Surgical Aspects Research Articles

Surgical aspects of treatment a patient with choledocholithiasis after gastropancreatoduodenectomy resection

Cholelithiasis is a common problem in surgery. The pathological basis of the disease is a imbalance between cholesterol, bilirubin and bile acid metabolism. There are several risk factors for cholelithiasis, both modifiable and non-modifiable. Complications of this pathology most often require surgical intervention: either planned or emergency. One of such complications is choledocholithiasis. Most often, choledocholithiasis occurs as a result of migration of stones from the gallbladder, less often of stones form in the bile ducts. In the world and Russian literature, many works are devoted to the etiology, pathogenesis and the treatment of patients with choledocholithiasis. The diagnosis is confirmed using advanced imaging methods, such as magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography. A widely used method of treatment is endoscopic retrograde cholangiopancreatography in combination with endoscopic papillosphincterotomy. However, in case of severe choledocholithiasis, including with an altered anatomical picture, standard methods do not always allow to achieve the desired result. This article describes a clinical case of successful treatment of a patient with choledocholithiasis that developed two years after gastropancreatoduodenal resection for adenocarcinoma of the major duodenal papilla.

Surgical management of conventional ameloblastoma: a retrospective cohort study over the past 21 years.

Conventional ameloblastoma presents infiltrative behavior and its treatment ranges from enucleation combined with adjuvant therapies to marginal/segmental resection. The purpose of this study is to present a cohort of twenty-four patients with ameloblastoma treated in the same institution after marginal/segmental resection for the past 21 years. All cases had diagnosis confirmation by incisional biopsy. Patients with an unconfirmed diagnosis and missing follow-up information were excluded. Data were categorized into clinicopathological, surgical and recurrence aspects. Thirteen patients were females (54%). The mean age was 40.2 years. Mandible was the most affected site (91%). The mean length of the lesions was 4.10cm (± 2.06) and the multilocular aspect was predominant (83%). Root resorption (37.5%), tooth displacement (45.8%) and cortical perforation (45.8%) were noticed. Histologically, most of the cases were follicular (n = 19,79%). Microscopic analysis showed positive margins in four cases. Patients were treated by marginal (n = 19) and segmental (n = 5) resections. Recurrence occurred in two cases (8.33%). Both primary and recurrent ameloblastomas were treated through marginal resections and no recurrence was observed during the past 9 and 5 years after the last intervention, respectively. The overall mean follow-up was 79.25 months and patients are still monitored over these years. Marginal/segmental resection of conventional ameloblastoma is associated with a low recurrence rate.

Postoperative nursing in robot‐assisted urologic surgery: Are there any platform‐based differences?

AbstractMany robotic platforms are currently available for urologic surgery, each with its technical characteristics. It can be hypothesised that these characteristics might affect postoperative nursing, as they affect several aspects of surgery. They could, therefore, impact the surgical outcomes and wound characteristics, involving aspects of postoperative care such as mobilization, nutrition and length of stay. Although data are available on surgical technique aspects and intraoperative nursing, studies have yet to offer insights and considerations about the potential effect of having different robotic platforms on postoperative nursing care. We aimed to verify whether the technical features of the available robots could impact postoperative nursing. We conducted an integrative review on PubMed, CINAHL and Scopus, using Medical Subject Headings (MeSH) and free‐text terms; wildcards and boolean operators were also used. Studies of any design were included. Fifteen papers were retrieved; the key themes emerging from the literature regard trocar setup, technical characteristics of the robots (e.g. single or multiple ports), pneumoperitoneum and Trendelenburg degree. According to the literature, none of these characteristics produce differences in postoperative nursing. The fundamental concepts of postoperative care in surgical inpatients stay the same no matter the robotic platform used. Having competing platforms able to ensure reduced complications without impacting postoperative nursing allows health care facilities to adopt the newest technologies without the need for differentiated nursing protocols. This is an advantage in times of global nursing shortage as it avoids the need for additional platform‐based nursing training.

