bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of Successful Secondary Hyperparathyroidism Treatment on Cardiovascular Morbidity in Patients with Chronic Kidney Disease Stage IIIB-V
Authors: Da Canal F , Vetter D , Breuer E , Hübel K , Miculic F , de Rougemont O , Wüthrich R
Published: June 2023

Background

Chronic kidney disease (CKD) patients grade III B(GFR 30-44ml/min), IV (GFR 15-29ml/min) and grade V (GFR <15ml/min) are patients with a severe chronic Kidney disease that are shortly before or in need of dialysis. 61.7% of patients on hemodialysis have been found to have secondary hyperparathyroidism. It has been associated with high cardiovascular morbidity by calcification of tissue leading to lung fibrosis and right heart insufficiency.

Aims

To assess the effect of treatment success of secondary renal hyperparathyroidism (SHPT) on cardiovascular morbidity.

Methods

Retrospective single-center analysis. 211 patients chronic kidney disease (CKD) stages IIIB-V undergoing computed tomography for coronary artery calcium (CAC) scoring at the University Hospital of Zurich between 2015 and 2019. Presence of and control of SHPT was assessed at the timepoint of CAC scoring, and 6-12 months prior. Information on left ventricular ejection fraction (LVEF), and left ventricular hypertrophy (LVH) were obtained from echocardiography at the timepoint of CAC scoring. Independent predictive factors for ACS and LVH were assessed by multivariable analysis.

Results

34% (n=72) of the patients had uncontrolled SHPT, whereas 66% (n=139) had either no-(n=98) or a controlled SHPT(n=41). Patients with uncontrolled SHPT had a significantly lower LVEF (p=0.028), significantly more pronounced LVH (p=0.003), a higher left ventricular myocardial mass index (LVMMI) (p=0.002) than the group with no SHPT or well controlled SHPT. Uncontrolled SHPT had a significant higher risk for developing ACS (p=0.011) compared to no-or controlled SHPT patients (41.7% vs 31.7%).

Conclusions

Insufficient control of SHPT has a negative impact on cardiovascular morbidity with lower LVEF, increased LVH and a higher incidence of ACS. Increased focus on SHPT control in CKD patients is important and may have a beneficial impact on cardiovascular outcomes. If all conservative measures do not lead to a sufficient alignement of the secondary hyperparathyroidism parathyroidectomy may be indicated.
Change in Perioperative Management of 14 Consecutive Patients with Pheochromocytoma – Is Alpha Blockade Still Necessary?
Authors: Goldmann A , Schmidt S , Gelpke H , Breitenstein S
Published: June 2023

Background

Pretreatment with alpha-blockers before surgery for pheochromocytoma or paraganglioma is considered the gold standard and is recommended in the 2014 Endocrine Consensus Guidelines. Meanwhile, there is evidence at specialized clinics that alpha blockade does not provide any benefit preoperatively. Due to an index case with severe side effects from alpha blockade and the recent evidence, we have refrained from preoperative alpha blockade before planned surgery for a catecholamine-secreting tumor in our hospital since 2018.

Aims

The aim of the study is to evaluate the outcome after change of perioperative management.

Methods

A retrospective analysis of patients was performed using data prospectively collected in the Eurocrine quality registry of all patients with pheochromocytomas and paragangliomas operated on at our hospital from 2018 to 2022.

Results

During this period, 14 patients with pheochromocytomas (n=10) and paragangliomas (n=4) underwent surgery. 21% (3 of 14) patients were pretreated by alpha blockers for 7-14 days, 79% (11/14) patients did not receive preoperative alpha blockade after interdisciplinary discussion. All patients with alpha blockade had significant orthostasis symptoms, and 2 patients experienced syncope despite adequate volume delivery. One of these patients suffered a traumatic brain injury after a fall. Intraoperatively, 50% (7 of 14) of the patients experienced a hypertensive crisis >200 mmHg, which was resolved with rapid anesthetic intervention. The 3 patients with alpha blockade had prolonged hypotension postoperatively, so catecholamines had to be administered after extubation in 2 patients. No relevant complications occurred.

Conclusions

In our hospital, no relevant complications occurred despite omission of alpha blockade for pretreatment in pheochromocytomas and paragangliomas. However, the number of cases in these rare tumors is low, nevertheless this seems to be feasible in a good interdisciplinary setting.
Delayed Return of Gastrointestinal Function after Hepatectomy: A Single-Center Cross-Sectional Study
Authors: Piazza G , Labgaa I , Uldry E , Melloul E , Halkic N , Demartines N , Joliat G R
Published: June 2023

Background

Hepatectomy remains associated with complication rates around 30-50%. Delayed return of gastrointestinal function (DRGF) has been reported in 10-20%.

Aims

This study aimed to assess DRGF predictors after hepatectomy.

Methods

This study included all consecutive adult patients undergoing hepatectomy between 01/2010 and 12/2019. DRGF was defined as need of postoperative nasogastric tube (NGT) insertion. Patients leaving the operation room with a NGT were excluded. Independent DRGF predictors were identified with multivariable logistic binary regression.

