143,732 results on '"SURGICAL complications"'
Search Results
2. Complications and Patient-Centered Outcomes of an Implant-Supported Single Crown After Immediate and Delayed Loading: A Systematic Review and Meta-analysis.
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Claudino Ribeiro, Anne Kaline, Heitor Veríssimo, Aretha, Madeira Lemos, Luisa, da Silva Bezerra, Aliane, Oliveira de Almeida, Érika, and Porto Carreiro, Adriana da Fonte
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DENTAL implants ,MEDICAL information storage & retrieval systems ,BONE resorption ,COMPLICATIONS of prosthesis ,DENTAL crowns ,TREATMENT effectiveness ,META-analysis ,DESCRIPTIVE statistics ,SURGICAL complications ,SYSTEMATIC reviews ,MEDLINE ,PATIENT-centered care ,QUALITY of life ,MEDICAL databases ,STATISTICS ,PATIENT satisfaction ,ONLINE information services ,CONFIDENCE intervals ,PERIODONTITIS ,EVALUATION - Abstract
Purpose: To assess the complications, satisfaction, and quality of life of patients rehabilitated with delayed and immediate loading of single crowns. Materials and Methods: An electronic search was conducted in PubMed/MEDLINE, Scopus, Web of Science, Cochrane Library, and Embase databases up to February 2023. Only prospective studies and randomized and nonrandomized clinical trials comparing immediate and delayed loading were included. For the quantitative analysis, dichotomous and consistent variables were evaluated with a 95% confidence interval. Results: A total of 20 studies were evaluated. No statistically significant difference was observed between protocols: satisfaction (I²: 0%; P = .42), quality of life (I²: 0 %; P = .05), biologic complications (I²: 9%; P = .17), mechanical complications (I²: 58%; P = .84), and survival rate (I²: 0%; P = .38). The subgroup analysis showed significant differences only for marginal bone loss (MBL) when immediate implants were placed in the mandible (I²: 15%; P = .01) and posterior zone (I²: 0%; P = .001). Conclusions: Complications and patient-centered outcomes for immediate single-implant crowns were comparable to delayed loading. Scientific evidence showed no significant difference between loading protocols for survival rates. Note that several factors could interfere with the complication events, implant failures, and MBL. The subgroup analysis showed that only immediate implants placed in the posterior mandible had a higher and statistically significant mean MBL. [ABSTRACT FROM AUTHOR]
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- 2024
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3. Clinical Evaluation of Mandibular Posterior Three-Unit Combined Tooth-/Implant-Supported Fixed Partial Dentures: Controlled Prospective Clinical Study.
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Ekren, Orhun, Kocak, Elif Figen, Ucar, Yurdanur, Benlidayi, Mehmet Emre, Tükel, Huseyin Can, and Yüksel, Hazal Duyan
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MANDIBLE surgery ,DENTAL implants ,RISK assessment ,JAW diseases ,DENTAL radiography ,DENTAL fillings ,BRIDGES (Dentistry) ,DENTAL abutments ,PERIAPICAL diseases ,TREATMENT effectiveness ,DESCRIPTIVE statistics ,SURGICAL complications ,LONGITUDINAL method ,CONTROL groups ,PRE-tests & post-tests ,DENTAL plaque ,COMPARATIVE studies ,TREATMENT failure ,DENTAL ceramics ,PERIPROSTHETIC fractures ,DISEASE risk factors - Abstract
Purpose: The aims of the study were to evaluate the clinical performance and the complications of combined tooth-/implant-supported three-unit fixed partial dentures (FPDs) in the posterior mandible. Materials and Methods: A total of 78 partially edentulous patients in the posterior mandible were recruited for the study (n = 26/group). Group 1 served as the control group and received two dental implants to support a three-unit FPD. Groups 2 and 3 were the experimental groups in which one implant was placed in conjunction with support from an adjacent tooth to support a three-unit FPD. Standard implants (= 8 mm) were included in Group 2, while short implants (< 8 mm) were included in Group 3. Periapical radiographs were taken for evaluation of crestal bone loss (CBL). Modified plaque index (MPI), bleeding index (BI), and sulcus depth values of the abutment teeth were recorded at the time of FPD delivery, 6 months after FPD delivery, and annually thereafter. Recorded complications included abutment tooth intrusions, cementation failures of the restorations, porcelain chipping/delamination, framework fracture, abutment screw loosening, abutment and abutment screw fracture, and implant fracture. Results: Statistically significant differences were observed between Group 1 (0.06 ± 0.17) and Group 2 (0.18 ± 0.32) and between Group 1 and Group 3 (0.17 ± 0.30) in terms of MPI (P = .05). No difference was observed between Group 2 (0.11 ± 0.34) and Group 3 (0.14 ± 0.36) or between Group 1 (0.04 ± 0.22) and Group 2 in terms of BI. There were statistically significant differences in terms of CBL between Group 1 (0.259 ± 0.05 mm) and Group 3 (0.11 ± 0.03 mm) and between Group 2 (0.03 ± 0.03 mm) and Group 3 (P = .05). The mean abutment tooth sulcus depth was 1.11 ± 0.31 mm for Group 2 and 1.20 ± 0.46 mm for Group 3. Conclusions: Within the limitations of the current study, it was concluded that combined tooth/implant-supported prostheses (CTISPs) are a predictable treatment choice in the posterior mandible. When a CTISP is planned, it is more predictable to use a short implant than a standard-length implant. [ABSTRACT FROM AUTHOR]
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- 2024
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4. Socket Shield Complications: The Management of Internal Shield Exposure. A Multicenter Case Series.
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Gluckman, Howard, Pohl, Snjezana, and Chen, Joey
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DENTAL implants ,COMPLICATIONS of prosthesis ,COSMETIC dentistry ,SURGICAL complications ,DENTAL extraction ,INFLAMMATION ,ALVEOLAR process ,CONNECTIVE tissues - Abstract
The socket shield technique has been proposed as a surgical method to prevent the collapse of the buccal plate following tooth extraction, leading to excellent soft tissue stability and long-term esthetic outcomes. Despite its success, this technique is still not without potential risks. One of the most common complications is internal exposure of the socket shield, which can present as inner soft tissue inflammation with or without exposure of a portion of the shield. This case series discusses this complication's etiology, diagnosis, treatment, management, and prevention. Data from 10 patients with 12 internally exposed sites are presented. [ABSTRACT FROM AUTHOR]
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- 2024
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5. Vascular Delay Soft Tissue Technique in Oral/Maxillary Bone Reconstructive Surgery: A Technical Note.
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Hernández-Alfaro, Federico, Valls-Ontañón, Adaia, Bertos-Quílez, Jorge, Giralt-Hernando, Maria, and Maria Ragucci, Gian
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OPERATIVE dentistry ,WOUND healing ,COMPUTER-aided design ,SURGICAL flaps ,PLASTIC surgery ,SURGICAL complications ,RISK assessment ,TREATMENT effectiveness ,SURGICAL wound dehiscence ,SURGICAL meshes ,BONE regeneration ,COMPUTED tomography ,TITANIUM ,SOFT tissue injuries ,DISEASE risk factors - Abstract
Purpose: The present study describes a new presurgical soft tissue technique in oral/maxillary bone reconstructive surgery for reducing the risk of soft tissue dehiscence and its related complications. Materials and Methods: Ten consecutive patients with Cawood and Howell type V atrophy were scheduled for CAD/CAM titanium mesh bone reconstructive surgery after applying the vascular delay technique 21 days before regenerative surgery. The surgical and healing complications were clinically assessed at nine time points, ranging from the time of bone regenerative surgery to 9 months after surgery. Surgical complications included flap damage and neurologic and vascular complications. Healing complications were subdivided into four classes. These classes comprised Class I: small membrane exposure (= 3 mm) without purulent exudate; Class II: large membrane exposure (> 3 mm) without purulent exudate; Class III: membrane exposure with purulent exudate; and Class IV: abscess formation without membrane. Results: The study sample included seven men and three women (mean age: 48.2 ± 3.5 years) with seven mandibular cases and three maxillary cases. The defect length ranged from three to six teeth, with a mean mesiodistal distance of 29.9 ± 8.5 mm and a mean volume augmentation of 2.03 ± 0.9 cm3. There were no surgical complications. One patient presented a Class I healing complication that did not affect the regeneration outcome. Conclusions: The vascular delay technique appears to reduce the risk of soft tissue dehiscence and exposure in bone regenerative surgery, though randomized studies involving larger samples and longer follow-up periods are needed in order to draw firm conclusions. [ABSTRACT FROM AUTHOR]
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- 2024
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6. Evaluation of Different Approaches for Sinus Membrane Perforation Repair During Sinus Elevation: A Systematic Review and Meta-analysis.
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Ferreira Soares, Lélio Fernando, de Almeida Malzoni, Carolina Mendonça, Iunes da Silveira, Marcela, Marcantonio Junior, Elcio, and Cristina Pigossi, Suzane
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MAXILLARY sinus surgery ,DENTAL implants ,ONLINE information services ,MEDICAL databases ,ARTIFICIAL membranes ,BONE growth ,META-analysis ,MEDICAL information storage & retrieval systems ,CONFIDENCE intervals ,MAXILLARY sinus ,SYSTEMATIC reviews ,SURGICAL complications ,RISK assessment ,QUALITY assurance ,DESCRIPTIVE statistics ,MEDLINE - Abstract
Purpose: To evaluate the impact of different approaches to sinus membrane perforation (SMP) repair on bone formation, postoperative complications, and implant loss risk. Materials and Methods: Electronic searches on PubMed, Web of Science, Scopus, Embase, and Cochrane Library databases were conducted for publications up to February 2021. All included articles reported SMPs submitted for repair. The proportion of implant loss in repaired SMP sites was calculated using a random-effects model meta-analysis. Results: A total of 130 studies reporting SMP repair protocols were included in the systematic review, with 20 selected for meta-analysis. A total of 1,972 sinuses that were perforated and repaired during sinus elevation using different approaches were included in the qualitative analysis. The resorbable collagen membrane was the most commonly reported treatment. The presence of sinusitis was the most frequently described complication. Regarding bone parameters, the majority of studies described no differences between perforated and repaired sinuses and intact membranes. No difference in the implant loss proportion was observed between sites with repaired SMP compared to undetected SMP. The proportion of implant loss in repaired sinuses membrane sites (independent of the material or implant placement time) was 4% (95% CI: 2.0 to 8.0). In meta-regression analysis, no association was observed between the SMP size and implant loss proportion (P = .86). Conclusions: The materials and techniques indicated for SMP management seem to securely seal the maxillary sinus, without a negative effect on the ultimate survival of the implants placed in the affected sinuses. [ABSTRACT FROM AUTHOR]
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- 2024
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7. Clinical Performance of Two-Piece Zirconia Dental Implants After 5 and Up to 12 Years.
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Karapataki, Sofia, Vegh, Daniel, Payer, Michael, Fahrenholz, Harald, Antonoglou, Georgios N., and MClinDent
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DENTAL implants ,TIME ,BONE resorption ,PERIODONTITIS ,SURGICAL complications ,TREATMENT effectiveness ,DESCRIPTIVE statistics ,PERI-implantitis ,LONGITUDINAL method ,EVALUATION - Abstract
Purpose: To assess the clinical performance of a two-piece zirconia implant system, with a focus on biologic complications. Materials and Methods: A total of 39 patients received 91 two-piece zirconia implants. The patients were recruited from two private clinics and were monitored for 5 to 12 years (median: 5.6 years). The primary outcomes were biologic complications, such as peri-implant infections (peri-implant mucositis and peri-implantitis), and the secondary outcome was radiographically evident marginal bone loss (MBL). Results: Three patients (7.7%) with 9 total implants (9.9%) presented with peri-implant mucositis. MBL that did not exceed the first thread was evident at 32 mesial sites (35%) and 25 distal sites (27.4%). MBL exceeding the first thread but not the third thread was evident at 6 mesial and 5 distal sites (thread pitch: 0.7 mm). Only one peri-implant pocket deepened (4 mm) and showed bleeding; however, the estimated MBL did not exceed 1.65 mm. No peri-implantitis occurred, and no implant was lost. Conclusions: This prospective study shows high survival rates and a seemingly low prevalence of biologic and prosthetic complications for this two-piece zirconia implant system over an observation period of up to 12 years. [ABSTRACT FROM AUTHOR]
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- 2023
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8. Effectiveness, Morbidity, and Costs of Transcrestal and Lateral Sinus Floor Elevation at Sites with Different Residual Bone Heights: A Re-Analysis of Data from a Parallel-Arm Randomized Trial.
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Farina, Roberto, Franzini, Chiara, Minenna, Luigi, Trombelli, Leonardo, and Simonelli, Anna
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MAXILLARY sinus surgery ,DENTAL implants ,TIME ,DISEASES ,MEDICAL care costs ,SURGICAL complications ,TREATMENT effectiveness ,COMPARATIVE studies ,DENTAL radiography ,DESCRIPTIVE statistics ,RESEARCH funding ,BONE grafting ,SECONDARY analysis - Abstract
Purpose: To comparatively evaluate transcrestal sinus floor elevation (tSFE) and lateral sinus floor elevation (lSFE) at sites with different residual bone heights (RBHs). Materials and Methods: A re-analysis of data from a parallel-arm, randomized trial comparatively evaluating tSFE and lSFE was performed. Within each RBH interval (< 4 mm or ≥ 4 mm), tSFE and lSFE groups were compared for chair time, surgery-related costs, morbidity, and radiographic parameters (including the proportion of the implant surface in direct contact with the radiopaque area [totCON%]). Results: The intention-to-treat (ITT) population consisted of 29 and 28 patients in the tSFE and lSFE groups, respectively. Irrespective of RBH, both tSFE and lSFE lead to a median totCON% of 100%. At sites with RBH < 4 mm, pain severity was significantly higher at days 0 and 1 in the tSFE group, with no intergroup difference in the dose of analgesics. LSFE was associated with a significantly higher frequency of bruising and greater cost. At sites with RBH ≥ 4 mm, a significantly lower frequency of postoperative signs/symptoms, less chair time, and lower costs were observed in the tSFE group. Conclusions: The selection of tSFE or lSFE within the investigated RBH intervals seems to be supported by differences in chair time, costs, and morbidity between the two techniques. At sites with RBH < 4 mm, clinicians preferring tSFE should encourage the administration of analgesics according to a predefined plan in the early postoperative phase. At sites with RBH ≥ 4 mm, tSFE should be preferred to lSFE due to reduced chair time, costs, and morbidity. [ABSTRACT FROM AUTHOR]
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- 2023
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9. CLINICAL EVALUATION OF THE CORONALLY ADVANCED LINGUAL FLAP TECHNIQUE FOR MAINTAINING PRIMARY WOUND CLOSURE OVER TITANIUM MESH AFTER GUIDED BONE REGENERATION: A RANDOMIZED CONTROLLED TRIAL.
