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BMC Surgery May 2024To comprehensively compare the effects of open Duhamel (OD), laparoscopic-assisted Duhamel (LD), transanal endorectal pull-through (TEPT), and laparoscopic-assisted... (Meta-Analysis)
Meta-Analysis Comparative Study
BACKGROUND
To comprehensively compare the effects of open Duhamel (OD), laparoscopic-assisted Duhamel (LD), transanal endorectal pull-through (TEPT), and laparoscopic-assisted endorectal pull-through (LEPT) in Hirschsprung disease.
METHODS
PubMed, Embase, Cochrane Library, Web of Science, CNKI, WanFang, and VIP were comprehensively searched up to August 4, 2022. The outcomes were operation-related indicators and complication-related indicators. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to evaluate the quality of evidence. Network plots, forest plots, league tables and rank probabilities were drawn for all outcomes. For measurement data, weighted mean differences (WMDs) and 95% credibility intervals (CrIs) were reported; for enumeration data, relative risks (RRs) and 95%CrIs were calculated.
RESULTS
Sixty-two studies of 4781 patients were included, with 2039 TEPT patients, 1669 LEPT patients, 951 OD patients and 122 LD patients. Intraoperative blood loss in the OD group was more than that in the LEPT group (pooled WMD = 44.00, 95%CrI: 27.33, 60.94). Patients lost more blood during TEPT versus LEPT (pooled WMD = 13.08, 95%CrI: 1.80, 24.30). In terms of intraoperative blood loss, LEPT was most likely to be the optimal procedure (79.76%). Patients undergoing OD had significantly longer gastrointestinal function recovery time, as compared with those undergoing LEPT (pooled WMD = 30.39, 95%CrI: 16.08, 44.94). The TEPT group had significantly longer gastrointestinal function recovery time than the LEPT group (pooled WMD = 11.49, 95%CrI: 0.96, 22.05). LEPT was most likely to be the best operation regarding gastrointestinal function recovery time (98.28%). Longer hospital stay was observed in patients with OD versus LEPT (pooled WMD = 5.24, 95%CrI: 2.98, 7.47). Hospital stay in the TEPT group was significantly longer than that in the LEPT group (pooled WMD = 1.99, 95%CrI: 0.37, 3.58). LEPT had the highest possibility to be the most effective operation with respect to hospital stay. The significantly reduced incidence of complications was found in the LEPT group versus the LD group (pooled RR = 0.24, 95%CrI: 0.12, 0.48). Compared with LEPT, OD was associated with a significantly increased incidence of complications (pooled RR = 5.10, 95%CrI: 3.48, 7.45). Patients undergoing TEPT had a significantly greater incidence of complications than those undergoing LEPT (pooled RR = 1.98, 95%CrI: 1.63, 2.42). For complications, LEPT is most likely to have the best effect (99.99%). Compared with the LEPT group, the OD group had a significantly increased incidence of anastomotic leakage (pooled RR = 5.35, 95%CrI: 1.45, 27.68). LEPT had the highest likelihood to be the best operation regarding anastomotic leakage (63.57%). The incidence of infection in the OD group was significantly higher than that in the LEPT group (pooled RR = 4.52, 95%CrI: 2.45, 8.84). The TEPT group had a significantly increased incidence of infection than the LEPT group (pooled RR = 1.87, 95%CrI: 1.13, 3.18). LEPT is most likely to be the best operation concerning infection (66.32%). Compared with LEPT, OD was associated with a significantly higher incidence of soiling (pooled RR = 1.91, 95%CrI: 1.16, 3.17). Patients with LEPT had the greatest likelihood not to develop soiling (86.16%). In contrast to LD, LEPT was significantly more effective in reducing the incidence of constipation (pooled RR = 0.39, 95%CrI: 0.15, 0.97). LEPT was most likely not to result in constipation (97.81%). LEPT was associated with a significantly lower incidence of Hirschprung-associated enterocolitis (HAEC) than LD (pooled RR = 0.34, 95%CrI: 0.13, 0.85). The OD group had a significantly higher incidence of HAEC than the LEPT group (pooled RR = 2.29, 95%CrI: 1.31, 4.0). The incidence of HAEC was significantly greater in the TEPT group versus the LEPT group (pooled RR = 1.74, 95%CrI: 1.24, 2.45). LEPT was most likely to be the optimal operation in terms of HAEC (98.76%).