Results

A total of 502 patients were included. DRGF occurred in 82 patients (16%). Among DRGF patients, 17% (n=14) needed a second NGT placement. DRGF incidences were similar before and after Enhanced Recovery After Surgery implementation (16/78=21% vs. 66/423=16%, p=0.281). DRGF was more frequent after major hepatectomy (55/239=23% vs. 27/263=10%, p<0.001). DRGF occurred more frequently in patients with preoperative embolization (26/88=30% vs. 55/407=14%, p<0.001), biliary anastomosis (20/48=42% vs. 61/450=14%, p<0.001), and extrahepatic resection (37/108=34% vs. 45/393=11%, p<0.001). Patients with DRGF had longer median operation duration (374 vs. 263 min., p<0.001) and higher median blood loss (1088 vs. 701 mL, p<0.001). DRGF patients developed more pneumonias (14/22=64% vs. 8/22=36%, p<0.001) and had longer median length of stay (19 vs. 8 days, p<0.001). On multivariable analysis, operation duration (OR 1, 95%CI 1.002-1.008, p<0.001) and postoperative biloma/biliary leak (OR 3.3, 95%CI 1.8-7.7, p<0.001) were independently associated with DRGF occurrence.

Conclusions

Postoperative DRGF occurred in 16% of the patients and was associated with longer length of stay. Surgery duration and postoperative biloma/biliary leak were found as independent predictors of DRGF.
Mesh-Enforced Repair and Anterior Fundoplication in Large Hiatal Hernias: Few Side-Effects and a High Patient Satisfaction – The Best Way to Go?
Authors: Süsstrunk J , Stimpfle D , Potthast S , Zingg U
Published: June 2023

Background

Nissen and Toupet fundoplication are the predominant procedures in the treatment of large hiatal hernias. Nevertheless, these techniques may cause relevant side-effects such as increased bloating or dysphagia, thus impairing the patient's quality of life.

Aims

To evaluate the mid-term outcome after mesh-enforced hiatoplasty and anterior fundoplication in large hiatal hernia repair.

Methods

Prospective single-center study investigating the clinical, endoscopic and radiological outcome after laparoscopic, mesh-enforced hiatoplasty and anterior fundoplication in patients with large hiatal hernias.

Results

Ninety-nine patients were operated between 2012–2022 and met all the inclusion criteria including postoperative computed tomography (CT). 68% were female, mean age was 71 ± 10 years, 72% of the patients needed proton pump inhibitors (PPI) prior to surgery. In all patients, more than 20% of the stomach was located supra diaphragmatic, in 65% more than 50% of the stomach was herniated. Mean operation time was 152 ± 45 minutes, there were no major intraoperative complications and one short-term postoperative complication demanding operative revision due to early recurrence. Mean length of stay was 5.1 ± 1.9 days. Upper endoscopy was performed in 94% after 16 weeks and showed a correct position in all cases. Clinical and CT follow-up were obtained in all patients after 1.6 ± 1 years. 87% had a correct position of the fundoplication in CT, 6% had a slippage and 7% a recurrent hernia. Two patients needed operative revision. 84% of patients reported their clinical outcome as excellent, 10% as good. Mean Gastrointestinal Qualitiy of Life Index was 126 ± 14. 98% of patients would perform the surgery again.

Conclusions

Mesh-enforced hiatoplasty and anterior fundoplication in large hiatal hernia repair is safe and leads to a high rate of patient satisfaction. The radiological outcome poorly correlates with clinical symptoms or patient reported outcome.
RefluxStop – A Novel Device to Address Gastroesophageal Reflux Disease in the Context of Esophageal Hypomotility
Authors: Borbély Y , Haltmeier T , Prevost G A , Dipietro Martinelli C , Kröll D
Published: June 2023

Background

RefluxStop is a non-active, implantable medical device intended to reduce esophageal acid exposure in patients with gastroesophageal reflux disease (GERD). RefluxStop does not affect the esophageal lumen and thus might also be suited for patients with esophageal hypomotility.

Aims

To report short-/midterm functional outcomes after implantation of RefluxStop.

Methods

All patients who received laparoscopic implantation of the RefluxStop device from 09/2018-12/2022 in a university hospital were included for retrospective analysis. Subjective (GERD-HRQL-questionnaires; after six weeks and every six-month thereof) and objective data (24h-pH-manometry, barium swallows and upper endoscopies) are reported as functional outcome parameters.

Results

Forty-five patients were included. Median age was 49.3y (min 28.1– max 76.8), median Body Mass Index 28kg/m2 (19-34), and 21 patients were female (46.7%). Nine patients (20%) had esophagitis Los Angeles grade C or more, 3 had non-acidic reflux (7%), and 32 (71%) had esophageal motility disorders. Primary presenting symptoms were typical in 31(69%), pain or dysphagia in 5(11%), respiratory in 8(18%) and nausea in 1 patient (2%). GERD-HRQL score was significantly reduced from baseline to 6 weeks postop (23.9 and 4.3 (p < 0.001)) and to last follow-up (6.8, p = 0.021). In the last follow-up, after a median of 3.2y, primary presenting symptoms were gone in 31(69%), improved in 6(13%), and stayed the same in 2(4%). Typical symptoms were gone or improved in 34 of 37 patients (92%), dysphagia and pain in 12 of 15 patients (80%), and respiratory symptoms in all of 14 patients. De novo bloating occurred in 1 patient and was improved or gone in 5 patients; no diarrhea was seen.

Conclusions

RefluxStop shows promising results over four years in a challenging patient population burdened with GERD and esophageal motility disorders.
Laparoscopic versus Ultrasound-Guided Transversus Abdominis Plane (TAP) Block in Colorectal Surgery: A Non-Inferiority, Multicentric Randomized Double-Blinded Clinical Trial
Authors: Mongelli F , la Regina D , Popeskou S G , Saporito A , Gaffuri P , Tasciotti E , Dossi R , Christoforidis D
Published: June 2023

Background

Postoperative pain management after laparoscopic colorectal surgery is of utmost importance to grant a better outcome, shorter length of hospital stay, and costs. The Transversus abdominis plane (TAP) block is a relatively new technique with great potential and is achieved through a direct blockade of pain fibers in the plane between the transversus abdominis and internal oblique muscles. Delivery can be achieved under ultrasound guidance performed by the anesthetist or under laparoscopic control performed by the surgeon, however, few studies investigated the best administration method.