A breast sharing technique using the pedicled IMAP flap for delayed breast reconstruction and contralateral symmetrising mammaplasty: A case series and evolution of the surgical technique in selected patients

IntroductionThe ‘breast-sharing’ procedure uses the disposable tissue as a flap to reconstruct the post-mastectomy defect. This enables simultaneous breast reconstruction and contralateral symmetrisation without additional donor site morbidity. However, controversies related to the oncological safety of this procedure have prevented its widespread uptake. We aim to present this technique based on a pedicled internal mammary artery perforator (IMAP) flap and discuss its technical feasibility and oncological safety. Patients and methodsBetween April 2013 and May 2022, a series of 10 consecutive patients underwent a breast-sharing procedure using the pedicled IMAP flap for breast reconstruction. Clinical and surgical aspects of the breast-sharing procedure were analysed. ResultsIn all cases, the breast-sharing technique allowed for simultaneous breast reconstruction and contralateral breast symmetrisation. Immediate complications included two total venous congestions and one hematoma. Three flaps had distal flap congestion. One flap required debridement and local flap reconstruction. All flaps required fat grafting during the secondary procedures to improve breast symmetry. With an average follow-up of 5,6 years, there was no evidence of recurrent disease. All patients were satisfied to very satisfied with the aesthetic outcome of this reconstructive option. ConclusionsThe breast-sharing technique based on the IMAP flap combines breast reconstruction and contralateral symmetrisation with good aesthetic outcomes in selected patients. The flap has a high complication rate related to venous drainage. Flap design modification and using ICG imaging may reduce venous congestion. A secondary venous micro-anastomosis at the axilla is highly recommended for persistent flap congestion. The reported incidence of contralateral breast cancer is low and thus the residual tissue obtained from the contralateral breast mammaplasty can be safely used for breast reconstruction. Level of EvidenceLevel IV

Surgical aspects of pediatric abdominal pain in the era of COVID-19: clinical consideration and outcomes.

Acute abdominal pain in pediatrics is a medical emergency that requires special attention. During COVID-19 pandemic, this disease presented in pediatric age by different presentations including abdominal presentations.The affected children are presented with abdominal pain, which may be caused by surgical causes or by the virus itself that necessitate surgical consultation. This study highlights the impact of the coronavirus pandemic on pediatric patients with acute abdominal pain regarding the presentation, clinical evaluation, and surgical management. A retrospective cohort study was done through the collection of data from medical records and authors' data repositories of pediatric patients presented with acute abdomen from March 2020 to March 2022, in three pediatric surgery tertiary centers. Eighty-four pediatric patients with acute abdominal pain were included in this study. The diagnosis of acute appendicitis was found in 31 patients (36.9%). Generalized abdominal pain was noted in 17 patients (20.2%) and presentation mimicked acute cholecystitis was occured in 14 patients (16.7%). ultrasonography revealed intussusception in 12 cases (14.3%). Multisystem inflammatory syndrome in children (MIS-C) was present in 9 cases (10.7%) and only one case of pancreatitis (1.2%). Conservative management was successful in 66 cases (78.6%), while operative intervention was needed in18 cases (21.4%). During the COVID-19 pandemic, acute abdominal pain in children was frequently observed. Careful follow up is critically important as most cases do not necessitate surgical intervention. It is crucial to consider COVID-19 as a differential diagnosis in children presenting with acute abdominal pain, particularly in cases of atypical appendicitis and intussusception to prevent unnecessary surgical procedures.

European Reference Network eUROGEN Guidelines on the Management of Anorectal Malformations, Part II: Treatment