CONCLUSION
LEPT may be a superior operation to OD, LD and TEPT in improving operation condition and complications, which might serve as a reference for Hirschsprung disease treatment.
Topics: Hirschsprung Disease; Humans; Network Meta-Analysis; Bayes Theorem; Laparoscopy; Digestive System Surgical Procedures; Postoperative Complications; Treatment Outcome; Transanal Endoscopic Surgery; Rectum
PubMed: 38702697
DOI: 10.1186/s12893-024-02416-0 -
Cureus Apr 2024The role of interns during general surgical rotation is crucial in shaping their future careers as surgeons. Surgical rotation offers a unique opportunity to gain...
BACKGROUND
The role of interns during general surgical rotation is crucial in shaping their future careers as surgeons. Surgical rotation offers a unique opportunity to gain valuable hands-on experience in fast-paced and challenging environments. However, interns often face significant challenges in obtaining the necessary practical training to develop proficiency in surgical techniques. This article aims to analyze some aspects of the accumulated competency of interns during their general surgery rotation, focusing on the range of skills and knowledge gained, in addition to the challenges faced.
SUBJECTS AND METHODS
We conducted a cross-sectional study using an anonymous web-based self-assessment questionnaire. The target population of the study included all Jazan University medical interns enrolled in the academic year 2022-2023.
RESULTS
Most participants showed low-to-average levels of proficiency in monitoring clinical evolution and treatment plans, ranging from fundamental awareness (n = 17, 17.5%) to working knowledge (n = 51, 52.6%), with only three participants (3.1%) reporting an expert level of proficiency. The same pattern was observed in the documentation of patient records (range: 7.2%, n = 7 for fundamental awareness to 42.3%, n = 41 for working knowledge). However, a significant proportion saw themselves as either proficient (n = 23, 23.7%) or experts (n = 15, 15.5%) in this aspect. Regarding bedside procedures, such as venipuncture, proctoscopy, nasogastric tube insertion, and urethral catheterization, the participants showed different proficiency levels, with the lowest in proctoscopy, where 66 (68.0%) of the participants reported only fundamental awareness. The results also revealed low perceived proficiency in performing surgical skin incisions, wound suturing, knot tying, application of surgical skin clips, and abscess drainage, with the lowest proficiency observed in the excision of superficial lumps as more than half of the participants reported only fundamental awareness (n = 51, 52.6%).
CONCLUSION
The results of this study indicate that documentation and monitoring of patient progress are the competencies mastered most by the majority of interns during their rotations in general surgery. However, the interns' overall level of proficiency in bedside procedures and basic surgical skills acquired during their rotation was low to average. Additionally, interns were dissatisfied with their training and the opportunities provided for them to actively engage in performing procedures in the operating room. This low proficiency is unrelated to pre-internship academic achievement, sex, or interest in future surgical careers. This suggests that efforts are needed to develop strategies to enhance interns' satisfaction and engagement, ultimately improving their overall experience during internships.
PubMed: 38694650
DOI: 10.7759/cureus.57412 -
Updates in Surgery Jun 2024Minimally invasive techniques for rectal cancer have demonstrated considerable advantages in terms of faster recovery and less post-operative complications. However, due...