Aims

The aim of this study was to assess if laparoscopic-assisted TAP block (L-TAPB) is as efficient as ultrasound-guided TAP block (U-TAPB) in postoperative pain control.

Methods

One-hundred-sixteen patients scheduled for elective laparoscopic colon resections from February 2018 to December 2021 at two Swiss hospitals, were included and randomized with a 1:1 ratio to receive either L-TAPB or U-TAPB. The primary outcome was the percentage of patients requesting reserve opioids. Secondary outcomes were total opioid consumption within the first 24 hours after surgery, postoperative pain on the visual analog scale (VAS) at 3, 6, 12, and 24 hours after surgery, and TAP block-related complications.

Results

There were almost twice as many patients in the L-TAPB group requesting opioid reserves compared to the U-TAPB group (54.5% vs. 29.8%, p=0.008) although no statistical significance was found in the overall dose in 24 hours. For all other variables (pain on the VAS at 3, 6, 12, and 24 hours after surgery, the need for epidural analgesia, complications related to the TAP block, and hospital stay no statistically significant difference between the L-TAPB and the U-TAPB groups was noted.

Conclusions

Our results, although marginal differences between groups were noted, showed the non-inferiority of the laparoscopic delivery compared to ultrasound-guided administration.
Ondansetron for Low Anterior Resection Syndrome (LARS): A Double Blind, Placebo Controlled, Cross-Over, Randomized Study
Authors: Roesel R , Christoforidis D , Popeskou S G , Faes S , Vanoni A , Galafassi J , Ferrario Di Tor Vajana E Di Medea A , Piotet L M
Published: June 2023

Background

Low Anterior Resection Syndrome (LARS) after rectal resection is common and debilitating. Current management strategies include behavioural and dietary modifications, physiotherapy, antidiarrheal drugs, enemas and neuromodulation, but results are not always satisfactory.

Aims

This study examines the efficacity and safety of Ondansetron, a serotonin receptor antagonist, to treat patients with LARS.

Methods

This is a randomized, multi-centric, double-blinded, placebo-controlled, cross-over study. Patients with LARS (LARS score >20) no longer than 2 years after rectal resection were randomised to receive either 4 weeks of Ondansetron followed by 4 weeks of placebo (O-P group) or 4 weeks of placebo followed by 4 weeks of Ondansetron (P-O group). The primary endpoint was LARS severity measured using the LARS score; secondary endpoints were incontinence (Vaizey score) and quality of life (IBS-QoL questionnaire). Patients’ scores and questionnaires were completed at baseline and after each 4-week treatment period.

Results

Out of 46 randomized patients, 38 were included in the analysis. From baseline to the end of the first period, in the O-P group, the mean (SD) LARS score decreased by 25% (from 36.6 (5.6) to 27.3 (11.5)) and the proportion of patients with major LARS (score >30) went from 15/17 (88%) to 7/17 (41%), (p=0.001). In the P-O group, the mean (SD) LARS score decreased by 12% (from 37 (4.8) to 32.6 (9.1)), and the proportion of major LARS went from 19/21 (90%) to 16/21 (76%). After cross over, LARS scores deteriorated again in the O-P group receiving placebo, but further improved in the P-O group receiving Ondansetron. Mean Vaizey scores and IBS QoL scores followed a similar pattern.

Conclusions

Ondansetron should be included in the treatment algorithms of LARS after low anterior resection for rectal cancer because it is a safe and simple treatment that appears to improve both symptoms and quality of life.
Surgical Outcomes, Long-Term Recurrence Rate and Resource Utilization in a Prospective Cohort of 165 Patients Treated by Transanal Total Mesorectal Excision for Distal Rectal Cancer
Authors: Gloor S , Pozza G , Troller R , Wehrli M , Adamina M
Published: June 2023

Background

Transanal total mesorectal excision (taTME) is an alternative to laparoscopic and robotic TME owing to its reported superior ability to achieve clear margins in distal rectal cancers. Worrisome reports of high recurrence and complication rates triggered a moratorium in few countries.

Aims

This study assessed outcomes and resource utilization of taTME in a teaching hospital.

Methods

Patients with distal rectal cancer treated by taTME were prospectively included following ethical clearance and informed consent. Outcomes were reported as median & interquartile range (IQR).

Results

Audited yearly volume for TME was 43 (IQR 37-52). Consecutive 165 patients (67% male, 33% female) with a tumor 7cm (IQR 5-10) from the anal verge and a BMI of 26 (23-29) were followed for 50 months (IQR 32-79). Resection margins were threatened in 25% of the patients in preoperative MRI and 75% received neoadjuvant radiochemotherapy. Surgery lasted 348 min (293-425) and one conversion occurred (0.6%). Length of stay was 9 days (7-13). Good mesorectal dissection and clear margins were achieved in 96% of the specimen and 27 lymphnodes (IQR 20-38) were harvested. Ninety-day major morbidity affected 36 patients (21.8%), including 12 anastomotic leakages (7.2%). All leaks could be salvaged and ileostomy reversed within 6 months but for 2 patients who died (1.2%). Recurrence occurred locally in 9 patients (5.4%) and 44 had distant metastasis (26.7%). Five-year disease-free survival and overall survival were 67% and 90%. In multivariate analysis, long operation and frailty predicted anastomotic leak, while positive distal margin and lymphnodes predicted local recurrence and distant metastasis. A 2-team taTME saved 102 minutes operative time (422 (353-492) vs 320 (276-373) min. p<0.001) and EUR 1’385 when compared to a one-team approach, while allowing improved teaching opportunities.