Abstract Introduction Anorectal malformations (ARMs) are rare birth defects affecting the anorectum and oftentimes the genitourinary region. The management of ARM patients is complex and requires highly specialized surgical and medical care. The European Reference Network eUROGEN for rare and complex urogenital conditions aimed to develop comprehensive guidelines for the management of ARM applicable on a European level. Methods The Dutch Quality Standard for ARM served as the basis for the development of guidelines. Literature was searched in Medline, Embase, and Cochrane. The ADAPTE method was utilized to incorporate the newest available evidence. A panel of 15 experts from seven European countries assessed currency, acceptability, and applicability of recommendations. Recommendations from the Dutch Quality Standard were adapted, adopted, or rejected and recommendations were formed considering the current evidence, expert opinion, and the European context. Results Surgical and medical treatment of ARM, postoperative instructions, toilet training, and management of fecal and urinary incontinence were addressed. Seven new studies were identified. The panel adapted 23 recommendations, adopted 3, and developed 8 de novo. The overall level of newly found evidence was considered low. Conclusion Treatment of ARM patients requires a multidisciplinary team and expertise about anatomical and surgical aspects of the disease, as well as long-term follow-up. This guideline offers recommendations for surgical and medical treatment of ARM and associated complications, according to the best available evidence and applicable on a European level.

Osteoarthritis in athletes – surgical and non-surgical aspects of treatment

Introduction: Osteoarthritis (OA) is a degenerative chronic process that primarily affects the elderly, but there are also reports of OA in the young and sports-active population. Symptoms of OA usually include pain, joint stiffness, and crepitation. Physical, radiologic, and laboratory tests are required for diagnosis. The main goal of OA treatment is to restore normal function to the joint affected by OA. Methods: A literature search on PubMed was used to collect facts about the relationship between sports and OA and possible treatment methods. All forms of articles were considered in the literature search. Articles that were not written in English were not included. Literature from the library of the Faculty of Medicine in Mostar was an additional source of information. Results: OA occurs more frequently in people who play or have played professional sports. On the other hand, daily exercise has a positive effect on cartilage metabolism. Most articles reported the occurrence of OA in former professional athletes. The joint most commonly affected by OA was the knee. Injuries were a predictive factor for the occurrence of OA, and most studies talk about anterior cruciate ligament injuries. Running and football were the most commonly studied sports. Treatment options include conservative treatment, surgical methods, and biological therapy. Conclusion: Frequent strain and injury in athletes can cause cartilage damage and potentially lead to the development of OA. The benefits of exercise far outweigh the risks of developing OA. In addition, some studies report a significant stimulating effect of exercise on cartilage cell metabolism. Treatment of OA consists of the use of analgesics, intra-articular therapy, and physiotherapy. Surgical methods are considered when conservative approaches are unsuccessful. Biological therapy and similar treatments are the new potential treatments.

Systematic Review of Robotic-Assisted Peripheral and Central Lymphatic Surgery.

Robotic-assisted lymphatic reconstruction has gained increasing interest over the past few years. The aim of this study was to systematically investigate the benefits of robotic-assisted lymphatic surgery based on currently published literature. A systematic review evaluating the feasibility, surgical aspects, and both objective and subjective improvements in patients with impairment of the peripheral or central lymphatic system was performed according to the PRISMA guidelines. The review was registered on PROSPERO. The literature search yielded 328 articles after the removal of duplicates, followed by a full-text review of the 29 articles, out of which a total of 11 relevant articles were deemed eligible. Among these, seven used a retrospective design and four a prospective design. All studies included confirmed the feasibility of robotic-assisted lymphatic surgery and reported promising results concerning both technical aspects and patient-related outcomes. However, currently, only a limited number of studies directly compare the robotic-assisted approach to the manual approach, and these studies have limited statistical analyses. Despite the heterogeneous measurands, all studies showed the feasibility of robotic-assisted lymphatic surgery, and seven provided promising data on patient-related outcomes. Additional studies are needed to further identify future directions in robotic-assisted lymphatic surgery.

Dental Nursing in implant dentistry: a skillset apart and how to get there.

The role of the dental nurse is fundamental in the provision of implant treatment, both from a surgical and restorative aspect. While the restoration of an implant can be largely based on the foundation knowledge of restorative dentistry, the surgical stages require a unique skillset. This article aims to highlight the benefits of undertaking further training for the dental nurse in providing surgical support, the skillset needed, and the pathways for achieving career progression.

