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The American Surgeon Nov 2023To analyze the risk and benefit of bowel preparations in elective colo-rectal surgery.
OBJECTIVE
To analyze the risk and benefit of bowel preparations in elective colo-rectal surgery.
BACKGROUND
Mechanical bowel preparations (MBPs) have been popularized in colo-rectal surgery since studies in the 1970s, but recent data has called their use into question and examined complication rates between patients with and without bowel preparations.
METHODS
A retrospective case-review was performed consisting of 1237 elective colo-rectal surgeries performed by two surgeons between 2008 and 2021. Patients received either a MBP, a mechanical bowel preparation with oral antibiotics (OAMBP), oral antibiotics alone (OA), or no bowel preparation; some patients across all categories received an enema.
RESULTS
Bowel preparations combined (MBP and OAMBP) totaled 436 patients and showed no statistically significant difference ( > .05) in primary outcomes of wound infection and anastomotic leak when compared to the 636 patients without a bowel preparation and 165 patients with OA. The analysis controlled for comorbidities and presence of enema. Of secondary outcomes, urinary tract infections (UTIs) were significantly more common in patients who received a bowel preparation ( = .047). All other outcomes showed no significant difference between groups, including complications on day of surgery; complications, readmission with and without surgery, and ileus formation within 30 days of surgery; sepsis; pneumonia; and length of stay (LOS). The presence of enemas did not have a statistically significant effect on outcomes.
CONCLUSIONS
This study's data does not support the routine use of MBPs in elective colo-rectal surgery and draws into further question whether MBPs should remain standard of care.
Topics: Humans; Retrospective Studies; Surgical Wound Infection; Cathartics; Anti-Bacterial Agents; Antibiotic Prophylaxis; Anastomosis, Surgical; Preoperative Care; Elective Surgical Procedures
PubMed: 37776089
DOI: 10.1177/00031348231204911 -
Nutrients Oct 2023The impact of perioperative immunonutrition on patients undergoing radical gastrectomy remains undetermined. This study aimed to assess the influence of enteral... (Randomized Controlled Trial)
Randomized Controlled Trial
Perioperative Enteral Immunonutrition Support for the Immune Function and Intestinal Mucosal Barrier in Gastric Cancer Patients Undergoing Gastrectomy: A Prospective Randomized Controlled Study.
OBJECTIVE
The impact of perioperative immunonutrition on patients undergoing radical gastrectomy remains undetermined. This study aimed to assess the influence of enteral immunonutrition support on postoperative immune function and intestinal mucosal barrier function following radical gastrectomy, contrasting findings with a control group to furnish evidence for perioperative enteral nutrition support.
METHODS
In this prospective randomized trial, 65 patients who underwent radical gastrectomy between June 2022 and June 2023 were included. Participants were allocated to either the study group (receiving enteral immunonutrition) or the control group (not receiving enteral immunonutrition). We compared postoperative rehabilitation and complications between the groups, analyzed the intestinal mucosal barrier function markers on the 3rd and 7th postoperative days, and delved deeper into peripheral blood cell immunity, inflammation, and nutritional indicators.
RESULTS
The cohort consisted of 30 patients in the study group and 35 in the control group, with no significant differences in demographic attributes between the two groups. On the 3rd postoperative day, the diamine oxidase, D-lactic acid, and endotoxin levels in the study group were significantly lower than those in the control group ( = 0.029, = 0.044, and = 0.010, respectively). By the 7th postoperative day, these levels continued to be significantly diminished in the study group ( = 0.013, = 0.033, and = 0.004, respectively). The times to first flatus ( = 0.012) and first bowel movement ( = 0.012) were significantly shorter in the study group. Moreover, postoperative complications in the study group were fewer than in the control group ( = 0.039). On the 7th postoperative day, the study group had lower peripheral white blood cell (WBC) levels ( = 0.020) and neutrophil-lymphocyte ratios (NLR) ( = 0.031), but displayed elevated albumin levels ( = 0.006). One month post-surgery, the CD4+T and CD8+T counts were significantly greater in the study group ( = 0.003 and = 0.012, respectively). Correlation analyses indicated that NLR and complications were associated with endotoxin levels.
CONCLUSION
Administering perioperative enteral immunonutrition enhances postoperative immune and intestinal mucosal barrier functions in patients undergoing radical gastrectomy. This effect leads to diminished inflammatory responses, a decreased rate of postoperative complications, and accelerated patient recovery.