Conclusions

Transanal total mesorectal excision allowed sound surgical quality and excellent oncologic outcomes in a Swiss teaching hospital.
Robotic-Assisted Totally Extraperitoneal (eTEP) Hernia Repair with a Suprapubic Approach for Umbilical and Epigastric Hernias: A Retrospective Study
Authors: Mongelli F , Pini R , Iaquinandi F , Cianfarani A , Gaffuri P , la Regina D
Published: June 2023

Background

In the treatment of umbilical and epigastric hernias, during the last years were developed robotic-assisted techniques to avoid intraperitoneal mesh placement. Robotic-assisted transabdominal preperitoneal (eTAPP) and totally extraperitoneal (eTEP) were described and studies reported that both techniques were safe and achieved optimal results. However, no evidence is reported regarding the best technique.

Aims

The aim of our study was to assess the safety and effectiveness of the robotic-assisted eTEP compared to eTAPP with suprapubic trocar insertion to treat umbilical and epigastric hernias.

Methods

We selected from a prospectively maintained database patients who underwent robotic-assisted umbilical and epigastric hernia repair with a suprapubic approach, either eTEP or eTAPP. We retrieved clinical and follow-up data and a statistical analysis was carried out.

Results

During the study period, 53 patients were included. The mean age was 59.0 ± 13.9 years, 45 patients (84.9%) were male and the mean BMI was 28.0 ± 5.9 kg/m2. Most hernias were umbilical (81.1%) and primary (83.0%). Operative time was slightly shorter for eTEP than eTAPP (106 ± 43 min vs. 126 ± 74 min, p=0.232). No intraoperative complications occurred. Postoperatively, only a case of bleeding and a seroma were recorded. The length of follow-up was 11.3 ± 6.4 months in the eTEP group vs. 20.5 ± 9.7 months in the eTAPP group and no case of recurrence, chronic pain, or significant dysesthesia was recorded.

Conclusions

In our study, we found that the eTEP approach to treat epigastric and umbilical hernias was safe and feasible and achieved excellent perioperative and follow-up results. The outcomes were similar to patients undergoing the eTAPP approach, but with the advantages of a shorter operative time and not entering the peritoneum.
Prevalence of Anal Incontinence in a Population of Healthcare Workers
Authors: Balaphas A , Liot E , Meyer J , Toso C , Meurette G , Kassouha A , Gogniat V , Vuagnat H , Ris F
Published: June 2023

Background

Anal incontinence is now recognized as a major health issue due to its economic burden and impact on quality of life. However, the true prevalence of this condition remains a matter of debate.

Aims

Our aim was to evaluate the prevalence of anal incontinence among the collaborators of a tertiary hospital.

Methods

An anonymous questionnaire was sent to the collaborators of a tertiary hospital. Jorge-Wexner and LARS scores and questions related to different definitions of anal and stool incontinence were evaluated. Demographic characteristics of the participants along with specific medical history were also collected.

Results

Among the 14279 collaborators, 2532 participants filled the questionnaire (17.7%). This sample was representative of the total hospital staff regarding age, gender and occupation. Twenty-nine percent of the participants reported occasional episodes of anal incontinence (more than once a month but less than once a week). The Jorge-Wexner score was ≥ 3 in 20.9% of the participants and 15% reported rare episodes of stool incontinence. However, only 2.3% fulfilled the strict Rome IV criteria for stool incontinence. A difference between women and men regarding the presence of anal incontinence was found (32.2% versus 21% p <0.001) but was not statistically significant for Rome IV criteria. In women, vaginal delivery was not associated with anal incontinence in univariate and multivariate analysis or with Rome IV criteria after adjustment. On the other hand, diabetes was strongly associated with Rome IV criteria (OR: 3.3, 95% CI: 1.09-10.08, p= 0.035). History of proctological procedure was also significantly and strongly associated with anal incontinence and Rome IV criteria (OR: 4, 95% CI: 1.86-8.6, p<0.001).

Conclusions

Prevalence of anal incontinence was higher than expected in an active population. We also demonstrated that the association between childbirth and anal incontinence was less important than expected.
Regenerative Therapy with Autologous Stromal Vascular Fraction Derived Mesenchymal Stem Cells and Platelet-Rich Plasma to Treat Complex Perianal Diseases
Authors: Bächler T , Pozza G , Gingert C , Palm C , Adamina M
Published: June 2023

Background

The high recurrence rate of surgically treated anal fistula remains a concern in proctology.

Aims

This study investigated the healing rate of complex anal fistula procedures supplemented by regenerative therapy with autologous stromal vascular fraction derived mesenchymal stem cells and platelet-rich plasma (SVF-PRP).

Methods

Consecutive patients with complex anal fistula were prospectively assessed by a validated incontinence questionnaire and MRI 4 and 12 months after surgery. Fistula were drained with setons prior to definitive surgery. SVF was harvested from subcutaneous abdominal fat and PRP from peripheral blood. Distal fistulectomy to the sphincter was performed and the wound left open, while the internal orifice was closed. SVF-PRP was injected around the fistula. Patients showered their excision wound until dry. Outcomes were reported as median & interquartile range (IQR).