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Attia, Rasha, El-Nahass, Hani, Anis, Maged, and Hosny, Manal
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MANDIBLE surgery ,WOUND healing ,SUTURING ,SURGICAL flaps ,GUIDED tissue regeneration ,TONGUE ,SURGICAL complications ,TREATMENT effectiveness ,RANDOMIZED controlled trials ,COMPARATIVE studies ,ORAL surgery ,SURGICAL meshes ,SURGICAL site ,DESCRIPTIVE statistics ,TITANIUM ,STATISTICAL sampling ,WOUND care ,PATIENT safety - Abstract
This study evaluated the clinical efficacy of the coronally advanced lingual flap (CALF) technique in terms of the extent of lingual and buccal flap advancement, the maintenance of primary wound closure, and safety in comparison to buccal flap advancement alone during horizontal ridge augmentation in the posterior mandible. A total of 14 patients were randomly allocated to two different groups: buccal flap advancement without the CALF technique (control), referred to as the NO-CALF group, and buccal flap advancement with the CALF technique (test), referred to as the CALF group. Wound healing was monitored weekly for the first 4 weeks, then at 2, 4, 6, and 9 months postoperatively for any sod tissue dehiscence (titanium mesh [TM] exposure) along the incision line. The extent of lingual and buccal flap advancement was measured, and any intraoperative and postoperative CALF-related complications were reported. The difference between groups was statistically significant (P < .0001) in terms of (1) TM exposure: 83.3% of cases in the NO-CALF group showed early Class П exposures, whereas the CALF group showed no exposure; (2) mean lingual flap advancement: 3.9 ± 1.1 mm and 14.4 ± 3.8 mm for the NO-CALF and CALF groups, respectively; and (3) mean buccal flap advancement: 15.8 ± 2.1 mm and 10.5 ± 1.4 mm for the NO-CALF and CALF groups, respectively. There were no reported complications related to the CALF technique. Tension-free primary wound closure was facilitated and maintained during the healing period by applying the CALF technique, which is a reliable technique to safely advance the lingual flap coronally. [ABSTRACT FROM AUTHOR]
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- 2023
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10. COMPARISON OF THE CLINICAL EFFICACY OF BIORESORBABLE XENOGENEIC PERITONEAL MEMBRANE VS CONNECTIVE TISSUE GRAFT IN THE MANAGEMENT OF GINGIVAL RECESSION DEFECTS: A RANDOMIZED CONTROLLED CLINICAL TRIAL.
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P., Tinu George, Tadepalli, Anupama, Parthasarathy, Harinath, Ponnaiyan, Deepa, Ramachandran, Lakshmi, and Cholan, Priyanka
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BIOPROSTHESIS ,COLLAGEN ,XENOGRAFTS ,SURGICAL flaps ,GINGIVAL recession ,CUSPIDS ,BICUSPIDS ,PAIN ,CONNECTIVE tissues ,SWINE ,PLASTIC surgery ,SURGERY ,PATIENTS ,SURGICAL complications ,COSMETIC dentistry ,TOOTH roots ,PERITONEUM ,TREATMENT effectiveness ,RANDOMIZED controlled trials ,COMPARATIVE studies ,PRE-tests & post-tests ,PATIENTS' attitudes ,ATTITUDES toward illness ,ORAL surgery ,DESCRIPTIVE statistics ,STATISTICAL sampling ,TRANSPLANTATION of organs, tissues, etc. ,LONGITUDINAL method - Abstract
This randomized controlled trial aimed to determine the clinical efficacy of xenogeneic collagen membrane (XCM) derived from porcine peritoneum in combination with a coronally advanced flap (CAF) in the management of gingival recession defects and to compare the outcomes to those of connective tissue grafts (CTGs). A total of 12 systemically healthy individuals presenting with 30 isolated/multiple Cairo RT 1/2 gingival recession defects in maxillary canines and premolars were randomly treated either with CAF + XCM or CAF + CTG. Recession height (RH), gingival biotype (GB), gingival thickness (GT), width of keratinized gingiva (WKG), and width of attached gingiva (WAG) were recorded at baseline and at 3, 6, and 12 months. Patient perceptions of pain and esthetics and the modified root coverage esthetic score (MRES) were also documented. From baseline to 12 months, both groups showed a significant reduction in mean RH (CAF + CTG: 2.73 ± 0.79 mm to 0.33 ± 0.61 mm; CAF + XCM: 2.73 ± 0.88 mm to 1.20 ± 0.77 mm). At 12 months, CAF + CTG sites had a mean root coverage percentage (MRC%) of 85.60% ± 28.74%, whereas CAF + XCM sites had an MRC% of 55.13% ± 31.22%. CAF + CTG-treated sites had significantly better outcomes, with a greater number of sites achieving complete root coverage (n = 11) and higher MRES scores than the porcine peritoneal membrane group (P < .05). [ABSTRACT FROM AUTHOR]
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- 2023
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11. Treatment of Maxillary Gingival Recessions Using the Modified Coronally Advanced Tunnel Technique in Combination with a Volume-Stable Collagen Matrix: A Prospective Case Series with a 12-Month Follow-up.
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Jalilvand, Navid, Kasapoudis, Dimitrios, Altun, Ersin, Aarabi, Ghazal, Hajilou, Sahar, and Beikler, Thomas
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MAXILLA surgery ,COLLAGEN ,GINGIVAL recession ,SURGICAL flaps ,DENTAL care ,SURGICAL complications ,TREATMENT effectiveness ,ORAL surgery - Abstract
The aim of this case series was to evaluate the clinical performance of a new volume-stable collagen matrix (VCMX) in combination with the modified coronally advanced tunnel technique (MCAT) for the treatment of gingival recessions. Thirteen patients with a total of 33 maxillary RT1 single and multiple gingival recessions were included in the study. Probing pocket depth (PPD), recession width (RECW), recession depth (REC), height of keratinized tissue (HKT), and gingival thickness (GT) were assessed at baseline and at the 12-month follow-up. Postoperative healing was uneventful in all cases without any complications. At 12 months, mean root coverage (MRC) was 92.88%, with complete root coverage (CRC) in 87.88% of treated sites. The present findings suggest that VCMX in combination with MCAT results in predictable coverage of maxillary RT1 gingival recessions. Further studies with larger sample sizes and control groups are needed to support these preliminary outcomes. [ABSTRACT FROM AUTHOR]
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- 2023
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12. Total shoulder arthroplasty in patients with dementia or mild cognitive impairment.
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Serna, Juan, Su, Favian, Lansdown, Drew, Feeley, Brian, Ma, C, and Zhang, Alan
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Anatomic total shoulder arthroplasty ,Dementia ,Medical complications ,Mild cognitive impairment ,Reverse total shoulder arthroplasty ,Surgical complications - Abstract
BACKGROUND: Anatomic total shoulder arthroplasty (ATSA) and reverse total shoulder arthroplasty (RTSA) reliably alleviate pain and restore shoulder function for a variety of indications. However, these procedures are not well-studied in patients with neurocognitive impairment. Therefore, the purpose of this study was to investigate whether patients with dementia or mild cognitive impairment (MCI) have increased odds of surgical or medical complications following arthroplasty. METHODS: The PearlDiver database was queried from 2010 through October 2021 to identify a cohort of patients who underwent either ATSA or RTSA and had a minimum 2-year follow-up. Current Procedural Terminology and International Classification of Diseases codes were used to stratify this cohort into three groups: (1) patients with dementia, (2) patients with MCI, and (3) patients with neither condition. Surgical and medical complication rates were compared among these three groups. RESULTS: The overall prevalence of neurocognitive impairment among patients undergoing total shoulder arthroplasty was 3.0% in a cohort of 92,022 patients. Patients with dementia had increased odds of sustaining a periprosthetic humerus fracture (odds ratio [OR] = 1.46, P
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- 2024
13. Implant Survival Rate in Mandible Reconstructed with Free Fibula Flaps After Oral Tumors: A Systematic Review and Meta-Analysis.
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Illand, Corentin, Destruhaut, Florent, Luis Porporatti, André, Wulfman, Claudine, Naveau, Adrien, and Rignon-Bret, Christophe
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DENTAL implants ,ONLINE information services ,MEDICAL databases ,MOUTH tumors ,SURGICAL flaps ,DENTURES ,META-analysis ,MEDICAL information storage & retrieval systems ,CONFIDENCE intervals ,MANDIBLE ,SYSTEMATIC reviews ,PLASTIC surgery ,SURGICAL complications ,SURVIVAL rate ,DESCRIPTIVE statistics ,FIBULA ,MEDLINE ,DATA analysis software - Abstract
Purpose: To assess the implant survival rate in mandibles reconstructed with free fibula flap after oral tumor resection after 1 year of prosthetic loading. A secondary objective was to compare immediate or delayed implant placement protocols in this population. Materials and Methods: Electronic and manual searches were performed on different databases for controlled and prospective trials that indicated implant survival rate. This systematic review followed PRISMA guidelines. Risk of bias was evaluated using Cochrane Collaboration tools. Meta-analyses heterogeneity source assessment and GRADE evaluation were performed among studies with identical follow-ups. Results: Among 305 primarily selected articles, 109 were eligible after reading the title and abstract, and 8 were included after full-text reading: 2 randomized controlled trials and 6 prospective studies comprising 140 patients and 507 implants. Meta-analyses estimated an overall survival rate of 97% (95% CI: 94% to 99%) after 1 year of prosthetic loading. The survival rate was 98% (95% CI: 94% to 100%) with immediate implantation and 97% (95% CI: 90% to 99%) with delayed implantation. Only 3 studies reported radiotherapy treatment, with no real impact on implant survival rate. Overall, 69% of tumors were benign. Conclusions: Implant placement in vascularized fibula flaps in the mandible is recommended for patients undergoing segmental mandibular reconstruction after tumor resection. Within the limitations of this study, no significant difference in survival rates was found between immediate and delayed implant placement. [ABSTRACT FROM AUTHOR]
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- 2023
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14. The Use of Short Dental Implants: Where Are We Today?
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Stanford, Clark M., Chvartszaid, David, Oates, Thomas W., Estafanous, Emad, Ellingsen, Jan-Eirik, and Osswald, Martin
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DENTAL implants ,DENTAL materials ,SERIAL publications ,SURGICAL complications ,MAXILLA ,PLASTIC surgery ,TREATMENT effectiveness ,DENTISTRY ,BONE grafting ,DISEASE risk factors - Abstract
The article discusses research published in the 2021 issue of the "International Journal of Environmental Research and Public Health" which evaluated the use of short dental implants compared to standard dental implants. The research reviewed studies on short implants and standard-length implants placed in augmented and nonaugmented edentulous sites, short implant survival, stability and marginal bone levels, and implants placed in the posterior maxilla and in medically compromised patients.
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- 2023
15. Technique-Related Survival Rate and Complications of Zygomatic Implant Placement: A Systematic Review and Meta-Analysis.
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Gabriele, Guido, Chisci, Glauco, Cascino, Flavia, Ricci, Nicolò Maria, Marruganti, Crystal, and Ferrari, Marco
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DENTAL implants ,ONLINE information services ,CONFIDENCE intervals ,META-analysis ,ZYGOMA ,SURGICAL complications ,RETROSPECTIVE studies ,MAXILLOFACIAL prosthesis ,DESCRIPTIVE statistics ,MEDLINE ,LONGITUDINAL method - Abstract
Purpose: To assess the survival rate (SR) and probability of postoperative complications at both the implant and patient level for each of the four surgical techniques for zygomatic implant (ZI) placement: Brånemark, sinus slot, extrasinus, and extramaxillary. Materials and Methods: A systematic literature review and meta-analysis of clinical studies that reported the survival rate and postoperative ZI complications for the rehabilitation of atrophic edentulous maxillae was conducted based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) recommendations. Two independent reviewers consulted four databases during the literature search: MEDLINE (PubMed), Google Scholar, Clinicaltrials.gov, and LILACS. Duplicate articles were eliminated. Results: A total of 35 studies were included in the metaanalysis. Subgroup analysis showed that study design (prospective vs retrospective) had no significant impact (P = .10) on the outcomes. The SR was highest for the Brånemark and extrasinus techniques (100%) and lowest for the sinus slot technique (94%; 95% CI = 86% to 102%). The extramaxillary (38%; 95% CI = 1% to 3%) and the Brånemark (29%; 95% CI = 15% to 44%) techniques resulted in the highest occurrence of patient-level complications. Moreover, the extramaxillary technique showed the highest percentage of prothesis-related complications (44%; 95% CI = 27% to 62%). Conclusions: ZI placement was demonstrated to be a reliable technique for the rehabilitation of severely atrophic maxillae, irrespective of the surgical technique evaluated. Accurate case and surgical protocol selection is of paramount importance to reduce technique-related postoperative complications. [ABSTRACT FROM AUTHOR]
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- 2023
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16. Intervention of Refractory Arthrofibrosis After Anterior Cruciate Ligament Reconstruction: A Case Report.