Gender gap among plastic surgery residents: the Italian experience

Aim: Despite the significant increase in the proportion of graduating female physicians in recent decades, gender representation in surgical training remains imbalanced. The initial rise in female interest in plastic surgery has reached a plateau. Gender bias, affecting women’s confidence and opportunities, negatively impacts training and career prospects. This study aims to quantify and analyze disparities in surgical training opportunities, workplace treatment, and career advancement among male and female plastic surgery residents in Italy. Methods: Our study involved all Italian plastic surgery residents contacted between February and March 2024. A 21-item survey assessed professional, surgical, and personal aspects, focusing on gender gap differences. Responses were expressed in percentages and compared utilizing the Fisher Exact test. Results: A total of 551 surveys were distributed to Italian plastic surgery residents, with 46 responses each among women and men. Gender disparities persisted in workplace treatment, with more women reporting discrimination. Significant differences were identified in treatment inequality by hospital personnel and patients, the occurrence of inappropriate comments in the workplace, inquiries regarding work-life balance and career advancement opportunities, an augmented gender gap in surgical vs . clinical programs, and the perception of a negative impact of gender on surgical training. Conclusion: In conclusion, our study emphasizes the pervasive gender inequality in plastic surgery training, urging action against systemic biases hindering female surgeons’ progress. Gender equity efforts should combat discrimination, promote work-life balance, and foster inclusive training environments. Addressing these issues can create a field that empowers all surgeons to thrive.

POLYCYSTIC OVARY SYNDROME AND ENDOMETRIOSIS: IMPACT ON FERTILITY AND QUALITY OF LIFE AND SURGICAL OPTIONS.

Polycystic Ovary Syndrome (PCOS) and endometriosis are gynecological disorders that affect a significant number of women of reproductive age, severely impacting their fertility and quality of life. PCOS is characterized by ovarian dysfunction, hyperandrogenism, and the presence of multiple ovarian cysts, while endometriosis involves the growth of endometrial tissue outside the uterus, causing chronic pelvic pain and infertility. Both conditions are complex, with multifactorial etiologies that include genetic, hormonal, and environmental components. Additionally, the intersection of these conditions can exacerbate symptoms and complicate clinical management. Surgical options, such as laparoscopy for the removal of ovarian cysts or endometrial lesions, play a crucial role in treatment, improving fertility and relieving pain. Objective: to analyze the impact of Polycystic Ovary Syndrome and endometriosis on fertility and quality of life, as well as to evaluate the available surgical options. Methodology: based on the PRISMA checklist, encompassing a detailed search in the PubMed, Scielo, and Web of Science databases. Five main descriptors were used: "Polycystic Ovary Syndrome," "Endometriosis," "Fertility," "Quality of Life," and "Surgical Options." Three inclusion criteria were: articles published in the last 10 years, studies involving women of reproductive age, and research addressing both PCOS and endometriosis. Three exclusion criteria were: studies in languages other than English and Portuguese, articles not addressing surgical aspects, and publications focused exclusively on medicinal treatment. Results: indicated that the coexistence of PCOS and endometriosis is associated with a significant negative impact on fertility, with reduced rates of natural conception. Surgical options, particularly laparoscopy, were effective in removing ovarian cysts and endometrial lesions, resulting in improved fertility and reduced chronic pelvic pain. Additionally, surgical intervention contributed to an overall improvement in the quality of life of patients, although the risks and benefits must be carefully considered in each individual case. Conclusion: the interaction between Polycystic Ovary Syndrome and endometriosis presents considerable challenges for the fertility and quality of life of affected women. Surgical options, especially laparoscopy, offer significant benefits but should be weighed according to the specific circumstances of each patient. The review highlighted the importance of a multidisciplinary approach to managing these conditions, aiming to optimize reproductive outcomes and overall patient well-being.