Results

40 patients (23 males : 17 females) were included from December 2019 to December 2022. Age was 40 years (IQR 30-53). Five patients (12.5%) suffered from perineal Crohn's disease and 3 had a rectovaginal fistula (7.5%). Patients had 2 prior fistula surgeries (IQR 1-3) and SVF-PRP fistula repair was performed 8 months (IQR 5-22.5) after initial diagnosis. Operation time was 82 minutes (IQR 73-95). Five patients were discharged on the day of surgery, 32 on postoperative day 1, and 3 on postoperative day 2. Follow up was 12 months (IQR 6-16). There was no deterioration in fecal continence. Two out of 40 patients (5%) experienced an early failure within 2 months of SVF PRP. All other patients were back to work and leisure. At 4 months of follow-up, 34/40 (85%) patients were clinically well with no active fistula. Of 30 patients who reached 12 months follow-up, 5 had an active fistula in MRI (16%) or on clinical ground.

Conclusions

SVF-PRP is a safe and promising addition to the broad armentarium of treatments for complex perianal fistula.
Pouch Resizing for Weight Regain after Roux-En-Y Gastric Bypass: Results from a High-Volume Single Center
Authors: Hehl S J , Maurer S , Hauser R , Serra M , Alceste D , Gero D , Thalheimer A , Bueter M , Widmer J
Published: June 2023

Background

The most effective treatment for obesity and associated comorbidities is metabolic-bariatric surgery (MBS). Nevertheless, weight regain is reported in 10-30% of patients after Roux-en-Y gastric bypass (RYGB), eventually with a recurrence of obesity-associated comorbidities. Pouch resizing (PR), the resizing of an enlarged gastric pouch, is commonly performed as a low-risk secondary surgery to stabilize or even reduce the regained weight. However, the effectiveness of PR lacks scientific evidence.

Aims

To analyze the effect of PR after RYGB on long-term weight loss, course of comorbidities, complication rates and patient satisfaction.

Methods

Forty-eight patients undergoing PR between January 2016 and December 2020 were included. Data were collected retrospectively from a prospective database. PR was performed laparoscopically and included a resection of the enlarged gastric pouch and a redo of the gastrojejunostomy. Additionally, thirty-seven patients participated in a survey evaluating postoperative patient satisfaction.

Results

Nadir-weight after RYGB was reached after 26.3 ± 19.4 months; PR was performed after a mean time of 106.2 ± 45.5 months. Mean follow-up after PR was 55.9 ± 18.5 months. Mean BMI before PR was 39 ± 5.4 kg/m2. Mean BMI at 1, 3 and 5 years after PR was 37 ± 5.5 kg/m2, 35 ± 7.6 kg/m2 and 35 ± 7.5 kg/m2 respectively. Obesity-associated comorbidities were resolved in 53% of patients five years after PR. Postoperative complications analog grade ≤2 of the Clavien-Dindo classification occurred in 12.5% while complications grade ≥3 occurred in 10.4% of patients. There was no mortality. The postoperative survey showed high levels of satisfaction after PR.

Conclusions

PR for weight regain after primary RYGB is a safe procedure resulting in weight stabilization and resolution of obesity-associated comorbidities. PR is thus a valuable option to at least stop weight regain after primary RYGB in well-selected patients leading to high levels of patient satisfaction.
Reproductive Health in Female Bariatric Patients: A National Survey of Bariatric Professionals
Authors: Lazaridis I , Lukovnikova S , Köstler T , Mattiello D , Andreou A , Zingg U , Cavelti-Weder C , Delko T
Published: June 2023

Background

A significant proportion of bariatric patients are women of childbearing age. Bariatric patients may be at risk of nutritional and surgical complications that can be impacted by and can impact pregnancy.

Aims

We aimed to investigate perioperative reproductive health practices, knowledge and recommendations of bariatric professionals regarding reproductive health counseling, contraception and pregnancy in female bariatric patients of reproductive age.

Methods

We conducted a national, online survey among bariatric professionals. Survey topics included demographic factors, perioperative reproductive health practices, attitudes and knowledge about contraception and recommendations regarding pregnancy.

Results

A total of 72 healthcare professionals participated. The majority of participants responded that female patients of reproductive age are more than the half of the referred bariatric patients. Only 23 respondents (31.9%) referred always female patients of reproductive age to a gynecologist prior to a bariatric procedure, but 75% always discuss family planning. 51.4% of the participants do not recommend a certain type of bariatric operation in women of reproductive age, but 19 (26.4%) and 9 (12.5%) participants recommend Roux-en-Y gastric bypass and sleeve gastrectomy, respectively. There was a strong variance regarding the recommendations about contraception after surgery. Only 51.4% inform the patients about possible surgical, bariatric surgery-related complications during future pregnancies. More than half of the participants reported inadequate knowledge regarding absorption and safety of contraception pills after bariatric surgery. Although most professionals routinely follow- up and provide counselling on maternal and fetal risks in pregnant women with previous bariatric surgery, 65% have no standardized protocol for such patients who present with acute abdominal pain in their practice.

Conclusions

Despite acknowledging the importance of reproductive health counseling, bariatric professionals address perioperative and contraception issues inconsistently and mostly reported lack of adequate knowledge in the latter. Therefore, a stronger collaboration between bariatric professionals and women`s healthcare providers is needed to improve care of female bariatric patients in reproductive age.
Clavicular Hook Plate versus Dog-Bone Technique for Acute High-Grade Acromioclavicular Joint Dislocation – A Retrospective Cohort Study Comparing Clinical Outcome Scores, Complications and Costs
Authors: Hess S , Bütler K , Haupt S , Grehn H , Sommer C , Michelitsch C
Published: June 2023

Background

Arthroscopically assisted coracoclavicular (CC) ligament fixation techniques have been promoted as providing superior outcomes for the treatment of acute high-grade acromioclavicular joint (ACJ) dislocations. Nevertheless, there is a lack of high-level evidence for clinically relevant benefits. At our institute, orthopaedic surgeons use an arthroscopically assisted coracoclavicular ligament fixation technique (DB), while general trauma surgeons use a clavicular hook plate (cHP) technique.