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Zhang, Ling, Fan, Shuai, and Cai, Bin
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KNEE joint , *PATIENT aftercare , *RANGE of motion of joints , *SURGICAL complications , *TREATMENT effectiveness , *MANIPULATION therapy , *QUADRICEPS muscle , *MUSCLE strength , *ANTERIOR cruciate ligament surgery , *KINEMATICS - Abstract
Objectives: Although nonsurgical and surgical management of knee arthrofibrosis has been reported in the literature, there is little information on the effect of procedural treatment modalities of refractory arthrofibrosis on clinical outcomes. The purpose of this case report is to describe the intervention of refractory knee arthrofibrosis after anterior cruciate ligament reconstruction and investigate long-term clinical outcomes after procedural intervention. Methods: A 27-year-old male presented with decreased range of motion (ROM), patellar mobility, strength, and knee joint function following anterior cruciate ligament reconstruction of his left knee. After failed conservative management, the patient underwent manipulation under anesthesia (MUA) to release scar tissue. Following MUA, the emphasis of comprehensive physiotherapy was on decreasing inflammation, relieving pain, and maintaining patellar mobility while increasing knee joint ROM and strength. Knee ROM, patellofemoral motion, gait, and quadriceps recruitment were measured 3, 6, 12, and 24 months after MUA. Results: At 2-year follow-up after MUA, the patient continued to present with decreased ROM and quadriceps strength compared to the contralateral knee, but had returned to a running program and reported knee joint dysfunction no longer interfered with his daily activities. Conclusions: This case report demonstrates signs and symptoms that could indicate knee arthrofibrosis and introduces procedural intervention for refractory arthrofibrosis after anterior cruciate ligament reconstruction. [ABSTRACT FROM AUTHOR]
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- 2023
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17. Ossification and Bone Regeneration in a Canine GBR Model, Part 1: Thick vs Thin Glycated Cross-Linked Collagen Devices.
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Pesce, Paolo, Zubery, Yuval, Goldlust, Arie, Bayer, Thomas, Abundo, Roberto, and Canullo, Luigi
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METAPLASTIC ossification ,COLLAGEN ,CUSPIDS ,BLOOD vessels ,REGENERATION (Biology) ,REGRESSION analysis ,SURGICAL technology ,SURGICAL complications ,ADVANCED glycation end-products ,GLYCOPROTEINS ,HISTOLOGY ,COMPUTED tomography ,ANIMALS - Abstract
Purpose: To compare glycated multilayered membranes (OV) to a commercially available thin-layer membrane (OP) in a lateral ridge augmentation model in dogs. Materials and Methods: This was designed as a three-arm study, where one negative control (empty defect) was compared to two test arms: alveolar bone defects grafted with a mixture of 90% deproteinized bovine bone mineral and 10% porcine collagen, then covered with either a thick- (OV) or thin-layered (OP) membrane. Animals were randomly divided into three groups corresponding to the final sacrifice times of 4 weeks, 12 weeks, and 24 weeks. Sections underwent microCT, histology, histopathology, and histomorphometry. Results: No statistical differences were observed for OV compared to OP regarding the percentage of mineral volume and mean mineral density, amount of bone maturation, percentage of bone graft and membrane remaining in the grafted area, alveolar ridge width measurements, membrane mineralization, or ossification. Test groups presented significantly higher values compared to the empty control for all the endpoints. Conclusions: Within its limitations, this in vivo study highlighted that multilayered thick glycated membranes can serve as effective occlusive barriers for up to 6 months. [ABSTRACT FROM AUTHOR]
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- 2023
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18. Quantification of Bone Height and Bone Volume Around Dental Implants After Open Maxillary Sinus Elevation Surgery Using CBCT.
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Riben, Christopher, Lewin, Susanne, Kämpe, Johan, Öhman-Mägi, Caroline, and Thor, Andreas
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MAXILLARY sinus surgery ,DENTAL implants ,THREE-dimensional imaging ,DENTURES ,BONE growth ,RETROSPECTIVE studies ,ACQUISITION of data ,SURGICAL complications ,COMPARATIVE studies ,MEDICAL records ,DESCRIPTIVE statistics ,COMPUTED tomography ,BONE density - Abstract
Purpose: To assess, using CBCT, the volume and height of bone formation after open maxillary sinus elevation without the use of grafts. Materials and Methods: The study was retrospective and included 24 patients with a total of 67 implants. CBCT examinations were conducted at baseline (0 to 43 days postsurgery) and after an average healing period of 6.2 months (range: 5.1 to 7.8 months). The image analysis included metal artifact reduction, registration, and a standardized protocol for segmenting the anatomical structures of the maxillary sinus, including calculating the 3D volumetric changes after bone formation. Conventional manual 2D measurement of vertical bone formation was executed for comparison. Clinical factors assumed to be relevant for bone formation were obtained from patient medical records. Results: One implant was lost before prosthetic loading, representing an early implant loss rate of 1.5%. Differences in intra- and interexaminer reproducibility were registered for the conventional 2D method (P < .05). The average vertical bone formation measured with the 2D method was 4.8 mm (4.6 to 5.0 mm), covering 60.2% of the implant height within the sinus. The average volumetric bone formation measured with the developed 3D image-analysis method was 801 mm3 in total and 195 mm3 in a restricted region around each implant. Bone formation was registered in 62% of the volume of the restricted region. A correlation regarding bone formation was found between the two methods (R2 = 0.705). Clinical factors such as age, smoking, general health, and postoperative complications did not correlate with the amount of bone formed. Conclusion: CBCT image analysis is a promising method for objective 3D evaluation of bone formation after sinus elevation. A correlation was seen between the manually measured bone height (2D) and the bone volume in a restricted region around each implant using the developed method (3D). Reducing visual interpretation minimizes errors related to examiner reliability. Clinical factors did not significantly affect the volumetric bone formation. [ABSTRACT FROM AUTHOR]
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- 2023
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19. The Impact of Sinus Floor Elevation Techniques on Sinus Membrane Perforation: A Systematic Review and Network Meta-analysis.
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Chun-Teh Lee, Choksi, Karishma, Ming-Chieh Shih, Rosen, Paul S., Ninneman, Shale, and Yung-Ting Hsu
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MAXILLARY sinus surgery ,DENTAL implants ,ONLINE information services ,META-analysis ,MEDICAL information storage & retrieval systems ,MAXILLARY sinus ,SYSTEMATIC reviews ,SURGICAL complications ,DESCRIPTIVE statistics ,MEDLINE ,ODDS ratio ,BONE grafting ,DISEASE risk factors - Abstract
Purpose: To compare the risk of sinus membrane perforation (SMP) among lateral window sinus floor elevation (LSFE) and transcrestal sinus floor elevation (TSFE) techniques in prospective and retrospective studies for patients who underwent sinus augmentation for dental implant placement. Materials and Methods: A database search was conducted to screen the literature published from January 1960 to August 2021. The associations between SMP and surgical techniques as well as other clinical factors were evaluated via network meta-analysis. The impact of SMP on vertical ridge gain and implant survival was also evaluated. Results: Eighty-five studies with 5,551 SFE procedures were included. In LSFE techniques, using rotary burs showed the highest risk of SMP (surface under the cumulative ranking area [SUCRA] = 0.0745). In TSFE techniques, using reamers had the lowest risk of SMP (SUCRA = 0.9444). Increased SMP prevalence was significantly associated with reduced implant survival rate (odds ratio [OR] = 0.45 per 10% increase of SMP rate [95% credible interval (CreI): 0.21, 0.71], P < .001). Conclusions: With the inherent limitations, this network meta-analysis suggested that some techniques within either the LSFE or TSFE group may reduce SMP risk. Additional randomized controlled trials and better assessment of SMP are required to directly compare the risk of SMP between LSFE and TSFE. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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20. The Customized Alveolar Ridge-Splitting (CARS) Technique Combined with Guided Bone Regeneration or Sinus Elevation Augmentation in Maxillary Deficient Ridges.
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Bergamini, Marco, Froum, Stuart J., Muchhala, Stuti, Leung, Martin, Alzahrani, Khulood, and Yung Cheng Paul Yu
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MAXILLARY sinus surgery ,ALVEOLAR process surgery ,DENTAL implants ,OPERATIVE dentistry ,BONE lengthening (Orthopedics) ,GUIDED tissue regeneration ,MAXILLARY diseases ,SURGICAL complications ,CASE studies ,BONE regeneration - Abstract
Various techniques have been proposed to regenerate deficient ridges after tooth removal, including guided bone regeneration, block grafting, distraction osteogenesis, and ridge splitting. However, these procedures are techniquesensitive and often present complications which prevent reconstruction of the deficient ridge and implant placement. In an atrophic anterior or posterior maxilla, these techniques often fail to produce satisfactory long-term outcomes due to the poor bone quality, pneumatization of the maxillary sinus, and the highly cosmetic patient demands. The customized alveolar ridge-splitting (CARS) technique was introduced to improve outcomes and minimize the risk of complications. The synergistic combination of this technique with another augmentation procedure--including lateral window sinus augmentation and guided bone regeneration--allows implant placement into ridges with deficient bone volume both vertically and horizontally. This study presents two case reports that were successfully treated with the CARS technique and additional augmentation techniques to treat severely atrophic ridges in the anterior and posterior maxilla. [ABSTRACT FROM AUTHOR]
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- 2023
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21. Comparison of Guided Bone Regeneration with Periosteal Pocket Flap Technique Versus Autogenous Bone Block Graft for Horizontal Bone Augmentation: A Clinical Trial Study.
- Author
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Shiezadeh, Farid, Arab, Hamid Reza, Khoshkam, Vahid, Moeintaghavi, Amir, Forouzanfar, Ali, and Khodadadifard, Leila
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PERIOSTEUM ,DENTAL implants ,OPERATIVE dentistry ,STATISTICS ,HOMOGRAFTS ,PLASTIC surgery ,SURGICAL complications ,AUTOGRAFTS ,RANDOMIZED controlled trials ,COMPARATIVE studies ,BONE regeneration ,STATISTICAL sampling ,COMPUTED tomography ,DATA analysis ,BONE grafting - Abstract
The aim of this study was to assess changes in the horizontal dimension of the alveolar ridge using the autogenous bone block (ABB) or periosteal pocket flap (PPF) techniques prior to implant placement. This randomized trial study was conducted on 25 patients in need of horizontal bone augmentation who were randomly divided into two groups as follows: 13 underwent ridge augmentation with ABB in combination with allograft and collagen membrane, and 12 underwent ridge augmentation with the PPF technique. Radiographic examination via CBCT was conducted on all patients before and 26 weeks after the operation. Dimensional changes in the ridge width following surgery were measured within each group and also between the two groups in three regions: 0, 3, and 5 mm from the top of the alveolar crest. Eleven patients in the ABB group and all 12 patients in the PPF group successfully completed the study. Statistical analysis showed that the increase in alveolar ridge width in each group was significant, but the difference between the groups was not significant at any of the measured spots (0 mm from the crest, P = .25; 3 mm, P = .38; 5 mm, P = .73). However, more postoperative complications were observed with the ABB technique. According to the results of this study, there was no statistically significant difference between PPF and ABB techniques in terms of horizontal bone gain. [ABSTRACT FROM AUTHOR]
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- 2023
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22. Comparison of Implant Survival Rates and Biologic and Mechanical Complications with Implant-Supported Fixed Complete Dental Prostheses Using Four and Six Implants.
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Tamer, Yusuf and Özcan, Isıl
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RISK of prosthesis complications ,DENTAL implants ,MUCOSITIS ,EDENTULOUS mouth ,SURGICAL complications ,RETROSPECTIVE studies ,ACQUISITION of data ,SURGERY ,PATIENTS ,DENTAL veneers ,ACRYLIC resins ,TREATMENT effectiveness ,COMPARATIVE studies ,MEDICAL records ,DESCRIPTIVE statistics ,EQUIPMENT & supplies ,DISEASE risk factors ,EVALUATION - Abstract
This study aims to compare the incidence of biologic and mechanical complication rates and the survival rates after at least 5 years of implants and implant-supported fixed complete dental prostheses (IFCDPs) placed during second-stage surgery using four and six implants. A total of 77 patients (33 men, 44 women) with a mean age of 60.6 ± 8.8 years (range: 39 to 80 years) were included, and the total of 92 IFCDPs were classified into two groups: 51 received four implants, and 41 received six implants. No implant failed in the four-implant group (0/204), and one implant failed in the six-implant group (1/246), with no statistically significant differences (P > .05). One prosthetic failure occurred in the four-implant group (1/51), and one failure occurred in the six-implant group (1/41). Both groups experienced some technical and biologic complications, with no statistically significant differences between the groups (P > .05). For both groups, veneer or resin fracture was the most frequent mechanical complication, and mucositis was the most frequent biologic complication. The use of four or six implants may represent a predictable treatment option in the rehabilitation of completely edentulous patients with IFCDPs in the medium-term. [ABSTRACT FROM AUTHOR]
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- 2023
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23. A dimensional analysis of experienced intensive care unit nurses' clinical decision‐making for bleeding after cardiac surgery.