Minimally invasive techniques for rectal cancer have demonstrated considerable advantages in terms of faster recovery and less post-operative complications. However, due to the complex anatomy and a limited surgical field, conversion to open surgery is still sometimes required, with a negative impact on the short-and long-term outcomes. The purpose of this study was to analyse the conversion rate to open abdominal surgery during laparoscopic transanal total mesorectal excision (TaTME) procedures performed at a high-volume Italian referral center. All consecutive TaTME performed for mid-to-low rectal cancer between 2015 and 2023 were reviewed, independently if treated with a primary anastomosis (with/without a diverting ostomy) or an end stoma. All procedures were performed using a standardized approach by the same surgical team. Patients with benign diagnosis that underwent different-from rectal resection procedures and cases pre-operatively scheduled for open surgery were excluded. The primary outcome of interest was the rate of conversion, defined as an un-planned intraoperative switch to open surgery using a midline laparotomy. Secondary aims included the comparison of patients who had a longer vs shorter operative time. Out of 220 patients, 210 were selected. In 187 cases, a primary anastomosis was performed, while 23 patients received a terminal colostomy (1 in the converted group; 22 in the full MIS- TaTME group, 10.6%). A surgical approach modification occurred in two cases, with a conversion rate of 0.95%. Median operative time was 281 min. Reasons for conversions included intra-operative difficulties impairing the mini-invasive procedure without intra-operative complications in one case, and difficulties in the laparoscopic control of an intraoperative bleeding due to a splenic lesion in another patient. Male sex and a higher BMI were found to be statistically significantly associated to longer operative time (respectively: p = 0.001 and p = 0.0025). In a high-volume center, a standardized TaTME is associated to a low conversion rate to open abdominal surgery.
Topics: Humans; Rectal Neoplasms; Male; Conversion to Open Surgery; Female; Aged; Middle Aged; Laparoscopy; Operative Time; Transanal Endoscopic Surgery; Rectum; Anastomosis, Surgical; Treatment Outcome; Aged, 80 and over; Retrospective Studies; Digestive System Surgical Procedures
PubMed: 38679626
DOI: 10.1007/s13304-024-01844-0 -
Journal of Clinical Medicine Feb 2024Rectal examination through proctoscopy or rigid sigmoidoscopy is a common investigation in clinical practice. It is an important diagnostic tool for the workup and...
Rectal examination through proctoscopy or rigid sigmoidoscopy is a common investigation in clinical practice. It is an important diagnostic tool for the workup and management of anorectal pathologies. Performing the examination can be daunting not only for patients but also for junior doctors. There are associated risks with the procedure, such as pain, diagnostic failure, and perforation of the bowel. Simulation-based training is recognised as an important adjunct in clinical education. It allows students and doctors to practice skills and techniques at their own pace in a risk-free environment. These skills can then be transferred to and developed further in clinical practice. There is extensive research published regarding the role of simulation-based training in endoscopy, however, we identified no published study regarding simulation-based training in rigid sigmoidoscopy or proctoscopy. This study aims to establish the initial face, content, and construct validity of a tool-based visual anorectal examination advanced simulator model for proctoscopy and rigid sigmoidoscopy. This innovative, highly realistic simulated environment aims to enhance the training of healthcare professionals and improve the efficiency of detecting and diagnosing distal colorectal disease.
PubMed: 38592245
DOI: 10.3390/jcm13051423 -
JAMA Network Open Mar 2024
Topics: Humans; Proctoscopy; Early Detection of Cancer; Anus Neoplasms; Anal Canal
PubMed: 38427357
DOI: 10.1001/jamanetworkopen.2024.0019 -
JAMA Network Open Mar 2024
Topics: Humans; Proctoscopy; Cytology; Anus Neoplasms; HIV Infections
PubMed: 38427356
DOI: 10.1001/jamanetworkopen.2024.0068 -
Scientific Reports Feb 2024Colonoscopy and endoscopic ultrasound play pivotal roles in the assessment of rectal diseases, especially rectal cancer and inflammatory bowel diseases. Optical...
