data respectively. Categorical data statistical analysis was done using the Exact Fisher test. RESULTS: The mean time recorded until additional analgesia was needed in the treatment group was 246.00 ± 33.150 minutes and in the control group was 121.50 ± 23.792 minutes. The mean total 24-hour post-surgery additional analgesia was 82.50 ± 11.75 µg and 118.75 ± 11.10 µg for the treatment group and control group respectively. There were statistically significant differences in the duration of analgesia and the need for additional analgesia between the two subject groups (p &lt; 0.05). CONCLUSIONS: Administration of ketamine preemptive analgesia at a dose of 0.5 mg/kgBW resulted in longer analgesia duration and reduced the need for fentanyl as an additional analgesic in postoperative patients compared with no preemptive analgesia and showed no significant side effects.