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Lavoie, Patrick, Arbour, Caroline, Garneau, Amélie Blanchet, Côté, José, Crétaz, Maude, Denault, André, Gosselin, Émilie, Lapierre, Alexandra, Mailhot, Tanya, and Tessier, Virginie
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PROFESSIONAL autonomy , *RESEARCH funding , *QUALITATIVE research , *INTERPROFESSIONAL relations , *INTERVIEWING , *QUESTIONNAIRES , *DECISION making in clinical medicine , *WORK experience (Employment) , *SURGICAL complications , *CONCEPTUAL structures , *RESEARCH methodology , *CLINICAL competence , *GROUNDED theory , *DATA analysis software , *SOCIAL support , *HEMORRHAGE , *CARDIAC surgery , *CRITICAL care nurses - Abstract
Background: Bleeding following cardiac surgery is common and serious, yet a gap persists in understanding how experienced intensive care nurses identify and respond to such complications. Aim: To describe the clinical decision‐making of experienced intensive care unit nurses in addressing bleeding after cardiac surgery. Study Design: This qualitative study adopted the Recognition‐Primed Decision Model as its theoretical framework. Thirty‐nine experienced nurses from four adult intensive care units participated in semi‐structured interviews based on the critical decision method. The interviews explored their clinical judgements and decisions in bleeding situations, and data were analysed through dimensional analysis, an alternative to grounded theory. Results: Participants maintained consistent vigilance towards post‐cardiac surgery bleeding, recognizing it through a haemorrhagic dimension associated with blood loss and chest drainage and a hypovolemic dimension focusing on the repercussions of reduced blood volume. These dimensions organized their understanding of bleeding types (i.e., normal, medical, surgical, tamponade) and necessary actions. Their decision‐making encompassed monitoring bleeding, identifying the cause, stopping the bleeding, stabilizing haemodynamic and supporting the patient and family. Participants also adapted their actions to specific circumstances, including local practices, professional autonomy, interprofessional dynamics and resource availability. Conclusions: Nurses' decision‐making was shaped by their personal attributes, the patient's condition and contextual circumstances, underscoring their expertise and pivotal role in anticipating actions and adapting to diverse conditions. The concept of actionability emerged as the central dimension explaining their decision‐making, defined as the capability to implement actions towards specific goals within the possibilities and constraints of a situation. Relevance to Clinical Practice: This study underscores the need for continual updates to care protocols to align with current evidence and for quality improvement initiatives to close existing practice gaps. Exploring the concept of actionability further, developing adaptability‐focused educational programmes, and understanding decision‐making intricacies are crucial for informing nursing education and decision‐support systems. [ABSTRACT FROM AUTHOR]
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- 2024
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24. Race Does Not Affect Rates of Surgical Complications at Military Treatment Facility.
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West, Erin, Jackson, Laurinda, Greene, Howard, Lucas, Donald J, Gadbois, Kyle D, and Choi, Pamela M
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Introduction Racial minorities have been found to have worse health care outcomes, including perioperative adverse events. We hypothesized that these racial disparities may be mitigated in a military treatment facility, where all patients have a military service connection and are universally insured. Materials and Methods This is a single institution retrospective review of American College of Surgeons National Surgical Quality Improvement Program data for all procedures collected from 2017 to 2020. The primary outcome analyzed was risk-adjusted 30-day postoperative complications compared by race. Results There were 6,941 patients included. The overall surgical complication rate was 6.9%. The complication rate was 7.3% for White patients, 6.5% for Black patients, 12.6% for Asian patients, and 3.4% for other races. However, after performing patient and procedure level risk adjustment using multivariable logistic regression, race was not independently associated with surgical complications. Conclusions Risk-adjusted surgical complication rates do not vary by race at this military treatment facility. This suggests that postoperative racial disparities may be mitigated within a universal health care system. [ABSTRACT FROM AUTHOR]
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- 2024
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25. Efficacy of a novel traction method: outside-lesion clip-thread method for gastric endoscopic submucosal dissection of lesions of the greater curvature of the upper/middle stomach (with video).
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Yamada, Keisaku, Tajika, Masahiro, Tanaka, Tsutomu, Ito, Nobuhito, Takagi, Akihiro, and Niwa, Yasumasa
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STOMACH surgery , *DATA analysis , *HUMAN dissection , *STOMACH , *SCIENTIFIC observation , *FISHER exact test , *LOGISTIC regression analysis , *TREATMENT effectiveness , *RETROSPECTIVE studies , *MANN Whitney U Test , *VETERINARY dissection , *SURGICAL complications , *ORTHOPEDIC traction , *ENDOSCOPIC gastrointestinal surgery , *MEDICAL records , *ACQUISITION of data , *ONE-way analysis of variance , *STATISTICS , *VIDEO recording - Abstract
Background: Gastric endoscopic submucosal dissection (ESD) for lesions located on the greater curvature of the upper and middle (U/M) third of the stomach remains challenging, even for experienced endoscopists. Accordingly, we have developed a novel traction technique, termed the outside-lesion clip-thread method (O-CTM). In this method, a clip thread is attached to the healthy mucosa outside the circumferential incision line, and traction is applied to bring the scope and lesion into proximity for ESD. Here, we assessed the efficacy of ESD using the O-CTM compared to ESD without the O-CTM. Methods: We retrospectively reviewed data from 63 consecutive patients who underwent gastric ESD for 63 lesions located on the greater curvature of the U/M third of the stomach between September 2015 and April 2024. The primary outcome was the operation time, and secondary outcomes were resection speed, en bloc resection, R0 resection and complications in the O-CTM and without O-CTM ESD groups. Results: Of the 63 included lesions, 37 were resected without the O-CTM between September 2015 and June 2022 (without O-CTM group), and 26 lesions were resected using the O-CTM between July 2022 and April 2024 (O-CTM group). The O-CTM group had significantly shorter operation times (40 min vs. 77 min, p = 0.01) than the without O-CTM group. The resection speed was also significantly faster (20.1 mm2/min vs. 11.3 mm2/min, p = 0.02). No significant differences in en bloc resection rate, R0 resection rate, and complications were observed. Conclusions: Gastric ESD using O-CTM is beneficial when compared with the ESD without O-CTM in reducing operation time and improving resection speeds for treating lesions located on the greater curvature of the U/M region. [ABSTRACT FROM AUTHOR]
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- 2024
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26. Robotic, laparoscopic and open surgery for gallbladder cancer: a systematic review and network meta-analysis.
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Chee, Madeline Yen Min, Wu, Andrew Guan Ru, Fong, Khi-Yung, Yew, Ashley, Koh, Ye Xin, and Goh, Brian K. P.
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GALLBLADDER tumors , *SURGICAL robots , *LYMPH nodes , *CANCER relapse , *LAPAROSCOPIC surgery , *TREATMENT effectiveness , *META-analysis , *BILE duct diseases , *MINIMALLY invasive procedures , *CHOLECYSTECTOMY , *DESCRIPTIVE statistics , *OPERATIVE surgery , *SYSTEMATIC reviews , *MEDLINE , *SURGICAL complications , *ODDS ratio , *KAPLAN-Meier estimator , *MEDICAL databases , *ONLINE information services , *PROGRESSION-free survival , *LENGTH of stay in hospitals , *DATA analysis software , *CONFIDENCE intervals , *OVERALL survival , *PROPORTIONAL hazards models - Abstract
Introduction: Minimally invasive oncological resections have become increasingly widespread in the surgical management of cancers. However, the role of minimally invasive surgery (MIS) for gallbladder cancer (GBC) remains unclear. We aim to perform a systematic review and network meta-analysis of existing literature to evaluate the safety and feasibility of laparoscopic and robotic surgery in the management of GBC compared to open surgery (OS) by comparing outcomes. Methods: A literature search of the PubMed/MEDLINE (2000 to December 2021) and EMBASE (2000 to December 2021) databases was conducted. The primary outcome studied was overall survival, and secondary outcomes studied were postoperative morbidity, severe complications, incidence of bile leak, length of hospital stay, operation time, R0 resection rate, local recurrence and lymph node yield. Results: Thirty-two full-text articles met the eligibility criteria and were included in the final analysis with a total of 5883 patients undergoing either OS or MIS (laparoscopic or robotic) for GBC. 1- and 2-stage meta-analyses did not reveal any significant differences between OS, laparoscopic and robotic surgery in terms of overall survival, R0 resection, lymph node harvest, local recurrence and post-operative complications. Patients who underwent OS had significantly longer hospitalization stay and intra-operative blood loss compared to those who underwent laparoscopic or robotic surgery. Network meta-analysis did not reveal any significant differences between post-operative and survival outcomes of laparoscopic vs robotic surgery groups. Conclusion: This network meta-analysis suggests that both laparoscopic and robotic surgery are safe and effective approaches in the surgical management of GBC, with post-operative and survival outcomes comparable to OS. An MIS approach may also lead to shorter hospitalization stay, less intraoperative blood loss and post-operative complications compared to OS. There was no obvious benefit of either MIS approach (laparoscopic versus robotic) over the other. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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27. Suture versus tacks in minimally invasive transabdominal preperitoneal inguinal repair: a meta-analysis of randomized controlled trials.
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Pompeu, Bernardo Fontel, Almiron da Rocha Soares, Giulia, Pereira Silva, Mariana, Ponte Farias, Ana Gabriela, Oliveira de Sousa Silva, Raquel, and Mazzola Poli de Figueiredo, Sergio
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PERITONEUM surgery , *POSTOPERATIVE pain , *LAPAROSCOPIC surgery , *MINIMALLY invasive procedures , *META-analysis , *DESCRIPTIVE statistics , *CHI-squared test , *SURGICAL therapeutics , *SYSTEMATIC reviews , *MEDLINE , *SURGICAL complications , *INGUINAL hernia , *HERNIA surgery , *SUTURING , *MEDICAL databases , *CONFIDENCE intervals , *DATA analysis software , *QUALITY assurance , *SURGICAL meshes , *SUTURES , *CLINICAL trial registries , *TIME , *SENSITIVITY & specificity (Statistics) - Abstract
Introduction: There is uncertainty regarding the method of mesh fixation and peritoneal closure during transabdominal preperitoneal (TAPP) repair for inguinal hernias, with no definitive guidelines to guide surgeon choice. Methods: MEDLINE, Cochrane, Central Register of Clinical Trials, and Web of Science were searched for RCTs published until November 2023. Risk ratios (RRs) and mean differences (MD) with 95% confidence intervals (CIs) were pooled with a random-effects model. Statistical significance was defined as p < 0.05. Heterogeneity was assessed using the Cochran Q test and I2 statistics, with p values inferior to 0.10 and I2 > 25% considered significant. Statistical analyses were conducted using Review Manager version 5.4 and RStudio version 4.1.2 (R Foundation for Statistical Computing). Results: Eight randomized controlled trials (RCTs) were included, comprising 624 patients, of whom 309 (49.5%) patients were submitted to TAPP with the use of tacks, and 315 (50.5%) received suture fixation. The use of tacker fixation was associated with a significant increase in postoperative pain at 24 h (MD 0.79 [VAS score]; 95% CI 0.38 to 1.19; p < 0.0002; I2 = 87%) and one week (MD 0.42 [VAS score]; 95% CI 0.05 to 0.79; p < 0.03, I2 = 84%). The use of tacks was associated with shorter operative time (MD—25.80 [min]; 95% − 34.31– − 17.28; P < 0.00001; I2 = 94%). No significant differences were found in overall complications, chronic pain, seromas, hematomas, and urinary retention rates. Conclusion: In patients who underwent TAPP hernia repair, tacks are associated with decreased operative time but increased postoperative pain at 24 h and one week. [ABSTRACT FROM AUTHOR]
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- 2024
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28. Endoscopic repair of duodenal perforations, a scoping review.
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Williams, Jennifer, Joshi, Hansa, Schwartz, Michael, Kalola, Ami, Mercado, Alvin, Saracco, Benjamin, Adams, Amanda, Chaaya, Adib, Baik, Daniel, Elfant, Adam, and Hong, Young Ki
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MEDICAL information storage & retrieval systems , *WOUND healing , *INTESTINAL perforation , *GASTROINTESTINAL hemorrhage , *PERITONITIS , *POSTOPERATIVE pain , *ABDOMINAL pain , *STENOSIS , *TREATMENT effectiveness , *SYSTEMATIC reviews , *MEDLINE , *SURGICAL complications , *ENDOSCOPIC gastrointestinal surgery , *LITERATURE reviews , *MEDICAL databases , *LENGTH of stay in hospitals ,DUODENUM injuries - Abstract
Background: There is a discrepancy in the surgical and endoscopic literature for managing duodenal perforations. Although often managed conservatively, surgical repair is the standard treatment for duodenal perforations. This contrasts with the gastroenterology literature, which now recommends endoscopic repair of duodenal perforations, which are more frequently iatrogenic from the growing field of advanced endoscopic procedures. This study aims to provide a scoping review to summarize the current literature content and quality on endoscopic repair of duodenal perforations. Methods: The protocol for performing this scoping review was outlined by the Joanna Briggs Institute. All studies that reported primary outcomes of patients who had undergone endoscopic repair of duodenal perforations before February 2022, regardless of perforation etiology or repair type were reviewed, with studies after 1999 meeting inclusion criteria. The study excluded articles that did not report clinical outcomes of endoscopic repair, articles that did not describe where in the gastrointestinal tract the endoscopic repair occurred, pediatric patients, and animal studies. Results: 7606 abstracts were screened, with 474 full articles reviewed and 152 studies met inclusion criteria. 560 patients had duodenal perforations repaired endoscopically, with a technical success rate of 90.4% and a survival rate of 86.7%. Most of these perforations (74.5%) were iatrogenic from endoscopic procedures or surgery. Only one randomized control trial (RCT) was found, and 53% of studies were case reports. Conclusion: These results suggest that endoscopic repair could emerge as a viable first-line treatment for duodenal perforation and highlight the need for more high-quality research in this topic. [ABSTRACT FROM AUTHOR]
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- 2024
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29. Endoscopic approach for biliopancreatic disease after pancreaticoduodenectomy: a 10-year single-center experience.