Colonoscopy and endoscopic ultrasound play pivotal roles in the assessment of rectal diseases, especially rectal cancer and inflammatory bowel diseases. Optical coherence tomography (OCT) offers a superior depth resolution, which is a critical factor for individualizing the therapeutic concept and evaluating the therapy response. We developed two distinct rectoscope prototypes, which were integrated into a 1300 nm MHz-OCT system constructed at our facility. The rapid rotation of the distal scanning probe at 40,000 revolutions per minute facilitates a 667 Hz OCT frame rate, enabling real-time endoscopic imaging of large areas. The performance of these OCT-rectoscopes was assessed in an ex vivo porcine colon and a post mortem human in-situ colon. The OCT-rectoscope consistently distinguished various layers of the intestinal wall, identified gut-associated lymphatic tissue, and visualized a rectal polyp during the imaging procedure with 3D-reconstruction in real time. Subsequent histological examination confirmed these findings. The body donor was preserved using an ethanol-glycerol-lysoformin-based technique for true-to-life tissue consistency. We could demonstrate that the novel MHZ-OCT-rectoscope effectively discriminates rectal wall layers and crucial tissue characteristics in a post mortem human colon in-situ. This real-time-3D-OCT holds promise as a valuable future diagnostic tool for assessing disease state and therapy response on-site in rectal diseases.
Topics: Animals; Swine; Humans; Tomography, Optical Coherence; Proctoscopy; Endoscopy, Gastrointestinal; Rectum; Rectal Diseases; Rectal Neoplasms
PubMed: 38409328
DOI: 10.1038/s41598-024-55338-5 -
Medicine Jan 2024Laparoscopic total mesorectal excision (LaTME) and transanal total mesorectal excision (TaTME) are popular mid and low rectal cancer trends. However, there is currently... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Laparoscopic total mesorectal excision (LaTME) and transanal total mesorectal excision (TaTME) are popular mid and low rectal cancer trends. However, there is currently no systematic comparison between LaTME and TaTME of mid and low rectal cancer. Therefore, we systematically study the perioperative and pathological outcomes of LaTME and TaTME in mid and low rectal cancer.
METHODS
Articles included searching through the Embase, Cochrane Library, PubMed, Medline, and Web of science for articles on LaTME and TaTME. We calculated pooled standard mean difference (SMD), relative risk (RR), and 95% confidence intervals (CIs). The protocol for this review has been registered on PROSPERO (CRD42022380067).
RESULTS
There are 8761 participants included in 33 articles. Compared with TaTME, patients who underwent LaTME had no statistical difference in operation time (OP), estimated blood loss (EBL), postoperative hospital stay, over complications, intraoperative complications, postoperative complications, anastomotic stenosis, wound infection, circumferential resection margin, distal resection margin, major low anterior resection syndrom, lymph node yield, loop ileostomy, and diverting ileostomy. There are similarities between LaTME and TaTME for 2-year DFS rate, 2-year OS rate, distant metastasis rat, and local recurrence rate. However, patients who underwent LaTME had less anastomotic leak rates (RR 0.82; 95% CI: 0.70-0.97; I2 = 10.6%, P = .019) but TaTME had less end colostomy (RR 1.96; 95% CI: 1.19-3.23; I2 = 0%, P = .008).
CONCLUSION
This study comprehensively and systematically evaluated the differences in safety and effectiveness between LaTME and TaTME in the treatment of mid and low rectal cancer through meta-analysis. Patients who underwent LaTME had less anastomotic leak rate but TaTME had less end colostomy. There is no difference in other aspects. Of course, in the future, more scientific and rigorous conclusions need to be drawn from multi-center RCT research.
Topics: Humans; Animals; Rats; Rectum; Anastomotic Leak; Margins of Excision; Transanal Endoscopic Surgery; Rectal Neoplasms; Laparoscopy; Postoperative Complications; Treatment Outcome
PubMed: 38277570
DOI: 10.1097/MD.0000000000036859 -
Clinical and Translational... Apr 2024High-resolution anoscopy (HRA) is the gold standard for detecting anal squamous cell carcinoma (ASCC) precursors. Preliminary studies on the application of artificial...