Aims

The aim of the study was to compare clinical outcomes, complication rates and costs between the two groups.

Methods

The hospital database was searched for patients treated for acute traumatic high-grade (Rockwood Typ ≥III) ACJ dislocation using either a cHP or arthroscopically assisted DB technique between 2010 and 2019. Seventy-nine patients could be included (56 patients in the cHP group and 23 in the DB group). QuickDASH scores, subjective shoulder value (SSV) scores, pain scores (numerical pain rating scale 10) and complication rates were retrospectively collected through phone interviews and by screening patient charts as well as surgical reports. Costs per patient were obtained from the hospital's accounting system.

Results

Mean follow-up was 54±33.7 and 45±21.7 months in the cHP and DB group, respectively. QuickDASH and SSV scores did not differ but patients in the cHP group reported significantly lower pain scores (p=0.033). More patients reported hypertrophic or disturbing scars (p=0.49) and sensibility disturbances (p=0.007) in the cHP group. Three patients suffered from a frozen shoulder in the DB group (p=0.023).

Conclusions

Patient-reported outcomes are excellent after long-term follow up for both techniques. There are no clinically relevant differences in clinical outcome scores based on our results and a review of the literature. Both techniques certainly have their benefits regarding secondary outcome measures.
Does Fixation of Clavicle Fractures Improve Clinical Outcomes in Patients with Concomitant Multiple Rib Fractures?
Authors: van Veelen N , Hoepelman R J , Beeres F J , Beks R B , Houwert R M , Ijpma F F , Link B C
Published: June 2023

Background

Clavicle fractures are often accompanied by multiple rib fractures. The combination of these injuries results in decreased stability of the chest wall making these patients vulnerable to prolonged hospitalization and (respiratory) complications.

Aims

This study aims to assess whether performing clavicle fixation would improve clinical outcomes by adding chest wall stability.

Methods

A prospective multicenter study was performed including all adult patients with both multiple rib fractures and ipsilateral clavicle fractures admitted between January 2018 and March 2021. Patients treated operatively versus nonoperatively for their clavicle fracture were matched using propensity score matching. The primary outcome was the hospital length of stay. The secondary outcomes were, duration of mechanical ventilation, intensive care unit length of stay, pain, complications, and quality of life at 6 weeks and 12 months of follow-up.

Results

A total of 232 patients with concomitant ipsilateral clavicle and rib fractures were included. Fifty-two patients (22%) underwent operative treatment of which 39 could be adequately matched to 39 nonoperatively treated patients. No association was found between clavicle fixation and the hospital length of stay (mean difference=2.3, 95% CI -2.1 to 6.8, p=0.301) or any secondary endpoint. Eight of the 180 nonoperatively treated patients (4%) had a symptomatic nonunion, for which five underwent secondary clavicle fixation.

Conclusions

In patients with combined, ipsilateral clavicle and multiple rib fractures, plate fixation of the clavicle does not reduce hospital length of stay, pain, or (pulmonary) complications, nor does it improve quality of life.
Intraoperative 3D-Fluoroscopy Increases Accuracy of Syndesmotic Reduction in Ankle Fractures with Syndesmotic Instability
Authors: Duschek S , Leucht A K , Aregger F , Meier C
Published: June 2023

Background

Direct visual control and 2D-fluoroscopy is widely used to achieve an anatomic syndesmotic reduction in ankle fractures with syndesmotic instability. However, significant malreduction rates are reported.

Aims

It was the aim of this study to evaluate the accuracy of conventional syndesmotic reduction and to assess the impact of intraoperative 3D-imaging to improve the quality of syndesmotic reduction.

Methods

Single institution consecutive case series (02/2021–12/2022) including all patients undergoing operative treatment for ankle fractures with syndesmotic instability. Syndesmotic reduction was performed following open reduction and internal fixation of the malleolar fractures. Provisional tibiofibular alignment was obtained under visual control and 2D-fluoroscopy. With the ankle held in a neutral position, temporary fibulotibial transfixation was performed with 2 K-wires. 3D-imaging was obtained (Cios Spin, Siemens Healthineers, Forchheim-Germany). Non-anatomical positions of the fibula were devided into anterior, posterior, or rotational malreductions. If reduction was not satisfactory, the reduction was improved and 3D-imaging repeated. Once adequate reduction was obtained, definitive syndesmotic fixation was performed and the K-wires were removed.

Results

A total of 50 patients (mean age 44±16 years, m/f 27/23) were operated for ankle fractures with syndesmotic instability. Intraoperative 3D-imaging confirmed anatomic syndesmotic reduction in 31 patients (62%). In 15 patients (30%) reduction was repeated once, in 4 patients (8%) two additional reduction manoeuvers were necessary to obtain an anatomic result. Thus, a total of 23 malreductions were recorded in a total of 73 reduction manoeuvers (32%). Of these, we observed 16 anterior (70%), 2 posterior (9%) and 5 rotational malreductions (22%).