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Capasso, Mario, Dioscoridi, Lorenzo, Forti, Edoardo, Pugliese, Francesco, Cintolo, Marcello, Bonato, Giulia, Bravo, Marianna, Palermo, Andrea, Fimiano, Federica, and Mutignani, Massimiliano
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PANCREATIC diseases , *BILE duct diseases , *RETROSPECTIVE studies , *DESCRIPTIVE statistics , *TERTIARY care , *TREATMENT effectiveness , *CHI-squared test , *PANCREATICODUODENECTOMY , *SURGICAL complications , *ENDOSCOPIC gastrointestinal surgery , *DATA analysis software , *ENDOSCOPIC retrograde cholangiopancreatography - Abstract
Background and aim: In surgically altered anatomy (SAA), endoscopic retrograde cholangiopancreatography (ERCP) can be challenging, and it remains debatable the choice of the optimal endoscopic approach within this context. We aim to show our experience and evaluate the technical and clinical success of endoscopic treatment performed in the setting of adverse events (AE) after pancreaticoduodenectomy (PD). Methods: This study was conducted on a retrospective cohort of patients presenting biliopancreatic complications after PD from 01/01/2012 to 31/12/2022. All patients underwent ERCP at our Endoscopy Unit. Clinical, instrumental data, and characteristics of endoscopic treatments were collected. Results: 133 patients were included (80 M, mean age = 65 y.o.) with a total of 296 endoscopic procedures (median = 2 procedures/treatment). The indications for ERCP were mainly biliary AE (76 cases, 57.1%). Technical success was obtained in 121 patients of 133 (90.9%). 112 out of 133 (84.2%) obtained clinical success. Nine patients out of 112 (8%) experienced AEs. Clinical success rates were statistically different between patients with biliary or pancreatic disease (93.4% vs 73.6%, p < 0.0001). Septic patients were 38 (28.6%) and showed a worse prognosis than non-septic ones (clinical success: 65.7% vs 91.5%, p = 0.0001). During follow-up, 9 patients (8%), experienced recurrence of the index biliopancreatic disease with a median onset at 20 months (IQR 6–40.1). Conclusion: Our case series demonstrated that the use of a pediatric colonoscope in ERCP procedures for patients with AEs after PD is both safe and effective in treating the condition, even in a long-term follow-up. [ABSTRACT FROM AUTHOR]
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- 2024
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30. Duodeno-ileal diversion with self-forming magnets in a sutureless neodymium anastomosis procedure (SNAP) for weight recidivism after sleeve gastrectomy: feasibility and 9-month results.
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Arau, Roman Turro, Ortega, Antonio, Diez-Caballero, Alberto, Saez, Jose, Mata, Alfredo, Rosinach, Merce, Galvao Neto, Manoel, Teixeira, Andre, Bhandari, Mohit, Brunaldi, Vitor Ottoboni, Vila, Anna, Andres, Sandra, and Perez, Jorge Carlos Espinos
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SMALL intestine injuries , *DUODENUM surgery , *ILEUM surgery , *GASTRECTOMY , *WEIGHT loss , *POSTOPERATIVE care , *WOUNDS & injuries , *PATIENT safety , *LAPAROSCOPY , *DIGESTIVE system endoscopic surgery , *RESEARCH funding , *GASTROINTESTINAL hemorrhage , *ISCHEMIA , *MALNUTRITION , *SURGICAL anastomosis , *PILOT projects , *CLINICAL trials , *INTERVIEWING , *HERNIA , *MINIMALLY invasive procedures , *TREATMENT effectiveness , *DESCRIPTIVE statistics , *LONGITUDINAL method , *SURGICAL complications , *MORBID obesity , *MAGNETS , *COMPARATIVE studies , *WEIGHT gain - Abstract
Background: The sleeve gastrectomy (SG) has become the most common bariatric procedure worldwide. However, insufficient weight loss or weight recidivism is frequent, which may require effective and safe revisional procedures. Objective: To determine the technical feasibility and safety of a minimally invasive, duodeno-ileal side-to-side anastomosis using a Sutureless Neodymium Anastomosis Procedure (SNAP) for patients with weight recidivism or inadequate weight loss following SG. Methods: This is a prospective, single-arm, open-label pilot study that enrolled patients with obesity to assist in weight reduction following an SG performed > 12 months prior. For the SNAP, self-assembling magnets were deployed into the ileum (laparoscopically) and duodenum (per-oral endoscopy). Magnets were coupled under laparoscopic and fluoroscopic guidance to create a compression anastomosis. The primary endpoints were technical feasibility, weight loss, and rate of serious adverse events (SAEs). Results: Successful duodeno-ileal diversions were created with SNAP in 27 participants (mean age: 50.6 ± 9.1, mean BMI: 38.1 ± 4.6 kg/m2) with no device-related serious adverse events. Upper endoscopy at 3 months confirmed patent, healthy anastomoses in all patients. At 9 months, patients (n = 24) experienced 11.9 ± 6.2%, 14.5 ± 10.8%, and 17.0 ± 13.9% TBWL at 3, 6, and 9 months, respectively. There were no device-related SAEs. Conclusion: The SNAP is technically feasible and relatively safe, with all patients presenting widely patent anastomosis at 3 months. Patients experienced a progressive, clinically meaningful weight loss. Further studies are needed to confirm our findings. [ABSTRACT FROM AUTHOR]
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- 2024
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31. Does the pre-conversion platform matter? A comparison of laparoscopic and robotic converted to open colectomies.
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Ma, Rachel, La, Kristina, Xu, Vincent, Solis-Pazmino, Paola, Smiley, Abbas, Barnajian, Moshe, Ellenhorn, Joshua, Wolf, Joshua, and Nasseri, Yosef
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SURGICAL robots , *DATABASES , *SURGERY , *PATIENTS , *LAPAROSCOPIC surgery , *MULTIPLE regression analysis , *MINIMALLY invasive procedures , *TREATMENT effectiveness , *MEDICAL societies , *TREATMENT duration , *DESCRIPTIVE statistics , *ODDS ratio , *SURGICAL complications , *ANALYSIS of variance , *COMPARATIVE studies , *DATA analysis software , *CONFIDENCE intervals , *COLECTOMY , *NOSOLOGY , *EVALUATION - Published
- 2024
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32. Retrospective assessment of short-term outcomes of robotic- versus laparoscopic-assisted duodenal diamond anastomosis in neonates.
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Yang, Si-Si, Lv, Chengjie, Huang, Shoujiang, Tou, Jin-Fa, and Lai, Deng-Ming
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SURGICAL robots , *RESEARCH funding , *T-test (Statistics) , *LAPAROSCOPIC surgery , *SURGICAL anastomosis , *FISHER exact test , *TREATMENT effectiveness , *RETROSPECTIVE studies , *DESCRIPTIVE statistics , *MANN Whitney U Test , *INFECTION , *SURGICAL complications , *MEDICAL records , *ACQUISITION of data , *DUODENAL obstructions , *COMPARATIVE studies , *DATA analysis software , *LENGTH of stay in hospitals , *VOMITING , *MEDICAL care costs , *EVALUATION , *CHILDREN ,DUODENUM abnormalities ,DIGESTIVE organ abnormalities - Abstract
Objective: The purpose of this study was to retrospectively compare the short-term outcomes of robotic- (RAD) and laparoscopic-assisted duodenal diamond-shaped anastomosis (LAD) in neonates. Methods: Neonates who underwent RAD (n = 30) or LAD (n = 38) between January 2019 and December 2022 were analyzed retrospectively. Major patient data were collected, including preoperative, intraoperative, and postoperative information. Results: All patients were neonates below the age of 30 days weighing 4 kg. Thirty (44.1%) neonates underwent RAD and 38 neonates (55.9%) underwent LAD. Compared to the LAD group, the RAD group had a shorter intra-abdominal operation time (RAD, 60.0(50.0 ~ 70.0) min; LAD, 79.9(69.0 ~ 95.3) min; p < 0.001). There were no significant differences in immediate and 30-day complications between the two groups. Conclusions: RAD is safe and effective in neonates. Compared to traditional LAD, RAD showed comparable results. [ABSTRACT FROM AUTHOR]
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- 2024
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33. Birth weight and thoracoscopic approach for patients with esophageal atresia and tracheoesophageal fistula—a retrospective cohort study.
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Borselle, Dominika, Gerus, Sylwester, Bukowska, Monika, and Patkowski, Dariusz
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MORTALITY , *PATIENT safety , *QUALITATIVE research , *RECEIVER operating characteristic curves , *RESEARCH funding , *KRUSKAL-Wallis Test , *FISHER exact test , *RETROSPECTIVE studies , *QUANTITATIVE research , *CHI-squared test , *SURGICAL complications , *ODDS ratio , *THORACOSCOPY , *MEDICAL records , *ACQUISITION of data , *FUNDOPLICATION , *GASTROSTOMY , *BIRTH weight , *COMPARATIVE studies , *CONFIDENCE intervals , *TRACHEAL fistula ,ESOPHAGEAL atresia - Abstract
Background: This study aimed to analyze the results, feasibility and safety of the thoracoscopic approach for patients with esophageal atresia with tracheoesophageal fistula (EA/TEF) depending on the patient's birth weight. Methods: The study involved only type C and D EA/TEF. Among the analyzed parameters were the patients' characteristics, surgical treatment and post-operative complications: early mortality, anastomosis leakage, anastomosis strictures, chylothorax, TEF recurrence, and the need for fundoplication or gastrostomy. Results: 145 consecutive newborns underwent thoracoscopic EA with TEF repair. They were divided into three groups—A (N = 12 with a birth weight < 1500 g), B (N = 23 with a birth weight ≥ 1500 g but < 2000 g), and C—control group (N = 110 with a birth weight ≥ 2000 g). Primary one-stage anastomosis was performed in 11/12 (91.7%) patients—group A, 19/23 (82.6%)—group B and 110 (100%)—group C. Early mortality was 3/12 (25%)—group A, 2/23 (8.7%)—group B, and 2/110 (1.8%)—group C and was not directly related to the surgical repair. There were no significant differences in operative time and the following complications: anastomotic leakage, recurrent TEF, esophageal strictures, and chylothorax. There were no conversions to an open surgery. Fundoplication was required in 0%—group A, 4/21 (19.0%)—group B, and 2/108 (1.9%)—group C survivors. Gastrostomy was performed in 1/9 (11.1%)—group A, 3/21 (14.3%)—group B and 0%—group C. Conclusion: In an experienced surgeon's hands, even in the smallest newborns, the thoracoscopic approach may be safe, feasible, and worthy of consideration. Birth weight seems to be not a direct contraindication to the thoracoscopic approach. [ABSTRACT FROM AUTHOR]
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- 2024
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34. Efficacy and outcomes of per oral plication of the (neo)esophagus (POPE) for impaired emptying in achalasia and post-esophagectomy patients.
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Crafts, Trevor D., Seidel, Henry, Hedberg, Herbert M., Kuchta, Kristine, Carbray, JoAnn, Anderson, Derrius J., Joseph, Stephanie, Rwigema, Jean-Christophe, Ishii, Shun, and Ujiki, Michael B.
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ANTIBIOTICS , *ESOPHAGEAL surgery , *PNEUMONIA , *PATIENT safety , *PATIENT readmissions , *FISHER exact test , *QUESTIONNAIRES , *ENDOSCOPIC surgery , *TREATMENT effectiveness , *RETROSPECTIVE studies , *MANN Whitney U Test , *DESCRIPTIVE statistics , *SURGICAL complications , *QUALITY of life , *MEDICAL records , *ACQUISITION of data , *SUTURING , *REOPERATION , *ESOPHAGEAL achalasia , *LENGTH of stay in hospitals , *PATIENT satisfaction , *DATA analysis software , *ENDOSCOPY , *GASTROPARESIS , *REGRESSION analysis - Abstract
Background: Per-oral plication of the (neo)esophagus (POPE) is an endoscopic procedure used to improve emptying of the defunctionalized esophagus or gastric conduit, with the hope of improving symptoms and quality of life. As this procedure has only been performed in the United States for the past 4 years, safety and efficacy have not been well established. Methods: This is a retrospective case series for patients who underwent POPE from a single institution between 2019 and 2023. Data collected included demographics, preoperative diagnoses and treatments, imaging, endoscopic data, operative intervention, 90-day complications, and response to treatment. Quality of life and patient satisfaction data were collected by phone survey. Results: Seventeen cases were identified, encompassing 13 primary procedures and 4 repeat POPEs (re-POPE). Eight patients had end-stage achalasia and 5 had impaired gastric emptying after esophagectomy with gastric conduits. Median age was 65 years and median ASA was 3, with 38.5% female patients. POPE was performed with 2–6 plication sutures in an average of 75 min. The majority of patients discharged home the same day. For the 17 procedures, there were 4 complications. Two patients required antibiotics for pneumonia, while 4 required procedural intervention. There were no deaths. Preoperative symptoms improved or resolved at initial follow up in 82.3% of patients. Four patients experienced symptom recurrence and required re-POPE, 1 with achalasia and 3 with gastric conduits. Although all achalasia patients had an "end-stage esophagus," none have required esophagectomy since the introduction of POPE. Conclusions: POPE is an endoscopic procedure that is efficacious in relieving emptying difficulties for the end-stage esophagus and gastric conduit. It may obviate the need for esophagectomy or conduit replacement. Also, it can be repeated in select patients. While the risk profile of complications is favorable compared to alternative operations, patients with gastric conduits are at higher risk. [ABSTRACT FROM AUTHOR]
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- 2024
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35. Long-term outcomes of magnetic sphincter augmentation in sleeve gastrectomy and Roux-en-Y gastric bypass patients: a comprehensive analysis.