Topics: Humans; Stomach Neoplasms; Prospective Studies; Immunonutrition Diet; Postoperative Complications; Immunity; Gastrectomy; Endotoxins
PubMed: 37960219
DOI: 10.3390/nu15214566 -
Xenotransplantation 2023Antibody-mediated rejection (AMR) is the commonest cause of failure of a pig graft after transplantation into an immunosuppressed nonhuman primate (NHP). The incidence... (Review)
Review
Antibody-mediated rejection (AMR) is the commonest cause of failure of a pig graft after transplantation into an immunosuppressed nonhuman primate (NHP). The incidence of AMR compared to acute cellular rejection is much higher in xenotransplantation (46% vs. 7%) than in allotransplantation (3% vs. 63%) in NHPs. Although AMR in an allograft can often be reversed, to our knowledge there is no report of its successful reversal in a pig xenograft. As there is less experience in preventing or reversing AMR in models of xenotransplantation, the results of studies in patients with allografts provide more information. These include (i) depletion or neutralization of serum anti-donor antibodies, (ii) inhibition of complement activation, (iii) therapies targeting B or plasma cells, and (iv) anti-inflammatory therapy. Depletion or neutralization of anti-pig antibody, for example, by plasmapheresis, is effective in depleting antibodies, but they recover within days. IgG-degrading enzymes do not deplete IgM. Despite the expression of human complement-regulatory proteins on the pig graft, inhibition of systemic complement activation may be necessary, particularly if AMR is to be reversed. Potential therapies include (i) inhibition of complement activation (e.g., by IVIg, C1 INH, or an anti-C5 antibody), but some complement inhibitors are not effective in NHPs, for example, eculizumab. Possible B cell-targeted therapies include (i) B cell depletion, (ii) plasma cell depletion, (iii) modulation of B cell activation, and (iv) enhancing the generation of regulatory B and/or T cells. Among anti-inflammatory agents, anti-IL6R mAb and TNF blockers are increasingly being tested in xenotransplantation models, but with no definitive evidence that they reverse AMR. Increasing attention should be directed toward testing combinations of the above therapies. We suggest that treatment with a systemic complement inhibitor is likely to be most effective, possibly combined with anti-inflammatory agents (if these are not already being administered). Ultimately, it may require further genetic engineering of the organ-source pig to resolve the problem entirely, for example, knockout or knockdown of SLA, and/or expression of PD-L1, HLA E, and/or HLA-G.
Topics: Humans; Animals; Swine; Transplantation, Heterologous; Antibodies; Graft Rejection; Transplantation, Homologous; Complement System Proteins; Anti-Inflammatory Agents
PubMed: 37548030
DOI: 10.1111/xen.12816 -
BMC Anesthesiology Aug 2023Analgesia is very important for children with craniosynostosis who are undergoing cranial suture reconstruction. This study investigated the effectiveness and safety of... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
Analgesia is very important for children with craniosynostosis who are undergoing cranial suture reconstruction. This study investigated the effectiveness and safety of an analgesic technique based on scalp nerve block combined with general anesthesia versus general anesthesia alone.
METHODS
This was a single-center, prospective, randomized, controlled study. A total of 60 children aged 6-24 months who underwent cranial suture reconstruction were randomly divided into two groups: Group A (general anesthesia combined with scalp nerve block) and Group N (general anesthesia). The hemodynamics were recorded preoperatively, at 5 min after incision and at 1, 6 and 12 h after surgery; the pain was scored at 1, 6 and 12 h after surgery, and blood glucose was detected at 1 h after surgery.
RESULTS
The mean arterial pressure and heart rate at 5 min after incision and 1 h after surgery in Group N were higher than those in Group A; the blood glucose and FLACC score in Group N were higher than those in Group A; and the number of postoperative analgesic pump presses were also significantly increased in Group N.
CONCLUSION
Preoperative scalp nerve block can reduce hemodynamic fluctuation and postoperative pain in children undergoing cranial suture reconstruction for craniosynostosis. Thus, it can be safely and effectively applied in the anesthesia of these children.
Topics: Humans; Child; Cranial Sutures; Scalp; Prospective Studies; Blood Glucose; Nerve Block; Pain, Postoperative; Analgesics; Craniosynostoses; Ultrasonography, Interventional
PubMed: 37528335
DOI: 10.1186/s12871-023-02223-9 -
International Journal of Surgery... Dec 2023To compare robot-assisted thyroidectomy (RT) and open thyroidectomy (OT) through a prospective cohort study focusing on the rate of postoperative hypoparathyroidism,...
OBJECTIVE
To compare robot-assisted thyroidectomy (RT) and open thyroidectomy (OT) through a prospective cohort study focusing on the rate of postoperative hypoparathyroidism, efficacy, and quality of life (QoL).
