Hasil untuk "Surgery"

A. Vahrmeijer, M. Hutteman, J. Vorst et al.

V. Gloy, M. Briel, Deepak L. Bhatt et al.

Objective To quantify the overall effects of bariatric surgery compared with non-surgical treatment for obesity. Design Systematic review and meta-analysis based on a random effects model. Data sources Searches of Medline, Embase, and the Cochrane Library from their inception to December 2012 regardless of language or publication status. Eligibility criteria Eligible studies were randomised controlled trials with ≥6 months of follow-up that included individuals with a body mass index ≥30, compared current bariatric surgery techniques with non-surgical treatment, and reported on body weight, cardiovascular risk factors, quality of life, or adverse events. Results The meta-analysis included 11 studies with 796 individuals (range of mean body mass index at baseline 30-52). Individuals allocated to bariatric surgery lost more body weight (mean difference −26 kg (95% confidence interval −31 to −21)) compared with non-surgical treatment, had a higher remission rate of type 2 diabetes (relative risk 22.1 (3.2 to 154.3) in a complete case analysis; 5.3 (1.8 to 15.8) in a conservative analysis assuming diabetes remission in all non-surgically treated individuals with missing data) and metabolic syndrome (relative risk 2.4 (1.6 to 3.6) in complete case analysis; 1.5 (0.9 to 2.3) in conservative analysis), greater improvements in quality of life and reductions in medicine use (no pooled data). Plasma triglyceride concentrations decreased more (mean difference −0.7 mmol/L (−1.0 to −0.4) and high density lipoprotein cholesterol concentrations increased more (mean difference 0.21 mmol/L (0.1 to 0.3)). Changes in blood pressure and total or low density lipoprotein cholesterol concentrations were not significantly different. There were no cardiovascular events or deaths reported after bariatric surgery. The most common adverse events after bariatric surgery were iron deficiency anaemia (15% of individuals undergoing malabsorptive bariatric surgery) and reoperations (8%). Conclusions Compared with non-surgical treatment of obesity, bariatric surgery leads to greater body weight loss and higher remission rates of type 2 diabetes and metabolic syndrome. However, results are limited to two years of follow-up and based on a small number of studies and individuals. Systematic review registration PROSPERO CRD42012003317 (www.crd.york.ac.uk/PROSPERO).

T. Feldman, S. Kar, S. Elmariah et al.

J. Buell, D. Cherqui, D. Geller et al.

T. Monk, B. C. Weldon, C. Garvan et al.

F. Roques, S. Nashef, P. Michel et al.

F. Landoni, A. Maneo, A. Colombo et al.

Brian C. George, Jordan D. Bohnen, Reed G. Williams et al.

D. Schauer, H. Feigelson, C. Koebnick et al.

Objective: To determine whether bariatric surgery is associated with a lower risk of cancer. Background: Obesity is strongly associated with many types of cancer. Few studies have examined the relationship between bariatric surgery and cancer risk. Methods: We conducted a retrospective cohort study of patients undergoing bariatric surgery between 2005 and 2012 with follow-up through 2014 using data from a large integrated health insurance and care delivery systems with 5 study sites. The study included 22,198 subjects who had bariatric surgery and 66,427 nonsurgical subjects matched on sex, age, study site, body mass index, and Elixhauser comorbidity index. Multivariable Cox proportional-hazards models were used to examine incident cancer up to 10 years after bariatric surgery compared to the matched nonsurgical patients. Results: After a mean follow-up of 3.5 years, we identified 2543 incident cancers. Patients undergoing bariatric surgery had a 33% lower hazard of developing any cancer during follow-up [hazard ratio (HR) 0.67, 95% confidence interval (CI) 0.60, 0.74, P < 0.001) compared with matched patients with severe obesity who did not undergo bariatric surgery, and results were even stronger when the outcome was restricted to obesity-associated cancers (HR 0.59, 95% CI 0.51, 0.69, P < 0.001). Among the obesity-associated cancers, the risk of postmenopausal breast cancer (HR 0.58, 95% CI 0.44, 0.77, P < 0.001), colon cancer (HR 0.59, 95% CI 0.36, 0.97, P = 0.04), endometrial cancer (HR 0.50, 95% CI 0.37, 0.67, P < 0.001), and pancreatic cancer (HR 0.46, 95% CI 0.22, 0.97, P = 0.04) was each statistically significantly lower among those who had undergone bariatric surgery compared with matched nonsurgical patients. Conclusions: In this large, multisite cohort of patients with severe obesity, bariatric surgery was associated with a lower risk of incident cancer, particularly obesity-associated cancers, such as postmenopausal breast cancer, endometrial cancer, and colon cancer. More research is needed to clarify the specific mechanisms through which bariatric surgery lowers cancer risk.