INTRODUCTION
High-resolution anoscopy (HRA) is the gold standard for detecting anal squamous cell carcinoma (ASCC) precursors. Preliminary studies on the application of artificial intelligence (AI) models to this modality have revealed promising results. However, the impact of staining techniques and anal manipulation on the effectiveness of these algorithms has not been evaluated. We aimed to develop a deep learning system for automatic differentiation of high-grade squamous intraepithelial lesion vs low-grade squamous intraepithelial lesion in HRA images in different subsets of patients (nonstained, acetic acid, lugol, and after manipulation).
METHODS
A convolutional neural network was developed to detect and differentiate high-grade and low-grade anal squamous intraepithelial lesions based on 27,770 images from 103 HRA examinations performed in 88 patients. Subanalyses were performed to evaluate the algorithm's performance in subsets of images without staining, acetic acid, lugol, and after manipulation of the anal canal. The sensitivity, specificity, accuracy, positive and negative predictive values, and area under the curve were calculated.
RESULTS
The convolutional neural network achieved an overall accuracy of 98.3%. The algorithm had a sensitivity and specificity of 97.4% and 99.2%, respectively. The accuracy of the algorithm for differentiating high-grade squamous intraepithelial lesion vs low-grade squamous intraepithelial lesion varied between 91.5% (postmanipulation) and 100% (lugol) for the categories at subanalysis. The area under the curve ranged between 0.95 and 1.00.
DISCUSSION
The introduction of AI to HRA may provide an accurate detection and differentiation of ASCC precursors. Our algorithm showed excellent performance at different staining settings. This is extremely important because real-time AI models during HRA examinations can help guide local treatment or detect relapsing disease.
Topics: Humans; Deep Learning; Anus Neoplasms; Female; Male; Middle Aged; Squamous Intraepithelial Lesions; Carcinoma, Squamous Cell; Staining and Labeling; Proctoscopy; Aged; Algorithms; Neural Networks, Computer; Acetic Acid; Adult; Sensitivity and Specificity; Precancerous Conditions; Anal Canal; Predictive Value of Tests
PubMed: 38270249
DOI: 10.14309/ctg.0000000000000681 -
Revista Espanola de Enfermedades... Dec 2023We report the case of a 48-year-old male who presented with right lower abdominal pain and a mass for 2 weeks and got constipation for 5 days. An abdominal CT scan...
We report the case of a 48-year-old male who presented with right lower abdominal pain and a mass for 2 weeks and got constipation for 5 days. An abdominal CT scan conducted before admission at other hospitals revealed an obstruction in the blind ascending colon, which was suspected to be a malignant tumor. Proctoscopy revealed peritoneal implantation metastasis and multiple pelvic lymph nodes. Physical examination was unremarkable except for multiple lymph node enlargements in the inguinal area, without pain. A whole-body contrast-enhanced FDG-PET/CT revealed lymphoma involvement in the ascending colon, peritoneum, bone marrow, and lymph nodes in multiple regions of the body, with DLBCL as a suspected diagnosis. Pathological findings from the colonoscopy revealed atypical lymphocyte infiltration and Immunostaining indicated the presence of atypical lymphocytes with Ki-67 (90%) and tested positive for CD20, CD19, CD10, and BCL-6. Based on the above findings, stage IV DLBCL was diagnosed. Furthermore, EBV-DNA amplification was positive. The patient received R-CHOP treatment for 2 days before experiencing symptoms of fevers, chills, and abdominal pain. He underwent emergency surgery due to intestinal perforation, and preoperative blood tests revealed HIV-positive. The prognosis for the patient is poor due to sepsis.
PubMed: 38095193
DOI: 10.17235/reed.2023.10124/2023