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Ibrahim, Mina A., Mowoh, Daniel P., Al Khadem, Mai, Abbas, Mujjahid, and Khaitan, Leena
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GASTRECTOMY , *PATIENT compliance , *BARIATRIC surgery , *BIOPSY , *BODY mass index , *DIAGNOSTIC imaging , *MANOMETERS , *DIGESTIVE system endoscopic surgery , *ACADEMIC medical centers , *RESEARCH funding , *QUESTIONNAIRES , *TREATMENT effectiveness , *RETROSPECTIVE studies , *DESCRIPTIVE statistics , *SURGICAL complications , *MEDICAL records , *ACQUISITION of data , *MAGNETS , *DRUGS , *HEALTH outcome assessment , *PROTON pump inhibitors , *OVERWEIGHT persons , *GASTROESOPHAGEAL reflux , *GASTRIC bypass , *ESOPHAGUS , *TIME , *PATIENT aftercare , *ESOPHAGUS diseases , *DEGLUTITION disorders - Abstract
Introduction: Management of gastroesophageal reflux disease after bariatric procedures can be challenging. There are very few long-term studies in this arena. This study aims to evaluate the long-term outcomes of the magnetic sphincter augmentation (MSA) reflux management system in a cohort of bariatric patients who had previously undergone sleeve gastrectomy and Roux-en-Y gastric bypass, with a focus on assessing gastroesophageal reflux disease (GERD) scores, medication use, and patient-reported symptoms. Methods: We conducted a retrospective chart review of 16 consecutive bariatric patients who received MSA implants following sleeve gastrectomy (n = 14) or gastric bypass (n = 2) surgeries. Data were collected regarding BMI, GERD quality of life assessments (GERD-HRQL), reflux symptoms, and use of PPIs in the sleeve/RGB patients through an extended period with a mean follow-up of 48 months. Results: Patients were followed up for a range of.5–84 months. Preoperative assessments included upper gastrointestinal imaging (UGI), high-resolution manometry, Bravo pH studies, and esophagogastroduodenoscopy (EGD). Three patients exhibited reflux on UGI, and 13/13 patients had positive Bravo studies preoperatively. Sixteen patients had a lower esophageal sphincter (LES) pressure under 18 mmHg, and eight patients had biopsy-proven esophagitis. Long-term outcomes are as follows. Daily PPI use fell from 88 to 25% at greater than three years. GERD-HRQL scores fell from 50.6 at baseline (range 27–70) and normalized at long-term follow-up. GERD symptom of regurgitation completely resolved. At long term, two patients had dysphagia and two patients had ongoing reflux. No adverse events were noted. Conclusion: This is the first long-term outcomes study of magnetic sphincter augmentation placement after bariatric surgery. Our study showed the majority of patients had long-term improvement in GERD-HRQL scores and resolution/ relief of their reflux symptoms, with decreased use of PPIs. MSA is a safe, effective and durable management tool for reflux after bariatric surgery in carefully selected patients. [ABSTRACT FROM AUTHOR]
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- 2024
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36. Weight loss after Roux-en-Y gastric bypass and single anastomosis duodenoileostomy following failed sleeve gastrectomy.
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Chae, Ryan, Whitrock, Jenna, Nguyen, Christopher, Price, Adam, Vaysburg, Dennis, Imbus, Joseph, and Colvin, Jennifer
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GASTRECTOMY , *WEIGHT loss , *BODY mass index , *SURGICAL anastomosis , *PATIENT readmissions , *TREATMENT duration , *DESCRIPTIVE statistics , *OPERATIVE surgery , *SURGICAL complications , *ENTEROSTOMY , *TREATMENT failure , *COMPARATIVE studies , *SMALL intestine , *DEMOGRAPHY - Abstract
Objective: While sleeve gastrectomy (SG) results in sustained weight loss for the majority of patients, some will experience inadequate weight loss or weight regain requiring revision. The objective of this study was to evaluate differences in weight loss over time between patients undergoing Roux-en-Y gastric bypass (RYGB) or single anastomosis duodenoileostomy (SADI) after SG. Methods: We queried a single institution's bariatrics registry to identify patients who underwent RYGB or SADI after previous SG over a three-year period. Demographics, operative characteristics, and post-operative complications were evaluated. Interval total body weight loss (TBWL) and excess body weight loss (EBWL) were calculated from available follow-ups within 2 years. Results: We identified 124 patients who underwent conversion to RYGB (n = 61) or SADI (n = 63) following previous SG. There were no differences in sex, age, or medical comorbidities between groups. The median initial BMI was higher in the SADI group (44.9 vs. 41.9 for RYGB, p = 0.03) with greater excess body weight (56.7 vs. 64.3 kg, p = 0.04). The SADI group had a shorter median operative duration (157 vs. 182 min for RYGB, p < 0.01) and lower readmission rates (0 vs. 14.75%, p < 0.01). There was no difference in post-operative complications or need for rehydration therapy between the groups. Among 122 patients (98.4%) that had follow-up weights available, there were no differences in TBWL between groups. RYGB patients had a higher EBWL at 2, 3, and 6 months (p < 0.05 for all comparisons), but there were no differences between RYGB and SADI at 1 or 2 years. Conclusions: Both RYGB and SADI conversions proved effective for further weight loss following failed SG at our academic center. While neither demonstrated clear superiority in long-term (> 1 year) weight loss, RYGB's restrictive gastric pouch may explain its early weight loss advantage. [ABSTRACT FROM AUTHOR]
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- 2024
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37. Ambulatory bariatric surgery: a prospective single-center experience.
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Ali, Abdulaziz Karam, Safar, Ali, Vourtzoumis, Phil, Demyttenaere, Sebastian, Court, Olivier, and Andalib, Amin
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BARIATRIC surgery , *GASTRECTOMY , *AMBULATORY surgery , *BODY mass index , *PATIENT safety , *EMERGENCY room visits , *PATIENT readmissions , *TREATMENT effectiveness , *DISCHARGE planning , *DESCRIPTIVE statistics , *CHI-squared test , *MANN Whitney U Test , *LONGITUDINAL method , *SURGICAL complications , *DISEASES , *RESEARCH methodology , *CONVALESCENCE , *MORBID obesity , *DATA analysis software , *GASTRIC bypass - Abstract
Background: Ambulatory bariatric surgery has recently gained interest especially as a potential way to improve access for eligible patients with severe obesity. Building on our previously published research, this follow-up study delves deeper in the evolving landscape of ambulatory bariatric surgery over a 3-year period, focusing on predictors of success/failure. Methods: In a prospective single-center follow-up study, we conducted a descriptive assessment of all eligible patients as per our established protocol, who underwent a planned same-day discharge (SDD) primary sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) between 03/01/2021 and 02/29/2024. Trends in SDD surgeries over time were assessed over six discrete 6 month intervals. Primary endpoint was defined as a successful discharge on the day of surgery without emergency department visit or readmission within 24 h. Secondary outcomes included 30-day postoperative morbidity. Results: A total of 811 primary SG and 325 RYGB procedures were performed during the study period. Among them, 30% (n = 244) were SDD-SGs and 6% (n = 21) were SDD-RYGBs, respectively. At baseline, median age of the entire SDD cohort was 43 years old, 81% were females, and body mass index (BMI) was 44.5 kg/m2. The planned SDD approach was successful in 89% after SG (n = 218/244) and in 90% after RYGB (n = 19/21). Nausea/vomiting was the main reason for a failed SDD approach after SG (46%). The 30-day readmission rate was 1.5% (n = 4) for the entire SDD cohort including only one readmission in the first 24 h. The percentage of SDD-SGs performed as a proportion of total SGs increased over the initial five consecutive six-month intervals (14%, 25%, 24%, 38%, and 49%). Conclusion: Our SDD protocol for bariatric surgery demonstrates a favorable safety profile, marked by high success rate and low postoperative morbidity. These outcomes have led to a continued increase in ambulatory procedures performed over time especially SG. [ABSTRACT FROM AUTHOR]
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- 2024
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38. Increased staple line leak rates following re-sleeve: analysis comparing re-sleeve versus Roux-en-Y gastric bypass conversion and primary sleeve gastrectomy.
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Cornejo, Jorge, Zevallos, Alba, Sarmiento, Joaquin, Shojaeian, Fatemeh, Mokhtari-Esbuie, Farzad, Adrales, Gina, Li, Christina, and Sebastian, Raul
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GASTRECTOMY , *PEARSON correlation (Statistics) , *T-test (Statistics) , *DATA analysis , *SURGICAL anastomosis , *FISHER exact test , *PROBABILITY theory , *PATIENT readmissions , *VEINS , *MINIMALLY invasive procedures , *MANN Whitney U Test , *DESCRIPTIVE statistics , *SURGICAL complications , *LONGITUDINAL method , *STATISTICS , *REOPERATION , *THROMBOEMBOLISM , *DATA analysis software , *SMALL intestine , *GASTRIC bypass - Abstract
Background: Sleeve gastrectomy is the most common bariatric procedure and its long-term complications include inadequate weight loss, weight regain, and de novo GERD, often requiring revisional surgery. Revisions, notably re-sleeve and conversion to Roux-en-Y gastric bypass (RYGB), are frequently performed, but safety data is limited. Herein, we used the MBSAQIP database to compare 30 day outcomes of primary sleeve gastrectomy (SG) with re-sleeve (RS) and SG to RYGB conversion. Methods: Patients who underwent primary SG, RS, and SG to RYGB conversion within the MBSAQIP data registry from January 1, 2020 to December 31, 2022 were included in this study. Using Propensity Score Matching analysis, the cohorts were matched for 23 preoperative characteristics. We then compared 30 day postoperative outcomes and bariatric-specific complications between primary SG and RS (analysis 1) and between RS and SG to RYGB conversion (analysis 2). Results: A total of 302,961 were included. The matched cohorts in analysis 1 (n = 1630) and analysis 2 (n = 1633) had similar pre-operative characteristics. Propensity-matched outcomes in analysis 1 showed that patients in the RS group had significantly higher staple line leak (1.3% vs. 0.1%, p < 0.001) when compared to primary SG. Similarly, longer operative times (90.16 ± 51.90 min vs. 68.32 ± 37.54 min, p < 0.001) and higher rates of readmissions (5.5% vs. 2.1%, p < 0.001), reoperations (2.3% vs. 0.6%, p < 0.001), interventions (2.5% vs. 0.4%, p < 0.001) were found in those who underwent RS. In analysis 2, RS showed higher leak rates (1.3% vs. 0.5%, p = 0.015) when compared to conversion from SG to RYGB. Conclusion: The RS group has a higher risk of staple line leaks compared to primary SG and conversion from SG to RYGB. In our study, there was a 2.6-fold increase in staple line leak after re-sleeve compared to RYGB conversion and a 13-fold increase compared to primary SG. [ABSTRACT FROM AUTHOR]
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- 2024
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39. Impact of Toupet fundoplication with bougie on post-operative dysphagia and quality of life.
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Anderson, Derrius J., Kuchta, Kristine, Joseph, Stephanie, Rwigema, Jean-Christophe, Crafts, Trevor, Ishii, Shun, Hedberg, H. Mason, and Ujiki, Michael B.
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SURGERY , *PATIENTS , *T-test (Statistics) , *ESOPHAGEAL perforation , *LAPAROSCOPIC surgery , *TREATMENT effectiveness , *RETROSPECTIVE studies , *DESCRIPTIVE statistics , *MANN Whitney U Test , *SURGICAL equipment , *SURGICAL complications , *FUNDOPLICATION , *QUALITY of life , *DATA analysis software , *DEGLUTITION disorders , *GASTROESOPHAGEAL reflux , *DISEASE risk factors - Abstract
Introduction: Numerous studies comment on quality of life outcomes comparing complete and partial fundoplication with or without a bougie. Society guidelines are moving toward recommending partial fundoplication over complete fundoplication due to improved side effect profile with similar outcomes. Retrospective studies and randomized trials have elucidated that use of a bougie during Nissen fundoplication does impact long-term dysphagia. To date there are no retrospective or prospective data that guide practice for partial fundoplications. Objective: The purpose of this project is to investigate the clinical implications of using a bougie for Toupet fundoplication with regard to short-term and long-term dysphagia and need for further therapeutic interventions. Methods: A retrospective review of a prospectively maintained gastroesophageal database was performed. Demographic, pre-operative quality of life outcomes data, perioperative, and post-operative quality of life outcomes data of 373 patients from 2011 to 2022 undergoing Toupet fundoplication without bougie or with a traditional Savary 56Fr or 58Fr bougie were reviewed. The two groups were compared using student's t-test to identify statically significant differences between the groups. Results: Between 2011 and 2022, 373 patients underwent Toupet fundoplication (276 with traditional bougie, 97 without). Median follow-up in the bougie group was 19 months, versus 9 months in the non bougie group. There was no difference between early (3 weeks) and late dysphagia scores (6 months). In the bougie group there were two mucosal perforations due to the bougie. There were no statistically significant differences in GERD-HRQL, gas bloat, and dysphagia scores between groups at one year. Conclusion: There is no difference observed in early or late dysphagia scores, GERD-HRQL, gas bloat or need for dilation in patients undergoing Toupet fundoplication with or without a traditional bougie. It is reasonable to discontinue the use of a traditional bougie during Toupet fundoplication, especially due to risk of esophageal perforation. [ABSTRACT FROM AUTHOR]
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- 2024
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40. Safety and efficacy of robotic anti-reflux surgery in geriatric patients: a comparative analysis.