Conclusions

Syndesmotic reduction under visual control and 2D-fluoroscopy proved to be unreliable with a syndesmotic malreduction in almost one-third of all reduction manoeuvers. With the help of intraoperative 3D-imaging incorrect tibiofibular alignment before definite fixation was identified, reduction corrected and thereby the rate of malreductions reduced.
Outcomes of Stage IIIa and Well-Selected Stage IIIb or Oligometastatic Stage IV Non-Small Cell Lung Cancers Managed by Multimodal Therapy Including Immunotherapy and Surgery
Authors: Forster C , Abdelnour-Berchtold E , Chriqui L E , Bouchaab H , Peters S , Gonzalez M , Krueger T , Perentes J Y
Published: June 2023

Background

Resectable locally advanced non-small cell lung cancers (NSCLCs) are managed by multimodal approaches including systemic therapies followed by surgery. The recent inclusion of immunotherapy in neoadjuvant protocols has significantly improved tumor responses. In selected situations, bulky N2, N3 or oligometastatic NSCLCs with treated metastasis have shown excellent regression following chemo-immunotherapy and could be considered for surgery.

Aims

We here compare the oncological outcomes of stage IIIA (single N2) with stage IIIB (bulky N2, N3) or oligometastatic stage IV NSCLCs managed by chemo-immunotherapy followed by surgery.

Methods

We reviewed all patients treated in our institution between April 2017 and June 2022 for a locally advanced or oligometastatic NSCLC with chemo-immunotherapy followed by surgery in our prospectively collected database. We recorded, for each patient, the clinico-pathological characteristics, perioperative complications and oncological outcomes.

Results

Forty-eight patients (27 single station N2 stage IIIA (group 1) and 21 bulky N2, N3 or oligometastatic NSCLC (group 2)) were identified. Patient characteristics were comparable between groups. Surgery consisted in lobectomy (81%), bilobectomy (17%) or pneumonectomy (2%). Complete resection was achieved in 46 (95%) patients with R1 resection in two patients due to lymph node effraction. Complete tumor pathological response was achieved in 26% in group 1 and 33% in group 2. Postoperative morbidity was 48% in group 1 and 81% in group 2 (p=0.05). There was no mortality. Median follow-up was 16 months (IQR: 9-32). Progression-free survival was 6 months (IQR: 3-18) in group 1 and 5 months (IQR: 2-7) in group 2 (p=0.04). Overall recurrence rate was 40% (comparable between groups (p=0.08)) and consisted, in majority, of distant metastasis. Overall survival was comparable between groups (p=0.05).

Conclusions

The inclusion of immunotherapy in induction protocols has improved tumor response and allowed to consider advanced NSCLCs for surgical resection with good postoperative and oncological outcomes.
Lung Volume Reduction in Patients with Severe Emphysema: Bronchoscopic Lobar versus Surgical Tailored Treatment
Authors: Caviezel C , von Rotz J , Mengers J , Franzen D , Schneiter D , Opitz I
Published: June 2023

Background

Bronchoscopic lung volume reduction (BLVR) with valves excludes one whole lobe while lung volume reduction surgery (LVRS) allows tailored treatment by resection of only heterogeneous, hardly perfused target areas.

Aims

We hypothesize that by (bilateral) LVRS, more areas of low attenuation (LAA, ≤ - 950 houndsfield units) can be resected more precisely, thus generating more functional improvement than BLVR.

Methods

Empysema patients treated with BLVR and LVRS at our institution between August 2019 and October 2020 were collected prospectively and analyzed retrospectively. LVRS responders were defined as patients with a postoperative improvement of at least 10% in FEV1 in combination with 10% delta in 6-minute-walking-distance (6MWD) or residual volume (RV) or diffusion capacity (DLCO), within the BLVR group additionally with a chest CT scan proven target lobe atelectasis. We performed LAA measurement in preoperative CT scan and 3 months (LVRS) or 1 month (BLVR) postoperatively. Functional improvement as well as LAA reduction was measured in each group and the groups compared with each other.

Results

29 patients underwent LVRS, 19 were responders (5 bilateral LVRS, 14 unilateral), 3 were lost for follow up. Within the BLVR group (n=29), 18 were responders. In bilateral LVRS, improvement of 6MWD and FEV1 was significantly higher than in BLVR, accompanied by a significantly higher LAA-reduction (22.18 vs 9.54, p=0.009). In unilateral LVRS, LAA-reduction was not significantly higher (12.06 vs 9.54, p=0.267), while 6MWD and FEV1 still showed a higher postoperative improvement. RV reduction and DLCO improvement did not differ significantly between the groups.

Conclusions

LVRS might lead to significantly more functional improvement than BLVR with valves, maybe due to more resected LAA, especially in bilateral surgery. This concept may justify favoring primary bilateral LVRS over BLVR with valves in bilateral heterogeneous emphysema.
Salvage Surgery in Patients with Locally Advanced or Metastatic Non-Small Cell Lung Cancer
Authors: Werner R S , Furrer K , Lauk O , Caviezel C , Hillinger S , Schneiter D , Britschgi C , Guckenberger M , Opitz I
Published: June 2023

Background

In patients with stage IIIB, stage IIIC and stage IV non-small cell lung cancer (NSCLC), guidelines generally recommend systemic therapy with or without radiotherapy. Despite this treatment, complete response remains rare. However, in a selected group of patients with either residual disease after partial response to first-line systemic treatment, or oligo-recurrence, surgical resection within a salvage concept is under evaluation as an additional treatment option. Currently, clinical data on the outcome of this approach are scarce.

Aims

We aimed to assess short- and long-term outcomes of salvage surgery in advanced NSCLC.