Difficult Small Bowel Bleeding in Surgical View

Small bowel bleeding (SBB) accounts for 5%-10% of all gastrointestinal bleeding (GIB) cases. Several diagnostic modalities in SBB are performed. However, the small bowel is beyond the reach of these diagnostic modalities. A large amount of bleeding in GIB is a key factor leading to a poor prognosis. Appropriate and prompt diagnostic and treatment strategies are needed. Several diagnostic and management algorithms have been proposed. However, the processing of algorithm is complex and frequent mistakes are happened. Because of surgical aspects and sudden or gradual development of hemodynamic instability in SBB, algorithms considering surgical role and treatment have been published. The intra-operative enteroscopy (IOE) is a gold-standard method for detecting lesions in SBB. The primary goal of IOE is to detect specific bleeding focus in SBB. The determining the resection range is the secondary goal. In most cases in SBB, segmental resection is treatment of choice. However, in bleeding distal duodenum from distal to the ampulla of Vater to Treitz ligament, pancreas preserving distal duodenectomy could be performed. In terminal ileum bleeding, after resection of pathologic bowel, the reconstruction option is ileo-colic anastomosis or end enterostomy. Because of frequently developed postoperative morbidity and mortality, post-operative critical care is perfectly fit for an acute care surgeon’s role. Therefore, in the entire management process, an interprofessional team or multidisciplinary approach is critical for improving the quality of care of SBB and decreasing mistakes.

Assessing extremely negative online patient reviews and complaints of musculoskeletal oncology surgeons in the United States: a retrospective analysis

IntroductionPhysician-review websites (PRWs) are commonly used by patients while searching for a surgeon. There is no current literature investigating the factors that contribute to online one-star reviews of musculoskeletal oncology surgeons. This retrospective study aims to identify these factors to determine areas of care affecting patient’s subjective reviews.MethodsPatient ratings and comments regarding musculoskeletal oncology surgeons from the Musculoskeletal Tumor Society (MSTS) were collected from Vitals.com. One-star reviews with comments were then classified as either operative or nonoperative. These complaints were then further classified based on content including wait time, uncontrolled pain, time spent with the physician, surgical outcomes, medical staff/institutional complaints, and bedside manner.ResultsA total of 169 reviews (375 complaints) from 181 physicians were included. Of these complaints, 198 were from patients in the operative category while 177 were from patients in the nonoperative category. Bedside manner was the most common complaint. Operative patients reported higher instances of uncontrolled pain in their reviews, whereas nonoperative patients more frequently cited wait time. No significant difference in the complaints that mentioned the amount of time spent with the physician, bedside manner, a disagreement with the plan, or the medical staff or institution was found.ConclusionOnline one-star reviews of musculoskeletal oncology surgeons on Vitals.com referenced both surgical and non-surgical aspects of patient encounters, with bedside manner being the most popular complaint overall. Surgical patients were more likely to complain of uncontrolled pain whereas non-operative patients were more likely to complain of wait time.Type of studyOutcomes 2c.

Minimally invasive left colectomy with total intracorporeal anastomosis versus extracorporeal anastomosis. A single center cohort study. Stage 2b IDEAL framework for evaluating surgical innovation

PurposePerforming intracorporeal anastomoses in minimally invasive colon surgery appears to provide better short-term outcomes for patients with colon cancer. The aim of the study is to compare surgical aspects and short-term outcomes between intracorporeal and extracorporeal techniques in left colectomies with both laparoscopic and robotic approaches and evaluate advantages and disadvantages of intracorporeal anastomosis according to IDEAL framework (Exploration, stage 2b).MethodsThis is a single center, ambispective cohort study comparing total intracorporeal anastomosis (TIA) and standard surgery with extracorporeal anastomosis (EA). Patients with colon cancer treated by left colectomy, sigmoidectomy and high anterior resection by total intracorporeal anastomosis between May 2020 and January 2023 without exclusion criteria were prospectively included in a standardized database. Short-term outcomes in the group undergoing TIA were compared with a historical EA cohort. The main assessment outcomes were intraoperative complications, postoperative morbidity according to the Clavien-Dindo scale and the comparison of pathological. We conducted a preliminary comparative study within the TIA group between approaches, a primary analysis between the two anastomotic techniques, and a propensity score matched analysis including only the laparoscopic approach, between both anastomotic techniques.ResultsTwo hundred and forty-six patients were included: 103 who underwent TIA, 35 of them with laparoscopic approach and 68 with robotic approach, and a comparison group comprising another 103 eligible consecutive patients who underwent laparoscopic EA. There were no statistically significant differences between the two groups in terms of demographic variables. No statistically significant differences were observed in anastomotic dehiscence. Intraoperative complications are fewer in the TIA group, with a higher C-Reactive Protein levels. Relevant anastomotic bleeding and the number of retrieved lymph nodes were higher in EA group. Nevertheless, no differences were observed in terms of overall morbidity.ConclusionMinimally invasive left colectomy with intracorporeal resection and anastomosis is technically feasible and safe suing either a laparoscopic or a robotic approach. Clinical data from this cohort demonstrate outcomes comparable to those achieved through the conventional EA procedure in relation to postoperative morbidity and oncological efficacy, with indications suggesting that the utilization of robotic-assisted techniques may play a contributing role in enhancing overall treatment outcomes.