SUMMARY BACKGROUND DATA
Hypoparathyroidism is a frequent complication after thyroidectomy. Reducing the risk of hypoparathyroidism after total thyroidectomy is a crucial and difficult task for thyroid surgeons.
METHODS
We prospectively enroled 306 patients with papillary thyroid carcinoma into an RT group and OT group. The former used "super-meticulous" capsular dissection) and the latter used traditional meticulous capsular dissection. Patients were evaluated by scales [Short Form (SF)-36, Visual Impairment Scale (VIS), Swallowing Impairment Scale (SIS), Neck Impairment Scale (NIS), Scar questionnaire (SCAR-Q)].
RESULTS
The rates of transient hypoparathyroidism, permanent hypoparathyroidism, and transient hypocalcemia after surgery in the OT group and RT group were significantly different ( P <0.001). SIS and VIS scores in the two groups were significantly different ( P <0.001). SF-36 showed significant differences ( P <0.001) in the subsections of "physiological function", "body pain", "general health", "vitality", "social function", "role emotional", and "mental health" between the two groups. SCAR-Q showed that the length and appearance of scars showed significant differences between the two groups.
CONCLUSIONS
RT with Super-meticulous capsular dissection can protect parathyroid function and improve postoperative QoL, and could be a new option for robot-assisted surgery against thyroid cancer.
Topics: Humans; Thyroidectomy; Quality of Life; Robotic Surgical Procedures; Prospective Studies; Carcinoma, Papillary; Thyroid Neoplasms; Hypoparathyroidism; Neck Dissection; Postoperative Complications; Retrospective Studies
PubMed: 37755372
DOI: 10.1097/JS9.0000000000000725 -
BMC Cancer Sep 2023Radiotherapy (RT) following breast-conserving surgery (BCS) is mainly used to decrease the rate of ipsilateral breast tumor recurrence (IBTR) in women with breast ductal... (Randomized Controlled Trial)
Randomized Controlled Trial
Radiotherapy versus low-dose tamoxifen following breast-conserving surgery for low-risk and estrogen receptor-positive breast ductal carcinoma in situ: an international open-label randomized non-inferiority trial (TBCC-ARO DCIS Trial).
BACKGROUND
Radiotherapy (RT) following breast-conserving surgery (BCS) is mainly used to decrease the rate of ipsilateral breast tumor recurrence (IBTR) in women with breast ductal carcinoma in situ (DCIS). Recent studies have demonstrated that low-dose tamoxifen significantly reduces IBTR in breast DCIS. Here, we aim to determine whether the administration of low-dose tamoxifen is non-inferior to RT in preventing IBTR in patients with low-risk characteristics of breast DCIS.
METHODS/DESIGN
This is a prospective, international, open-label, randomized, non-inferiority trial. Patients with low-risk clinicopathologic features (> 40 years old, low risk of breast cancer susceptibility gene (BRCA) 1 and BRCA2 mutations, mammographically detected unicentric and non-mass lesions, low- or intermediate-grade without comedo or necrosis, measuring < 2.5 cm with margins ≥ 3 mm, and estrogen receptor-positive status) of DCIS who underwent BCS will be randomized at a 1:1 ratio to either receive tamoxifen (5 mg/day) for 5 years or undergo RT with conventional fractions (50 Gy in 25 fractions) or hypofractionations (40.05 Gy in 15 fractions). Randomization will be stratified by the Taiwan Breast Cancer Consortium. As approximately 5% of patients cannot tolerate the side effects of low-dose tamoxifen and will receive RT, we estimate that 405 patients will be randomized to a low-dose tamoxifen arm and 405 patients to the RT arm, according to a non-inferiority margin within 5% of IBTR difference and 90% β-power noticing non-inferiority. The primary endpoints are breast tumor recurrence, including ipsilateral, regional, contralateral, and distant recurrence of breast DCIS or invasive cancer. The secondary endpoints are overall survival and adverse effects of RT and tamoxifen. Translational studies will also be conducted for this trial.
DISCUSSION
This is the first non-inferiority trial on breast DCIS. This study will provide an important recommendation for clinical physicians on whether to use low-dose adjuvant tamoxifen for patients with low-risk breast DCIS who do not want to receive adjuvant RT.
TRIAL REGISTRATION
ClinicalTrials.gov, ID: NCT04046159, Registered on April 30, 2019.