Methods

We retrospectively identified 35 patients with initial stage IIIB, IIIC, or IV NSCLC who underwent anatomical lung resection to treat local relapse or residual disease. All patients had initially received systemic treatment with or without radiotherapy. Patients were only included if surgical resection had not been part of the first-line treatment approach.

Results

Among 35 patients (54% male, mean age 60.2±10.9 years), the initial clinical UICC stage was IIIB in 4, IIIC in 4, IVA in 22, and IVB in 5 cases. The indication for salvage resection was residual disease after first-line treatment in 21 cases and local relapse in 14 cases. Anatomical lung resections included 22 lobectomies, 11 pneumonectomies, 1 bilobectomy and 1 segmentectomy. R0-resection was achieved in 94.3% and pathological complete response was found in 22.9% of all resections. 30-and 90-day mortality were 0% and 11.4%, respectively.

mOS and progression-free-survival (calculated from the date of salvage surgery) of the entire cohort were 69 months [95% CI 37–101 months] and 22 months [95% CI: 0–45 months] respectively.

Conclusions

In selected patients with advanced stage NSCLC presenting with local relapse or residual disease after systemic treatment, anatomical salvage lung resections are associated with a favorable short- and long-term outcome. However, further prospective evaluation of this treatment approach is required.
Can Hypothermic Oxygenated Perfusion Mitigate Ischemia-Reperfusion Injury in Ex-Situ Split Grafts? – A Comparative Study with Living Donation in Pediatric Liver Transplantation
Authors: Muller X , Mabrut J Y , Rossignol G , Mohkam K , Ruiz M , Collardeau-Frachon S , Dubois R , Depaulis C , Antonini T
Published: June 2023

Background

The gold standard in pediatric split liver transplantation (SLT) is living donation (LD) providing high-quality grafts with short static cold storage (SCS).

Aims

This study investigates the protective effect of hypothermic oxygenated perfusion (HOPE) on ex-situ partial grafts from deceased donors in comparison to standard ex-situ Static-Split and LD SLT.

Methods

We included all consecutive HOPE-Split, Static-Split and LD SLT performed from 2018-2022 at a single center. The primary endpoint was early ischemia-reperfusion injury (IRI) based on reperfusion biopsy (graded from none/0 to severe/4), the occurrence of post reperfusion syndrome (PRS, drop≥30% of systolic arterial pressure) and post-LT transaminase release.

Results

A total of 46 SLT (14 HOPE-Split, 17 Static-Split, and 15 LD) were included. With a median perfusion duration of 100min, HOPE-Split had a significant decrease of SCS compared to Static-Split (473 min vs 538 min; p=0.02) with similar total preservation time (p=0.13). This translated into lower rates of mild to severe IRI (grade≥2; p=0.03) and significantly reduced neutrophilic infiltrate than Static-Split (p=0.04; Fig.1). The PRS was also reduced in HOPE-Split (0% vs 35%, p=0.02) with less transaminase release. Despite prolonged SCS (473 vs 117min, p<0.001), HOPE-Split was comparable to LD regarding grade≥2 IRI (64 vs 40%; p=0.17) and PRS (0 vs 6.7% p=0.34), with however higher transaminase release (571 vs 244 UI/L/100g; p=0.004). Overall, 3-months surgical complications, graft and recipient survival did not differ among groups.

Conclusions

HOPE allowed improved preservation of ex-situ split grafts compared to static cold storage, resulting in similar early IRI profiles then LD grafts. Preservation with HOPE may offer a promising strategy to improve outcomes and expand selection criteria in split LT for pediatric recipients.
Where to Draw the Line in Ex-Situ Split Liver Transplantation for Adult Recipients? – A Benchmarking Analysis
Authors: Muller X , Rossignol G , Mabrut J Y , Mohkam K , Sepulveda A , Lesurtel M , Dondero F , Goumard C , Scatton O , Allard M A , Cherqui D , Pittau G
Published: June 2023

Background

A comprehensive outcome analysis of ex situ right split liver graft transplantation (RSLT) is currently lacking.

Aims

Benchmarking outcomes of RSLT against best achievable results from whole LT offers a novel comparative approach.

Methods

This retrospective study includes all consecutive ex-situ RSLT for adult recipients performed from 2014-2019 at 4 high volume transplant centers (>70 LT/year). Outcomes including overall morbidity expressed by the comprehensive complication index (CCI) and graft related complications were compared to the published benchmark cutoffs for whole graft LT.

Results

We included 129 ex-situ RSLT with 76% H45678 (n=98) and 24% (n=31) H5678 grafts. The median follow-up was 4.8 years. Overall and severe 1-year morbidity expressed by the CCI were within established whole graft LT benchmarks. Biliary complication rates were slightly higher than the benchmark due to the occurrence of cut-surface leaks. The arterial thrombosis rate was outside the benchmark cutoff (7% vs ≤4.4%) leading to a higher retransplantation

rate. However, overall 1-year graft and recipient mortality were well within the benchmark cutoffs, resulting in a 5-year overall recipient survival of 88.5%. Selecting benchmark cases for RSLT defined by low-risk recipient-donor criteria including static cold storage time ≤10h and recipient MELD≤20 points, did not significantly reduce overall morbidity nor arterial complication rate. In contrast, the type of split graft (H45678 vs.H5678) did impact on both arterial and biliary complications.

Conclusions

This large multicenter series of ex-situ right split grafts disclosed an overall 1-year morbi-mortality comparable to the best achievable results in whole graft LT. The results show that the main morbidity burden in adult RSLT is related to technical criteria rather than graft-recipient matching.