F. Prete, A. Pezzolla, F. Prete et al.

Objective:The aim of this study was to evaluate the safety and efficacy of elective rectal resection for rectal cancer in adults by robotic surgery compared with conventional laparoscopic surgery. Summary of Background Data:Technological advantages of robotic surgery favor precise dissection in narrow spaces. However, the evidence base driving recommendations for the use of robotic surgery in rectal cancer primarily hinges on observational data. Methods:We searched MEDLINE, Embase, and CENTRAL for randomized controlled trials (until August 2016) comparing robotic surgery versus conventional laparoscopic surgery. Data on the following endpoints were evaluated: circumferential margin status, mesorectal grade, number of lymph nodes harvested, rate of conversion to open surgery, postoperative complications, and operative time. Data were summarized as relative risks (RR) or weighted mean differences (WMDs) with 95% confidence intervals (95% CIs). Risk of bias of studies was assessed with standard methods. Results:Five trials were eligible, including 334 robotic and 337 laparoscopic surgery cases. Meta-analysis showed that RS was associated with lower conversion rate (7.3%; 4 studies, 544 participants, RR 0.58; 95% CI 0.35–0.97, P = 0.04, I2 = 0%) and longer operating time (MD 38.43 minutes, 95% CI 31.84–45.01: P < 0.00001) compared with laparoscopic surgery. Perioperative mortality, rate of circumferential margin involvement (2 studies, 489 participants, RR 0.82, 95% CI 0.39–1.73), and lymph nodes collected (mean 17.4 Lymph Nodes; 5 trials, 674 patients, MD −0.35, 95% CI −1.83 to 1.12) were similar. The quality of the evidence was moderate for most outcomes. Conclusion:Evidence of moderate quality supports that robotic surgery for rectal cancer produces similar perioperative outcomes of oncologic procedure adequacy to conventional laparoscopic surgery. Robotic surgery portraits lower rate of conversion to open surgery, while operating time is significantly longer than by laparoscopic approach.

C. Temple-Oberle, M. Shea-Budgell, M. Tan et al.

M. Mullen, A. D. Michaels, J. Mehaffey et al.

Mahdi Yousefi Nejad, Karim Farajian, Hossein Jaleb

One of the major indicators in evaluating the performance of hospitals and their managers is the average length of stay of patients; given the importance of this indicator, the present study has examined the factors affecting the length of stay of hospitalized patients. This study was conducted with the aim of identifying the key factors affecting the length of stay of patients and providing practical solutions for improving the management of hospital beds. Data from 26,907 patients were analyzed using clustering models, clustering algorithms (K-Means) and association rules extraction (Apriori). The data consists of 10 numerical and discrete columns. The variables include 10 items, which are respectively: gender, marital status, hospitalization department, physician specialty, insurance, blood transfusion, surgery, type of discharge, age, and length of stay. The findings showed that the variables of surgery and blood transfusion have the greatest impact on the average length of stay in the hospital.

Victor Fages, Gregory Baud, Marion Fericot et al.

Obesity is a major public health issue that affects a significant proportion of patients with end-stage renal disease (ESRD). In patients undergoing peritoneal dialysis (PD), obesity complicates treatment by increasing the risk of mechanical complications and infections and reducing the effectiveness of peritoneal exchanges. Furthermore, obesity limits access to kidney transplantation, making weight loss a crucial goal. Bariatric surgery is emerging as an effective strategy for improving metabolic condition and promoting placement on a transplant waiting list. Sleeve gastrectomy (SG) is now the preferred technique for helping obese patients on ESRD lose weight, particularly due to its favorable safety profile, reduced operating time, and absence of intestinal bypass, thus limiting the risk of deficiencies. The available data, although limited to case series and isolated reports, suggest that SG can be performed in PD patients either with early resumption of PD or after a temporary transition to hemodialysis depending on clinical status. Optimized protocols include a gradual resumption of PD at low volumes, minimizing the risk of leakage or infection. Bariatric surgery therefore appears feasible and generally safe in PD patients, provided that a rigorous multidisciplinary assessment and close nutritional monitoring are carried out to prevent malnutrition and sarcopenia. It is a relevant therapeutic option for improving access to kidney transplantation and optimizing the prognosis of obese patients with ESRD. This article was written following a presentation at the Société Francophone de Néphrologie, Dialyse et Transplantation 2025 on the feasibility of bariatric surgery in PD.

Rebecca Black, BApSc, Speech Pathologist(SP), Duy Duong Nguyen, MD PhD, Anna Miles, PhD et al.

