bluuebunny/crossref_metadata_2025_split huggingface dataset:
Local Treatment of Neuroendocrine Liver Metastases: How Effective and Safe is Stereotactic Microwave Ablation?
Authors: Hanreich C , Perrodin S F , Candinas D , Lachenmayer A , Kim-Fuchs C 
Published: June 2023

Abstract

Background
The less invasiveness of local ablation techniques such as stereotactic microwave ablation (SMWA) for the treatment of malignant hepatic lesions has made it an attractive alternative to conventional surgical resection.

Aims
The aim of this retrospective study was to assess the successful ablation rate of neuroendocrine tumor liver metastases (NETLM) 3 months after SMWA, the recurrence-free survival time, as well as the rate of peri- and early post interventional complications.

Methods
Retrospective analysis including all patients treated with SMWA for NETLM in our institution between 03/2015 and 07/2022. SMWA was performed as per the decision of the interdisciplinary tumorboard. Patients were included independent of location of primary tumors, disease stage, prior treatments. Patients underwent follow-up imaging (FU) every 1-6 months.

Results
41 metastases were ablated in 21 interventions in 17 patients with a mean age of 63.6±9.7 years. A median of two lesions (range 1-4) were ablated per intervention. Mean time until first FU was 2.8±1.5 months. 39 of 41 (95.1%) lesions were fully ablated at the first FU. The two incompletely ablated lesions were treated using re-ablation and systemic treatment, respectively. A local recurrence occurred in further two ablation zones (4.9%) after 3.6 years in a patient with a progressive disease. Remaining 37 (90.2%) patients had no tumor recurrence in the ablation zone at the latest available FU (mean 24.3±17.3 months). Postinterventional length of hospital stay was a median of 1 [IQR 1;1.5]. No complications higher than Clavien Dindo Grade II occurred.

Conclusions
SMWA is a good minimal invasive intervention for the treatment of NETLM with low morbidity and high local efficacy.
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

Abstract

Background
Chronic kidney disease (CKD) patients grade III B(GFR 30-44ml/min), IV (GFR 15-29ml/min) and grade V (GFR &lt;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

Abstract

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 &gt;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

Abstract

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&lt;0.001). DRGF occurred more frequently in patients with preoperative embolization (26/88=30% vs. 55/407=14%, p&lt;0.001), biliary anastomosis (20/48=42% vs. 61/450=14%, p&lt;0.001), and extrahepatic resection (37/108=34% vs. 45/393=11%, p&lt;0.001). Patients with DRGF had longer median operation duration (374 vs. 263 min., p&lt;0.001) and higher median blood loss (1088 vs. 701 mL, p&lt;0.001). DRGF patients developed more pneumonias (14/22=64% vs. 8/22=36%, p&lt;0.001) and had longer median length of stay (19 vs. 8 days, p&lt;0.001). On multivariable analysis, operation duration (OR 1, 95%CI 1.002-1.008, p&lt;0.001) and postoperative biloma/biliary leak (OR 3.3, 95%CI 1.8-7.7, p&lt;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

Abstract

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

Abstract

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 &lt; 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

Abstract

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

Abstract

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 &gt;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 &gt;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

Abstract

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&lt;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

Abstract

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

Abstract

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 &lt;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&lt;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.