Establishment and analysis of quality index system for pediatric tumor nursing.

Nursing management considers nursing quality management at its core. Evaluation indexes of nursing quality not only control nursing quality, measure work enthusiasm, and judge the difference in nursing levels but also help nurses accurately understand the satisfaction degree of patients. To analyze pediatric tumor nursing quality evaluation indexes and establish a scientific and rigorous index system of children's nursing quality. Based on the "structure-process-result" in this study, the Delphi method was used to carry out questionnaire investigations and opinion collection for domestic experts in pediatrics, pediatric oncology internal medicine, and pediatric oncology surgical care and clinical aspects two times. In addition, the Kendall coordination coefficient and analytic hierarchy process were used to determine the content of indicators at all levels, set the weight, and finally establish the quality index system of pediatric tumor nursing. The response rate of 27 experts in the first round of the questionnaire was 100%, Ca0.77, Cs,0.73, Cr0.75, and the W value of the expert coordination coefficient was 0.315. In the second round of 27 expert consultations, the reply rate was 96%, Ca0.81, Cs0.80, Cr0.805, and the specialist coordination coefficient W value was 0.369. After two rounds of consultation, the importance evaluation scores of each indicator ranged from 3.31 to 4.88 and 3.29 to 5.00, respectively, and more than 94.7% of the indicators' importance evaluation scores were higher than 3.50. Finally, 3 Level-1 indicators, 12 Level-2 indicators, and 54 Level-3 indicators are established. This study has established a simple, comprehensive, and scientific quality index system for pediatric tumor nursing, highlighted the characteristics of pediatric tumor nursing, and provided an evaluation system for specialized nursing of pediatric tumors to more standardized pediatric tumor nursing and contribute to the sustainable and scientific development of pediatric tumor nursing.

Hemispheric surgery in children: perisylvian technique.

Hemispheric epilepsy is quite frequent in children, compared with adults, and encompasses pathological substrates as diverse as hemimegalencephaly, Rasmussen encephalitis, Sturge-Weber syndrome, and porencephaly, among others. These patients most often become pharmacoresistant and thus require surgical management. Although anatomical hemispherectomy is a possibility, the technique that is favored by most epilepsy surgery centers worldwide is functional hemispherotomy, which results in equivalent outcomes with fewer postoperative complications. Therefore, it is essential that pediatric epilepsy neurosurgeons become familiar with these techniques. The present video describes in detail all surgical aspects of the perisylvian hemispherotomy.

Surgical aspects and outcomes after nephrectomy for Wilms tumour in sub-Saharan Africa: A report from Wilms Africa Phase II-CANCaRe Africa.