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Marshall, Teagan E., Alqamish, Maria, Salehi, Niloufar, Al Asadi, Hala, Lee-Saxton, Yeon J., Tumati, Abhinay, Greenspun, Benjamin, Finnerty, Brendan M., Fahey III, Thomas J., and Zarnegar, Rasa
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SURGICAL robots , *RISK assessment , *BARIATRIC surgery , *SURGERY , *PATIENTS , *RESEARCH funding , *PATIENT readmissions , *QUESTIONNAIRES , *HERNIA , *TREATMENT effectiveness , *RETROSPECTIVE studies , *SURGICAL therapeutics , *DESCRIPTIVE statistics , *MANN Whitney U Test , *SURGICAL complications , *LONGITUDINAL method , *STOMACH surgery , *ROBOTICS , *GERIATRIC assessment , *REOPERATION , *FUNDOPLICATION , *QUALITY of life , *LENGTH of stay in hospitals , *COMPARATIVE studies , *DATA analysis software , *GASTROESOPHAGEAL reflux , *COMORBIDITY , *DISEASE risk factors , *OLD age - Abstract
Introduction: As our population ages, older adults are being considered for anti-reflux surgery (ARS). Geriatric patients typically have heightened surgical risk, and literature has shown mixed results regarding postoperative outcomes. We sought to evaluate the safety and efficacy of robotic ARS in the geriatric population. Methods: We conducted a single-institution review of ARS procedures performed between 2009 and 2023. Patients ≥ 65 were assigned to the geriatric cohort. We compared operative details, lengths of stay (LOS), readmissions, reoperations, and complications between the two cohorts. The gastroesophageal reflux disease health-related quality of life (GERD-HRQL) survey and review of clinic notes were used to evaluate ARS efficacy. Results: 628 patients were included, with 190 in the geriatric cohort. This cohort had a higher frequency of diabetes (16.3% vs 5.9% p < 0.0001), hypertension (50.0% vs 21.5% p < 0.0001), and heart disease (17.9% vs 2.3% p < 0.0001). Geriatric patients were more likely to exhibit hiatal hernias on imaging (51.6% vs 34.2% p < 0.0001) and were more likely to have large hernias (30.0% vs 7.1% p < 0.0001). Older adults were more likely to undergo Toupet fundoplications (58.4% vs 41.3%, p < 0.0001), Collis gastroplasties (9.5% vs 2.7% p < 0.0001), and relaxing incisions (11.6% vs 1.4% p < 0.0001). Operative time was longer for geriatric patients (132.0 min vs 104.5 min p < 0.0001). There were no significant differences in LOS, readmissions, or reoperations between cohorts. Geriatric patients exhibited lower rates of complications (7.4% vs. 14.6%, p = 0.011), but similar complication grades. Both groups had significant reduction in symptom scores from preoperative values. There were no significant differences in the reported symptoms between cohorts at any follow-up timepoint. Conclusion: Geriatric robotic ARS patients tend to do as well as younger adults regarding postoperative and symptomatic outcomes, despite presenting with larger hiatal hernias and shorter esophagi. Clinicians should be aware of possible need for lengthening procedures or relaxing incisions in this population. [ABSTRACT FROM AUTHOR]
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- 2024
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41. Perioperative impact of liver cirrhosis on robotic liver resection for hepatocellular carcinoma: a retrospective cohort study.
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Song, Shaoming, Wang, Zizheng, Liu, Kai, Zhang, Xiuping, Zhang, Gong, Zeng, Guineng, Zhu, Lin, Yao, Zhiyuan, Hu, Minggen, Wang, Zhaohai, and Liu, Rong
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SURGICAL robots , *RISK assessment , *POSTOPERATIVE care , *CIRRHOSIS of the liver , *PATIENT safety , *SURGERY , *PATIENTS , *RESEARCH funding , *T-test (Statistics) , *RECEIVER operating characteristic curves , *MULTIPLE regression analysis , *FISHER exact test , *PILOT projects , *SEVERITY of illness index , *TREATMENT effectiveness , *RETROSPECTIVE studies , *CANCER patients , *MULTIVARIATE analysis , *SURGICAL therapeutics , *SURGICAL blood loss , *HOSPITALS , *CHI-squared test , *MANN Whitney U Test , *DESCRIPTIVE statistics , *SURGICAL complications , *LONGITUDINAL method , *ODDS ratio , *MEDICAL records , *ACQUISITION of data , *STATISTICS , *HEPATECTOMY , *COMPARATIVE studies , *LENGTH of stay in hospitals , *BLOOD transfusion , *DATA analysis software , *CALIBRATION , *CONFIDENCE intervals , *PERIOPERATIVE care , *HEPATOCELLULAR carcinoma , *SENSITIVITY & specificity (Statistics) , *DISEASE risk factors , *DISEASE complications - Abstract
Background: The safety and efficacy of robotic liver resection (RLR) for patients with hepatocellular carcinoma (HCC) have been reported worldwide. However, the exact role of RLR in HCC patients with liver cirrhosis is not sufficiently determined. Methods: We conducted a retrospective study on consecutive patients with cirrhosis or non-cirrhosis who received RLR for HCC from 2018 to 2023. Data on patients' demographics and perioperative outcomes were collected and analyzed. Propensity score matching (PSM) analysis was performed. Multivariate logistic regression analysis was performed to determine the risk factors of prolonged postoperative length of stay (LOS) and morbidity. Results: Of the 571 patients included, 364 (64%) had cirrhosis. Among the cirrhotic patients, 48 (13%) were classified as Child–Pugh B. After PSM, the cirrhosis and non-cirrhosis group (n = 183) had similar operative time, estimated blood loss, postoperative blood transfusion, LOS, overall morbidity (p > 0.05). In addition, the intraoperative and postoperative outcomes were similar between the two groups in the subgroup analyses of patients with tumor size ≥ 5 cm, major hepatectomy, and high/expert IWATE difficulty grade. However, patients with Child–Pugh B cirrhosis had longer LOS and more overall morbidity than that of Child–Pugh A. Child–Pugh B cirrhosis, ASA score > 2, longer operative time, and multiple tumors were risk factors of prolonged LOS or morbidity in patients with cirrhosis. Conclusion: The presence of Child–Pugh A cirrhosis didn't significantly influence the difficulty and perioperative outcomes of RLR for selected patients with HCC. However, even in high-volume center, Child–Pugh B cirrhosis was a risk factor for poor postoperative outcomes. [ABSTRACT FROM AUTHOR]
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- 2024
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42. Prophylactic pancreatic duct stenting to reduce the risk of post-ampullectomy pancreatitis: a comprehensive review and meta-analysis of 1858 patients.
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Chandan, Saurabh, Canakis, Andrew, Deliwala, Smit, Frohlinger, Michael, Khan, Shahab R., Mohan, Babu P., Dahiya, Dushyant S., Ramai, Daryl, Facciorusso, Antonio, Sharma, Neil R., Adler, Douglas G., and Kochhar, Gursimran S.
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DUODENUM surgery , *MEDICAL information storage & retrieval systems , *PANCREATIC duct , *META-analysis , *SURGICAL complications , *PANCREATITIS , *SYSTEMATIC reviews , *MEDLINE , *ONLINE information services , *CONFIDENCE intervals - Abstract
Background: The effectiveness of prophylactic pancreatic duct stenting (PPDS) in preventing post-ampullectomy pancreatitis (PAP) at the time of endoscopic ampullectomy (EA) has been reported, however, results are conflicting. We conducted a systematic review and meta-analysis looking at the use of PPDS in reducing PAP as well as overall post-ampullectomy complications. Methods: Multiple databases were searched through May 2023 for studies reporting on EA. Meta-analysis was performed to determine pooled proportions and relative risk (RR) with 95% confidence intervals (CI) of PAP, with and without PPDS. Pooled rates of adverse events including perforation, delayed bleeding, cholangitis, and procedure related mortality were assessed. Random effects model was used for our meta-analysis and heterogeneity was assessed using the I2 statistics. Results: Thirty-four studies (14 case series, 18 cohort studies and 2 randomized controlled trials) with 1868 patients were included. The overall pooled rate of PAP was 12.3% (CI 10.3–14.5). We found no statistically significant difference in rates of PAP among patients with PPDS, 11.9% (CI 8.9–15.7) and without PPDS, 16.6% (CI 13.4–20.4), RR 0.8 (CI 0.51–1.28), p = 0.4. In terms of severe PAP, we found no difference between the two groups. The overall pooled rates of successful en-bloc and piecemeal resection were 74.8% (CI 67.3–81.1) and 25.1% (CI 19–32.4). Additionally, pooled rates of ampullary stenosis, post procedural bleeding, perforation, cholangitis, and procedure related mortality were 3.6%, 11.1%, 4.2%, 3.5%, and 1.3%, respectively. Conclusions: Our analysis shows that PPDS at the time of EA does not offer a significant protective effect against PAP. While the incidence of PAP was higher among the no PPDS group, it is plausible that this is more likely due to variation among studies in terms of lesion size, length/size of pancreatic stent used and etiology of ampullary lesions. Future well-designed randomized controlled trials are needed to validate our findings. [ABSTRACT FROM AUTHOR]
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- 2024
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43. Impact of hypoalbuminemia on outcomes following pancreaticoduodenectomy: a NSQIP retrospective cohort analysis of 25,848 patients.
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Sawchuk, Taylor, Verhoeff, Kevin, Jogiat, Uzair, Mocanu, Valentin, Shapiro, A. M. James, Anderson, Blaire, Dajani, Khaled, and Bigam, David L.
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RISK assessment , *PREOPERATIVE period , *GOODNESS-of-fit tests , *BODY mass index , *RECEIVER operating characteristic curves , *MULTIPLE regression analysis , *SEX distribution , *SMOKING , *QUESTIONNAIRES , *BLOOD protein disorders , *TREATMENT effectiveness , *RETROSPECTIVE studies , *DESCRIPTIVE statistics , *DISEASE prevalence , *AGE distribution , *PANCREATICODUODENECTOMY , *SURGICAL complications , *LONGITUDINAL method , *ODDS ratio , *MEDICAL records , *ACQUISITION of data , *ANALYSIS of variance , *STATISTICS , *ALBUMINS , *CONFIDENCE intervals , *COMORBIDITY , *DISEASE risk factors ,MORTALITY risk factors - Abstract
Background: Efforts to preoperatively risk stratify and optimize patients before pancreaticoduodenectomy continue to improve outcomes. This study aims to determine the impact of hypoalbuminemia on outcomes following pancreaticoduodenectomy and outline optimal hypoalbuminemia cut-off values in this population. Methods: The ACS-NSQIP (2016–2021) database was used to extract patients who underwent pancreaticoduodenectomy, comparing those with hypoalbuminemia (< 3.0 g/L) to those with normal albumin. Demographics and 30-day outcomes were compared. Multivariable modeling evaluated factors including hypoalbuminemia to characterize their independent effect on serious complications, and mortality. Optimal albumin cut-offs for serious complications and mortality were evaluated using receiver-operating characteristic curves. Results: We evaluated 25,848 pancreaticoduodenectomy patients with 2712 (10.5%) having preoperative hypoalbuminemia. Patients with hypoalbuminemia were older (68.2 vs. 65.1; p < 0.0001), and were significantly more likely to be ASA class 4 or higher (13.9% vs. 6.7%; p < 0.0001). Patients with hypoalbuminemia had significantly more 30-day complications and after controlling for comorbidities hypoalbuminemia remained a significant independent factor associated with 30-day serious complications (OR 1.80, p < 0.0001) but not mortality (OR 1.37, p = 0.152). Conclusions: Hypoalbuminemia plays a significant role in 30-day morbidity following pancreaticoduodenectomy. Preoperative albumin may serve as a useful marker for risk stratification and optimization. [ABSTRACT FROM AUTHOR]
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- 2024
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44. The learning curve of laparoscopic splenectomy and esophagogastric devascularization for portal hypertension with 10-year follow-up.
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Wang, Dong, Chen, Xiao, Lv, Ling, Yang, Tao, Huang, Bo, Cao, Yanlong, Zhang, Yong, Lu, Jianguo, and Yin, Jikai
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ESOPHAGEAL varices , *T-test (Statistics) , *RESEARCH funding , *PORTAL hypertension , *LAPAROSCOPIC surgery , *COMPUTED tomography , *FISHER exact test , *RETROSPECTIVE studies , *SURGICAL blood loss , *TREATMENT effectiveness , *MANN Whitney U Test , *CHI-squared test , *DESCRIPTIVE statistics , *SURGICAL complications , *LOG-rank test , *SPLENECTOMY , *DATA analysis software , *OVERALL survival , *ABDOMINAL radiography , *PATIENT aftercare - Abstract
Introduction and objectives: Laparoscopic splenectomy and esophagogastric devascularization (LSED) are minimally invasive, effective, and safe in treating esophageal-fundic variceal bleeding with portal hypertension (PHT). The study aimed to assess the learning curve of LSED by cumulative summation (CUSUM) analysis. The 10-year follow-up data for LSED and open surgery were also examined. Patients and methods: Five hundred and ninety-four patients were retrospectively analyzed. Operation time, intraoperative blood loss, open operation conversion, and postoperative complications were selected as the evaluation indicators of surgical ability. The learning curve of LESD was assessed by the CUSUM approach. Patient features, perioperative indices, and 10-year follow-up data were examined. Results: Totally 236 patients underwent open surgery, and 358 underwent LSED. Patient characteristics were similar between groups. The LSED patients experienced less intraoperative blood loss, fewer complications, and faster recovery compared to the open surgery cohort. The learning curve of LESD was maximal for a case number of 50. Preoperative general characteristics were comparable for both stages. But the skilled stage had decreased operation time, reduced blood loss, less postoperative complications, and better recovery compared to the learning stage. The LSED group had higher recurrent hemorrhage-free survival rate and increased overall survival in comparison with cases administered open surgery in the 10-year follow-up. Free-liver cancer rates were similar between two groups. Conclusions: About 50 cases are needed to master the LSED procedure. Compared to open surgery, LSED is a safer, feasible, and safe procedure for PHT patients, correlating with decreased rebleeding rate and better overall survival. [ABSTRACT FROM AUTHOR]
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- 2024
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45. Indocyanine green fluorescence perfusion testing in robot-assisted hepatic arterial infusion pump placement.