Topics: Humans; Female; Adult; Carcinoma, Intraductal, Noninfiltrating; Receptors, Estrogen; Mastectomy, Segmental; Tamoxifen; Neoplasm Recurrence, Local; Prospective Studies; Breast Neoplasms; Drug-Related Side Effects and Adverse Reactions
PubMed: 37710198
DOI: 10.1186/s12885-023-11291-6 -
Canadian Journal of Anaesthesia =... Nov 2023Postoperative atrial fibrillation (POAF) is a common complication following cardiac surgery. Although the evidence suggests that beta blockers prevent POAF, they often... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Postoperative atrial fibrillation (POAF) is a common complication following cardiac surgery. Although the evidence suggests that beta blockers prevent POAF, they often cause hypotension. Landiolol, an ultra-short-acting β blocker, may prevent POAF, without adverse hemodynamic consequences.
SOURCE
We searched MEDLINE, CENTRAL, Embase, and trial registries between January 1970 and March 2022. We included randomized controlled trials (RCTs) that evaluated the effect of landiolol for the prevention of POAF after cardiac surgery. Two reviewers independently assessed eligibility, extracted data, and assessed risk of bias using the Risk of Bias 2.0 tool. We pooled data using random-effects models. We used the Grading of Recommendations, Assessment, Development and Evaluations framework to assess certainty of evidence.
PRINCIPAL FINDINGS
Nine RCTs including 868 participants met the eligibility criteria. Patients randomized to landiolol (56/460) had less POAF compared with controls (133/408) with a relative risk (RR) of 0.40 (95% confidence interval [CI], 0.30 to 0.54; I = 0%;) and an absolute risk of 12.2% vs 32.6% (absolute risk difference, 20.4%; 95% CI, 15.0 to 25.0). Landiolol resulted in a shorter hospital length-of-stay (LOS) (268 patients; mean difference, -2.32 days; 95% CI, -4.02 to -0.57; I = 0%). We found no significant difference in bradycardia (RR, 1.11; 95% CI, 0.48 to 2.56; I = 0%). No hypotension was reported with landiolol. We judged the certainty of evidence as moderate for POAF (because of indirectness as outcomes were not clearly defined) and low for LOS (because of imprecision and concern of reporting bias).
CONCLUSION
In patients undergoing cardiac surgery, landiolol likely reduces POAF and may reduce LOS. A definitive large RCT is needed to confirm these findings.
STUDY REGISTRATION
PROSPERO (CRD42021262703); registered 25 July 2021.
Topics: Humans; Atrial Fibrillation; Postoperative Complications; Cardiac Surgical Procedures; Morpholines; Randomized Controlled Trials as Topic
PubMed: 37917331
DOI: 10.1007/s12630-023-02586-0 -
Annals of Medicine Dec 2023The present study makes a comparative assessment of the Floppy-Nissen (FN) and Nissen-Rossetti fundoplication (NRF) procedures. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
The present study makes a comparative assessment of the Floppy-Nissen (FN) and Nissen-Rossetti fundoplication (NRF) procedures.
METHODS
Included in the study were 80 patients who presented to the General Surgery Department outpatient clinic of Balcalı Hospital of the Cukurova University Faculty of Medicine with gastroesophageal reflux between March 2010 and March 2013 All patients were operated on by the same surgeon using the laparoscopic FN or NRF techniques in a randomized controlled manner. The preoperative and postoperative reflux-specific and nonspecific gastrointestinal symptoms of the patients were compared.
RESULTS
The duration of symptoms had no effect on the level of satisfaction; regurgitation, bloating and heartburn were more common in those with a longer duration of symptoms Of the patients, 92.5% were satisfied with their resulting condition, and 92.5% were inclined toward the surgery. It was further found that there was no difference between the symptoms or satisfaction levels of the patient groups who underwent the FN procedure and those who underwent the NRF procedure, other than those related to the duration of surgery. laparoscopic NF and the NRF fundoplication treatments, aside from the duration of surgery.
CONCLUSION
Our study revealed no significant difference between the laparoscopic NF and the NRF fundoplication treatments, aside from the duration of surgery.KEY MESSAGESThe Nissen-Rossetti technique can be used safely based on the similarity of its outcomes with those of the classical Nissen technique.Despite the documented success of laparoscopic anti-reflux surgery, the absence of studies comparing surgery and medical treatments prevents these discussions from being concluded.Comparison of Nissen Rossetti and Floppy Nissen Techniques in Laparoscopic Reflux Surgery.