Wilms tumour (WT) is one of the common and curable cancer types targeted by the Global Initiative for Childhood Cancer. Tumour excision is essential for cure. This analysis focuses on surgical outcomes of patients with WT in sub-Saharan Africa. We implemented a risk-stratified WT treatment guideline as a multicentre, prospective study across eight hospitals and six countries. Eligibility criteria were age 6months to 16years, unilateral WT, surgery performed after preoperative chemotherapy and diagnosed between 1 January 2021 and 31 December 2022. Data collection included a specific surgical case report form (CRF). The study registered 230 patients, among whom 164 (71.3%) had a nephrectomy. Ninety-eight percent of patients had a completed surgical CRF. Out 164 patients, 50 (30.5%) had distant metastases. Median tumour diameter at surgery was 11.0cm. Lymph node sampling was done in 122 (74.3%) patients, 34 (20.7%) had intraoperative tumour rupture, and for 18 (10.9%), tumour resection involved en bloc resection of another organ. Tumour size at surgery was significantly correlated with tumour rupture (p<.01). With a median follow-up of 17months (range: 2-33), 23 (14.0%) patients have relapsed. Twenty-two (13.4%) patients abandoned treatment post nephrectomy. Two-year event-free survival was 60.4%±4.7% with treatment abandonment as an event. Survival post nephrectomy is challenged by treatment abandonment, treatment-related mortality and relapse. Large tumours after preoperative chemotherapy were associated with a higher risk of tumour rupture. Earlier diagnosis and access to radiotherapy are expected to improve survival.

Dislocation of primary total hip arthroplasty: Analysis of risk factors and preventive options.

Total hip arthroplasty (THA) is one of the most successful elective operations in orthopedic surgery for improving pain and functional disability in patients with end-stage joint disease. However, dislocation continues to be a troublesome complication after THA, as it is a leading cause of revision and is associated with substantial social, health, and economic costs. It is a relatively rare, usually early occurrence that depends on both the patients' characteristics and the surgical aspects. The most recent and important finding is the special attention to be given preoperatively to spinopelvic mobility, which is closely related to the incidence of dislocation. Consequently, clinical and radiographic assessment of the lumbar spine is mandatory to identify an altered pelvic tilt that could suggest a different positioning of the cup. Lumbar spinal fusion is currently considered a risk factor for dislocation and revision regardless of whether it is performed prior to or after THA. Surgical options for its treatment and prevention include the use of prostheses with large diameter of femoral head size, dual mobility constructs, constrained liners, and modular neck stems.

Surgical aspects of the new guidelines on venous leg ulcers

Surgical aspects of the new guidelines on venous leg ulcers

Systematic review and meta-analysis of short-term outcomes: robot-assisted versus laparoscopic surgery for gastric cancer patients with visceral obesity.

The objective of this meta-analysis was to assess the comparative efficacy of robot-assisted and laparoscopic surgery in treating gastric cancer among patients characterized by a high visceral fat area (VFA). In April 2024, we conducted a comprehensive literature review using major international databases, such as PubMed, Embase, and Google Scholar. We restricted our selection to articles written in English, excluding reviews, protocols without published data, conference abstracts, and irrelevant content. Our analysis focused on continuous data using 95% confidence intervals (CIs) and standard mean differences (SMDs), while dichotomous data were assessed with odds ratios (ORs) and 95% CIs. We set the threshold for statistical significance at P < 0.05. Data extraction included baseline characteristics, primary outcomes (such as operative time, major complications, lymph node yield, and anastomotic leakage), and secondary outcomes. The meta-analysis included three cohort studies totaling 970 patients. The robotic-assisted group demonstrated a significantly longer operative time compared to the laparoscopic group, with a weighted mean difference (WMD) of - 55.76min (95% CI - 74.03 to - 37.50; P < 0.00001). This group also showed a reduction in major complications, with an odds ratio (OR) of 2.48 (95% CI 1.09-5.66; P = 0.03) and fewer occurrences of abdominal infections (OR 3.17, 95% CI 1.41-7.14; P = 0.005), abdominal abscesses (OR 3.83, 95% CI 1.53-9.57; P = 0.004), anastomotic leaks (OR 4.09, 95% CI 1.73-9.65; P = 0.001), and pancreatic leaks (OR 8.93, 95% CI 2.33-34.13; P = 0.001). However, no significant differences were observed between the groups regarding length of hospital stay, overall complications, estimated blood loss, or lymph node yield. Based on our findings, robot-assisted gastric cancer surgery in obese patients with visceral fat appears to be correlated with fewer major complications compared to laparoscopic surgery, while maintaining similar outcomes in other surgical aspects. However, it is important to note that robot-assisted procedures do tend to have longer operative times.