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van Dorst, Roderick W. J. J., Ten Haaft, Britte H. E. A., Franssen, Stijn, Borel Rinkes, Inne H. M., Groot Koerkamp, Bas, Swijnenburg, Rutger-Jan, and Hagendoorn, Jeroen
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SURGICAL robots , *FLUORESCENT dyes , *LIVER tumors , *METHYLENE blue , *RETROSPECTIVE studies , *INDOLE compounds , *DRUG infusion pumps , *CANCER chemotherapy , *SURGICAL complications , *INTRA-arterial infusions , *LENGTH of stay in hospitals , *RADIONUCLIDE imaging , *VIDEO recording ,HEPATIC artery surgery - Abstract
Background: Hepatic arterial infusion pump (HAIP) treatment is a technique used to treat liver localized malignancy with intra-arterial chemotherapy. Methylene blue is generally administered to verify hepatic perfusion and exclude inadvertent extrahepatic perfusion. The use of indocyanine green dye (ICG) combined with near-infrared (NIR) fluorescence imaging during robot-assisted HAIP placement may be an attractive alternative by providing high contrast without blue discoloration of the operative field. Methods: Data was collected retrospectively from 2 centers in the Netherlands. Intraoperative perfusion of the liver segments and extrahepatic perfusion were assessed using ICG/NIR as well as methylene blue on video imaging and correlated to postoperative 99 m-Tc perfusion scintigraphy. Results: 13 patients underwent robot-assisted surgery for HAIP placement; median length of stay was 4 days, complications occurred in 4 patients. Hepatic perfusion showed identical patterns when ICG was compared with methylene blue. In 1 patient, additional extrahepatic perfusion was found using ICG, leading to further vessel ligation. Intraoperative ICG perfusion was concordant with 99 m-Tc perfusion scintigraphy. Discussion: Liver and extrahepatic perfusion determined by ICG fluorescence imaging is concordant with blue dye perfusion and 99 m-Tc perfusion scintigraphy. Therefore, ICG fluorescence imaging is deemed a safe and reliable technique for perfusion testing during robot-assisted HAIP placement. [ABSTRACT FROM AUTHOR]
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- 2024
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46. Anastomotic tension "Bridging": a risk factor for anastomotic leakage following low anterior resection.
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Ito, Ryogo, Matsubara, Hideo, Shimizu, Ryoichi, Maehata, Takahiro, Miura, Yasutomo, Uji, Masahito, and Mokuno, Yasuji
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COLON surgery , *RECTAL diseases , *ABDOMINOPERINEAL resection , *STATISTICAL correlation , *STAPLERS (Surgery) , *SURGICAL anastomosis , *LAPAROSCOPIC surgery , *FISHER exact test , *MULTIPLE regression analysis , *RETROSPECTIVE studies , *MULTIVARIATE analysis , *MANN Whitney U Test , *DESCRIPTIVE statistics , *SURGICAL complications , *ODDS ratio , *MEDICAL records , *ACQUISITION of data , *ELECTRONIC health records , *STATISTICS , *RESEARCH , *CONFIDENCE intervals , *DATA analysis software , *DISEASE incidence , *DISEASE risk factors ,RECTUM tumors - Abstract
Background: Excessive tension at the anastomosis contributes to anastomotic leakage (AL) in low anterior resection (LAR). However, the specific tension has not been measured. We assessed whether "Bridging," characterized by the proximal colon resembling a suspension bridge above the pelvic floor, is a significant risk factor for AL following LAR for rectal cancer. Methods: This retrospective study reviewed the medical records and laparoscopic videos of 102 patients who underwent laparoscopic LAR using the double stapling technique at Yachiyo Hospital between January 2014 and December 2023. Patients were classified based on whether they had Bridging (tight or sagging) or were in a Resting state of the proximal colon, and the association between Bridging and AL was examined. Results: AL occurred in 31.3% of the Tight Bridging group, 20% of the Sagging Bridging group, and 2.2% of the Resting group (P = 0.002). The incidence of AL was significantly higher in patients with Bridging than in those without (23.2% vs. 2.2%, P = 0.003). Multivariate analysis revealed that Bridging is an independent risk factor for AL (odds ratio = 6.97; 95% confidence interval: 1.45–33.6; P = 0.016). Conclusions: The presence of Bridging is a significant risk factor for AL following LAR for rectal cancer, suggesting the need for implementing preventive measures in patients with this condition. [ABSTRACT FROM AUTHOR]
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- 2024
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47. Safety of robotic cholecystectomy as index training procedure: the UK experience.
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Stefanova, Irena, Alkhatib, Omar, Sheel, Andrea, Alabraba, Edward, Alibrahim, Mohammad, Arshad, Ali, Awan, Altaf, Baron, Ryan, Bhatti, Imran, Bhogal, Ricky, Dhakshinamoorthy, Vijayanand, Diaz-Nieto, Rafael, Dunne, Declan, Frampton, Adam E., Green, Alexander, Hajibandeh, Shahin, Hamady, Zaed, Horgan, Liam, Kissane, Eleanor, and Krishnan, Sailakshmi
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SURGICAL robots , *SCIENTIFIC observation , *CHOLECYSTECTOMY , *RETROSPECTIVE studies , *TREATMENT effectiveness , *DESCRIPTIVE statistics , *GALLBLADDER diseases , *PANCREATITIS , *SURGICAL complications , *MEDICAL records , *ACQUISITION of data , *RESEARCH , *DATA analysis software , *CHOLECYSTITIS - Abstract
Aims: To evaluate the safety profile of robotic cholecystectomy performed within the United Kingdom (UK) Robotic Hepatopancreatobiliary (HPB) training programme. Methods: A retrospective evaluation of prospectively collected data from eleven centres participating in the UK Robotic HPB training programme was conducted. All adult patients undergoing robotic cholecystectomy for symptomatic gallstone disease or gallbladder polyp were considered. Bile duct injury, conversion to open procedure, conversion to subtotal cholecystectomy, length of hospital stay, 30-day re-admission, and post-operative complications were the evaluated outcome parameters. Results: A total of 600 patients were included. The median age was 53 (IQR 65–41) years and the majority (72.7%; 436/600) were female. The main indications for robotic cholecystectomy were biliary colic (55.5%, 333/600), cholecystitis (18.8%, 113/600), gallbladder polyps (7.7%, 46/600), and pancreatitis (6.2%, 37/600). The median length of stay was 0 (IQR 0–1) days. Of the included patients, 88.5% (531/600) were discharged on the day of procedure with 30-day re-admission rate of 5.5% (33/600). There were no bile duct injuries and the rate of conversion to open was 0.8% (5/600) with subtotal cholecystectomy rate of 0.8% (5/600). Conclusion: The current study confirms that robotic cholecystectomy can be safely implemented to routine practice with a low risk of bile duct injury, low bile leak rate, low conversion to open surgery, and low need for subtotal cholecystectomy. [ABSTRACT FROM AUTHOR]
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- 2024
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48. Total RAMIE with three-field lymph node dissection by a simultaneous two-team approach using a new docking method for esophageal cancer.
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Sato, Kazuma, Fujita, Takeo, Otomo, Mayuko, Shigeno, Takashi, Kajiyama, Daisuke, Fujiwara, Naoto, and Daiko, Hiroyuki
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SURGICAL robots , *PNEUMONIA , *LYMPHADENECTOMY , *PATIENT safety , *SURGICAL wound dehiscence , *SCIENTIFIC observation , *ESOPHAGEAL tumors , *TREATMENT effectiveness , *CANCER patients , *RETROSPECTIVE studies , *SURGICAL therapeutics , *SURGICAL blood loss , *DESCRIPTIVE statistics , *SURGICAL complications , *POSTOPERATIVE period , *LENGTH of stay in hospitals , *TIME , *PARALYSIS ,DIGESTIVE organ surgery ,VOCAL cord diseases - Abstract
Background: Thoracic esophageal cancer surgery using robotic approaches for the thoracic and abdominal parts has recently been reported as total robot-assisted minimally invasive esophagectomy (RAMIE). We herein present the first report of a new technique for esophageal cancer: total RAMIE with three-field lymph node dissection (3FLND) by a simultaneous two-team approach using a new docking method. Methods: We reviewed 20 patients who underwent total RAMIE with 3FLND by a simultaneous two-team approach at the National Cancer Center East Hospital from March 2023 to September 2023. Short-term surgical outcomes and the safety and efficacy of this technique were analyzed. Results: The mean operative time for abdominal surgery with this new docking technique was 135 ± 19.6 min. The total operative time was 488 ± 42.9 min, and the time from the end of abdominal manipulation to the end of surgery was 80.1 ± 15.6 min. The intraoperative blood loss was 116.7 ± 64.4 mL. The incidence of anastomotic leakage, postoperative vocal cord paralysis, and postoperative pneumonia was 10%, 5%, and 10%, respectively. The median postoperative hospital stay was 14 days (range 11–63 days). No in-hospital deaths occurred, and R0 resection was possible in all cases. The average number of lymph nodes dissected was 87.7. Conclusion: These results demonstrate that total RAMIE with a simultaneous two-team approach using the new docking method can be safely introduced. The simultaneous cervical and abdominal manipulation with the new docking method allowed total RAMIE without prolonging the operating time, suggesting that it may be a valuable approach for esophageal cancer surgery. [ABSTRACT FROM AUTHOR]
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- 2024
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49. Unsedated colonoscopy utilizing virtual reality distraction: a pilot-controlled study.
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Veisman, Ido, Tardio Duchan, Moran, Lahat, Adi, Goldenfeld, Miki, Ukashi, Offir, Laish, Ido, Lang, Alon, Albshesh, Ahmad, Margalit Yehuda, Reuma, Senderowich, Yuval, Livne Margolin, Moran, Yablecovitch, Doron, Dvir, Revital, Neuman, Sandra, Ben-Horin, Shomron, and Levy, Idan
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VIRTUAL reality equipment , *PAIN measurement , *T-test (Statistics) , *CLINICAL trials , *PILOT projects , *FISHER exact test , *TREATMENT duration , *DESCRIPTIVE statistics , *MANN Whitney U Test , *VIRTUAL reality , *ANALGESICS , *COLON polyps , *SURGICAL complications , *DISTRACTION , *ANESTHETICS , *CONVALESCENCE , *PAIN , *PATIENT satisfaction , *LENGTH of stay in hospitals , *DATA analysis software , *SYSTOLIC blood pressure , *COLONOSCOPY , *ANESTHESIA , *RELAXATION techniques , *TIME , *ACTIVITIES of daily living - Abstract
Background: Sedation increases colonoscopy risks and prolongs recovery time. We examined whether virtual reality (VR) can substitute for sedation. The primary outcome was the overall satisfaction of patients who underwent colonoscopy with VR headset compared with patients who underwent standard sedation. Pain during the procedure, polyp detection rate (PDR), colonoscopy duration, post-colonoscopy adverse events, post-colonoscopy recovery, time-to-return to daily functions, and turnaround time at the endoscopy unit were secondary outcomes. Methods: The study was approved by Sheba Medical Center's ethics committee IRB number 21-8177-SMC. Sixty patients were sequentially enrolled in a 1:1 ratio to either standard sedated colonoscopy or VR-unsedated procedure, and all patients signed a written informed consent. 28/30 patients successfully completed the colonoscopy using VR headset. Overall satisfaction score was comparable between the groups. Results: There was no difference between VR and controls in colonoscopy duration, or PDR. VR patients had numerically lower rate of post-colonoscopy adverse events than controls. The proportion of VR patients who reported resuming daily activities on the day of the procedure was significantly higher than in the control group. The VR group patients spent significantly less time in the hospital compared to the control group. Conclusions: VR technology can provide adequate substitution for sedation for most patients undergoing colonoscopy and offers comparable patient satisfaction and faster return to daily activities. [ABSTRACT FROM AUTHOR]
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- 2024
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50. Benefits and risks of using laparoscopic ultrasonography versus intraoperative cholangiography during laparoscopic cholecystectomy for gallstone disease: a systematic review and meta-analysis.
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Edebo, Anders, Andersson, John, Gustavsson, Joss, Jivegård, Lennart, Ribokas, Darius, Svanberg, Therese, and Wallerstedt, Susanna M.
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CHOLANGIOGRAPHY , *MEDICAL information storage & retrieval systems , *MORTALITY , *LAPAROSCOPIC surgery , *CHOLECYSTECTOMY , *ULTRASONIC imaging , *TREATMENT effectiveness , *META-analysis , *DESCRIPTIVE statistics , *SURGICAL complications , *SYSTEMATIC reviews , *MEDLINE , *MEDICAL databases , *ONLINE information services , *CONFIDENCE intervals , *TREATMENT failure , *DATA analysis software , *GALLSTONES , *BILE ducts , *TIME - Abstract
Background: Intraoperative laparoscopic ultrasonography (LUS) or intraoperative cholangiography (IOC) can be used for visualisation of the biliary tract during laparoscopic cholecystectomy. The aim of this systematic review was to compare use of LUS with IOC. Methods: PubMed, Embase, the Cochrane Library, and Web of Science were searched (last update: April 2024). PICO: P = patients undergoing intraoperative imaging of the biliary tree during laparoscopic cholecystectomy for gallstone disease; I = intervention: LUS; C = comparison: IOC; O = outcomes: mortality, bile duct injury, retained gallstone, conversion to open cholecystectomy, procedural failure, operation time including imaging time. Included articles were critically appraised using checklists. Conclusions were based on studies without major risk of bias. Meta-analyses were performed using random effects models. Certainty of evidence was assessed according to GRADE. Results: Sixteen non-randomised studies met the PICO. Two before/after studies (594 versus 807 patients) contributed to conclusions regarding mortality (no events; very low certainty evidence), bile duct injury (1 versus 0 events; very low certainty evidence), retained gallstone (2 versus 2 events; very low certainty evidence), and conversion to open cholecystectomy (6 versus 21 events; risk ratio: 0.38 (95% confidence interval: 0.15–0.95); I2 = 0%; low certainty evidence). Seven additional studies, using intra-individual comparisons, contributed to conclusions regarding procedural failure; risk ratio: 1.12 (95% confidence interval: 0.70–1.78; I2 = 83%; very low certainty evidence). No studies reported operation time. Mean imaging time for LUS and IOC, reported in 12 studies, was 4.8‒10.2 versus 10.9‒17.9 min (mean difference: − 7.8 min (95% confidence interval: − 9.3 to − 6.3); I2 = 95%; moderate certainty evidence). Conclusion: It is uncertain whether there is any difference in mortality/bile duct injury/retained gallstone using LUS compared with IOC, but LUS may be associated with fewer conversions to open cholecystectomy and is probably associated with shorter imaging time. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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