bluuebunny/crossref_metadata_2025_split huggingface dataset:
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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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&lt;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.