Background: Oropharyngeal dysphagia and laryngeal dysfunction are complications of lung and heart transplantation. However, there is a lack of understanding around pre-operative function and an absence of standardized assessment protocols. We aimed to trial a pre- and post-operative protocol for assessing voice and swallowing function. Method: A prospective, longitudinal study of 14 adults undergoing investigation for lung or heart transplantation was conducted at a tertiary referral hospital. Patients were assessed pre-surgery and up to 6 months afterwards. The protocol involved phonation tasks with auditory-perceptual and acoustic analysis, videolaryngostroboscopy, a flexible endoscopic examination of swallowing and patient reported quality of life measures. Risk factors and clinical outcomes were extracted from patient records. Results: Patient self-reports of swallowing and voice difficulties were elevated pre-operatively. No evidence of swallowing difficulty was observed under endoscopic examination pre-transplant (Penetration-Aspiration Scale score <2; no accumulated secretions) and only one patient presented with incomplete glottic closure. Auditory perceptual ratings revealed voices were largely within the healthy range at baseline. One out of five patients presented with severe dysphonia post-operatively. Completion of evaluation measures prior to transplantation was 79% but post- operative rates were low due to feasibility challenges with follow up in this complex population. Conclusion: Novel evidence of self-reported pre-transplant voice and swallowing changes indicate value in baseline screening. Discrepancies between patient-report and instrumental assessment results highlight the need for multi-faceted evaluation. Large cohort studies are needed to determine the salient evaluation measures and time points for voice and swallowing assessment in this population.

Yeui-Seok Seo, Yonghyun Yoon, King Hei Stanley Lam et al.

<b>Background:</b> Ultrasound is increasingly used in plastic surgery for real-time guidance in minimally invasive procedures. However, standardized approaches for targeting the facial nerve (FN) trunk, particularly for motor nerve interventions, remain limited. This study aimed to evaluate the anatomical feasibility of an ultrasound-guided approach to the FN trunk using the posterior belly of the digastric muscle (PBDM) as a landmark. <b>Methods:</b> An exploratory feasibility design was used with a single fresh-frozen cadaver to perform ultrasound-guided dye injections targeting the anterior and posterior surfaces of the PBDM. Subsequent layer-by-layer dissection evaluated dye distribution relative to the facial and hypoglossal nerves. Additionally, real-time Doppler ultrasound in a live participant was conducted to visualize adjacent vascular structures, including the occipital and vertebral arteries. <b>Results:</b> The FN trunk was located deep to the PBDM and near the stylomastoid foramen. Anterior injections reached the FN trunk, whereas posterior injections followed the trajectory of the hypoglossal nerve. Doppler ultrasound enabled clear visualization of major vascular structures, supporting safe needle trajectory planning. <b>Conclusions:</b> This cadaveric feasibility study demonstrates a potentially reproducible ultrasound-guided anatomical approach to the FN trunk using consistent musculoskeletal and vascular landmarks. Incorporating Doppler vascular mapping enhances procedural safety and accuracy, providing a practical framework to facilitate clinical translation of image-guided motor nerve interventions in plastic and reconstructive surgery.

Ashot A. Avagimyan, Mohammad Sheibani, Artem I. Trofimenko et al.

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are now uncovering new possibilities in the field of internal medicine owing to their diverse protective effects. In the second part of the literature review, we explore potential applications of SGLT2i in hepatology, neurology, ophthalmology, and oncology, mechanisms of action of such drugs as dapagliflozin, empagliflozin, canagliflozin, etc, and their effect on different organs and systems.