Topics: Humans; Fundoplication; Gastroesophageal Reflux; Laparoscopy; Time Factors; Postoperative Period; Treatment Outcome
PubMed: 36896817
DOI: 10.1080/07853890.2023.2187075 -
Open Heart May 2024Myocardial revascularisation and cardiopulmonary bypass (CPB) can cause ischaemia-reperfusion injury, leading to myocardial and other end-organ damage. Volatile... (Randomized Controlled Trial)
Randomized Controlled Trial Comparative Study
Comparison between propofol and total inhalational anaesthesia on cardiovascular outcomes following on-pump cardiac surgery in higher-risk patients: a randomised controlled pilot and feasibility study.
OBJECTIVES
Myocardial revascularisation and cardiopulmonary bypass (CPB) can cause ischaemia-reperfusion injury, leading to myocardial and other end-organ damage. Volatile anaesthetics protect the myocardium in experimental studies. However, there is uncertainty about whether this translates into clinical benefits because of the coadministration of propofol and its detrimental effects, restricting myocardial protective processes.
METHODS
In this single-blinded, parallel-group randomised controlled feasibility trial, higher-risk patients undergoing elective coronary artery bypass graft (CABG) surgery with an additive European System for Cardiac Operative Risk Evaluation ≥5 were randomised to receive either propofol or total inhalational anaesthesia as single agents for maintenance of anaesthesia. The primary outcome was the feasibility of recruiting and randomising 50 patients across two cardiac surgical centres, and secondary outcomes included the feasibility of collecting the planned perioperative data, clinically relevant outcomes and assessments of effective patient identification, screening and recruitment.
RESULTS
All 50 patients were recruited within 11 months in two centres, allowing for a 13-month hiatus in recruitment due to the COVID-19 pandemic. Overall, 50/108 (46%) of eligible patients were recruited. One patient withdrew before surgery and one patient did not undergo surgery. All but one completed in-hospital and 30-day follow-up.
CONCLUSIONS
It is feasible to recruit and randomise higher-risk patients undergoing CABG surgery to a study comparing total inhalational and propofol anaesthesia in a timely manner and with high acceptance and completion rates.
TRIAL REGISTRATION NUMBER
NCT04039854.
Topics: Humans; Propofol; Feasibility Studies; Male; Female; Pilot Projects; Aged; Anesthetics, Intravenous; Middle Aged; Single-Blind Method; Coronary Artery Bypass; Anesthesia, Inhalation; Treatment Outcome; Risk Assessment; Risk Factors; COVID-19; Postoperative Complications; Anesthetics, Inhalation; Cardiopulmonary Bypass
PubMed: 38724266
DOI: 10.1136/openhrt-2024-002630 -
Medicine Dec 2023The concept of enhanced recovery after surgery (ERAS) was first proposed by Professor Kehlet from the University of Copenhagen in Denmark in 1997. The aim is to optimize...
The concept of enhanced recovery after surgery (ERAS) was first proposed by Professor Kehlet from the University of Copenhagen in Denmark in 1997. The aim is to optimize multiple perioperative management measures, promote rapid postoperative recovery, shorten hospital stay, and reduce surgical related costs, this article explores the effect of optimizing perioperative bowel preparation and diet management under the strategy of ERAS on the postoperative recovery of patients undergoing laparoscopic hysterectomy for benign gynecological diseases. We selected 90 patients who underwent laparoscopic total hysterectomy for benign gynecological diseases at Hebei General Hospital from June 2018 to June 2019, these patients are between the ages of 40 and 65. Divide these 90 patients into an experimental group and a control group using a random number table method (n = 45). The experimental group of patients applied the concept of accelerated rehabilitation surgery for perioperative intestinal preparation and dietary management. The control group patients received routine perioperative management. Compare the first postoperative exhaust time, first postoperative defecation time, incision healing status 7 days after surgery, and pelvic infection status 1 month after surgery between 2 groups of patients. The first postoperative exhaust time and first postoperative bowel movement time of the experimental group patients were shorter than those of the control group (P < .05), and the difference was statistically significant; The incidence of poor incision healing 7 days after surgery was lower than that of the control group (P < .05), and the difference was statistically significant; There was no statistically significant difference in the incidence of postoperative pelvic infection between the experimental group and the control group (P > .05). Perioperative intestinal preparation and dietary management under the concept of accelerated rehabilitation surgery can promote postoperative recovery of patients undergoing laparoscopic total hysterectomy, promote incision healing, and have good safety.
Topics: Female; Humans; Adult; Middle Aged; Aged; Laparoscopy; Perioperative Care; Postoperative Complications; Length of Stay; Hysterectomy; Pelvic Infection
PubMed: 38115304
DOI: 10.1097/MD.0000000000036396