L. Gianotti, M. Besselink, M. Sandini et al.

Background The optimal nutritional therapy in the field of pancreatic surgery is still debated. Methods An international panel of recognized pancreatic surgeons and pancreatologists decided that the topic of nutritional support was of importance in pancreatic surgery. Thus, they reviewed the best contemporary literature and worked to develop a position paper to provide evidence supporting the integration of appropriate nutritional support into the overall management of patients undergoing pancreatic resection. Strength of recommendation and quality of evidence were based on the approach of the grading of recommendations assessment, development and evaluation Working Group. Results The measurement of nutritional status should be part of routine preoperative assessment because malnutrition is a recognized risk factor for surgery‐related complications. In addition to patient's weight loss and body mass index, measurement of sarcopenia and sarcopenic obesity should be considered in the preoperative evaluation because they are strong predictors of poor short‐term and long‐term outcomes. The available data do not show any definitive nutritional advantages for one specific type of gastrointestinal reconstruction technique after pancreatoduodenectomy over the others. Postoperative early resumption of oral intake is safe and should be encouraged within enhanced recovery protocols, but in the case of severe postoperative complications or poor tolerance of oral food after the operation, supplementary artificial nutrition should be started at once. At present, there is not enough evidence to show the benefit of avoiding oral intake in clinically stable patients who are complicated by a clinically irrelevant postoperative pancreatic fistula (a so‐called biochemical leak), while special caution should be given to feeding patients with clinically relevant postoperative pancreatic fistula orally. When an artificial nutritional support is needed, enteral nutrition is preferred whenever possible over parenteral nutrition. After the operation, regardless of the type of pancreatic resection or technique of reconstruction, patients should be monitored carefully to assess for the presence of endocrine and exocrine pancreatic insufficiency. Although fecal elastase‐1 is the most readily available clinical test for detection of pancreatic exocrine insufficiency, its sensitivity and specificity are low. Pancreatic enzyme replacement therapy should be initiated routinely after pancreatoduodenectomy and in patients with locally advanced disease and continued for at least 6 months after surgery, because untreated pancreatic exocrine insufficiency may result in severe nutritional derangement. Conclusion The importance of this position paper is the consensus reached on the topic. Concentrating on nutritional support and therapy is of utmost value in pancreatic surgery for both short‐ and long‐term outcomes.

M. Bolliger, J.-A. Kroehnert, F. Molineus et al.

SummaryBackgroundThe standardized Clavien-Dindo classification of surgical complications is applied as a simple and widely used tool to assess and report postoperative complications in general surgery. However, most documentation uses this classification to report surgery-related morbidity and mortality in a single field of surgery or even particular intervention. The aim of the present study was to present experiences with the Clavien-Dindo classification when applied to all patients on the general surgery ward of a tertiary referral care center.MethodsWe analyzed a period of 6 months of care on a ward with a broad range of general and visceral surgery. Discharge reports and patient charts were analyzed retrospectively and reported complications rated according to the most recent Clavien-Dindo classification version. The complexity of operations was assessed with the Austrian Chamber of Physicians accounting system.ResultsThe study included 517 patients with 817 admissions, of whom 463 had been operated upon. Complications emerged in 12.5%, of which 19% were rated as Clavien I, 20.7% as Clavien II, 13.8% as Clavien IIIa, 27.6% as Clavien IIIb, 8.6% as Clavien IVa, and 10.3% as Clavien V. No Clavien grade IVb complication occurred within the investigation. Patients having undergone more complex surgery or with higher scores experienced significantly longer lengths of hospital stay.ConclusionThe Clavien-Dindo classification can easily be used to document complication rates in general surgery, even though this collective was not included in the original validation studies of Clavien et al. and consisted of more heavily impaired patients.

Caitlin C. Chambers, S. Ihnow, Emily J. Monroe et al.

Background: American medical schools have gradually achieved balance in the sex of medical graduates over the past 4 decades. However, orthopaedic surgery has remained disproportionately male-dominated. Our aim was to quantify this discrepancy across surgical specialties at the residency training and academic faculty levels. We additionally sought to evaluate the prevalence of women in orthopaedic subspecialty and research societies. Methods: Publicly available data from the Association of American Medical Colleges (AAMC) and the Accreditation Council for Graduate Medical Education (ACGME) for the 2005-2006 to 2016-2017 academic years were pooled for analysis of sex in surgical residency programs. The AAMC 2016 Faculty Roster provided data on the sex composition of academic medical faculty, including rank. Current subspecialty and research society membership demographic characteristics were obtained by directly contacting each group. Results: Female orthopaedic surgery residents represented 0.92% of all female medical residents in the 2016-2017 academic year. Orthopaedic surgery remains the medical specialty with the lowest proportion of female residents at 14.0% in the 2016-2017 academic year, up from 11.0% in the 2005-2006 academic year. The percentage increase over this time period (27.3%) lags behind other male-dominated fields such as neurological surgery (56.8%) and thoracic surgery (111.2%). Women account for 17.8% of full-time orthopaedic surgery faculty at American medical schools, lower than all other medical specialties. In the 2015-2016 academic year, 1 orthopaedic surgery department chair and only 8.7% of professors of orthopaedic surgery were female. Women make up 6.5% of the American Academy of Orthopaedic Surgeons (AAOS) membership. The specialty societies with the fewest women are The Knee Society (0.5%), The Hip Society (0.6%), and the Cervical Spine Research Society (1.5%). Conclusions: Orthopaedic surgery’s slow increase in the number of female residents and academic faculty lags behind that of other specialties. The lack of female orthopaedic surgeons in higher ranks within medical schools is detrimental to recruitment of female medical students to the field. Further efforts should be made toward increasing medical student exposure to orthopaedics and to female mentors in an effort to ensure that the field continues to attract the nation’s top medical graduates.