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PURPOSE: The impact of perineal descent (PD) on functional outcome and quality of life after ventral mesh rectopexy (VMR) is unknown. The purpose of this study was to analyze the effect of PD on the functional outcome and quality of life (QOL) after VMR. METHODS: A retrospective analysis was performed on fifty-five patients who underwent robotic VMR between 2018 and 2021. Pre and postoperative data along with radiological studies were gathered from a prospectively maintained database. The Cleveland Clinic Constipation score (CCCS), the Rome IV criteria and the 36-Item Short-Form Health Survey (SF-36), were used to measure functional results and QOL. RESULTS: All 55 patients (mean age 57.8 years) were female. Most patients had radiological findings of severe PD (n = 31) as opposed to mild/moderate PD (n = 24). CCCS significantly improved at 3 months and 1 year post-VMR (mean difference = -4.4 and -5.4 respectively, p < 0.001) with no significant difference between the two groups. The percentage of functional constipation Rome IV criteria only showed an improved outcome at 3 months for severe PD and at 1 year for mild/moderate PD (difference = -58.1% and -54.2% respectively, p < 0.05). Only the SF-36 subscale bodily pain significantly improved in the mild/moderate PD group (mean difference = 16.7, p = 0.002) 3 months post-VMR which subsided after one year (mean difference = 5.5, p = 0.068). CONCLUSION: Severe PD may impact the functional outcome of constipation without an evident effect on QOL after VMR. The results, however, remain inconclusive and further research is warranted.
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Laparoscopia , Prolapso Retal , Feminino , Humanos , Pessoa de Meia-Idade , Constipação Intestinal/cirurgia , Laparoscopia/métodos , Períneo/cirurgia , Qualidade de Vida , Prolapso Retal/cirurgia , Reto/cirurgia , Estudos Retrospectivos , Telas Cirúrgicas , Resultado do TratamentoRESUMO
INTRODUCTION: Tunneled dialysis catheters (TDCs) are important for hemodialysis in patients awaiting a permanent surgical solution, kidney transplantation or without feasible surgical access. Infection of a TDC is a common and severe complication, which often requires removal of the TDC and causes high morbidity and mortality. To date, several risk factors for TDC infections have been reported. This systematic review and meta-analysis aim to provide an overview of currently known risk factors. METHODS: A systematic literature search was conducted, including all studies describing patient-, catheter-, and dialysis-related risk factors for TDC infections. In case sufficient data was available for a risk factor, a meta-analysis with random effects model was performed. RESULTS: Out of 1273 studies, 30 were included describing a total of 71 risk factors. A meta-analysis was conducted for 26 risk factors. The average incidence of TDC infections was 1.16 ± 0.70/1000 catheter days. Diabetes (odds ratio, OR 1.96), coronary artery disease (OR 2.16), peripheral artery disease (OR 2.28), history of sepsis (OR 2.79), and the number of prior TDCs (OR 1.24) were the most significant risk factors for infection. CONCLUSION: Several risk factors are associated with increased TDC infection rates. Most of these risk factors are also linked with infection in other populations and most likely reflect the general frailty of hemodialysis patients. The association between many risk factors and TDC infections was often unclear due to the low number of studies available. Additional large cohort studies are necessary to demonstrate the relevance of these risk factors.
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A systematic review and meta-analysis were performed to investigate the value of donor-derived cell-free DNA (dd-cfDNA) as a noninvasive biomarker in diagnosing kidney allograft rejection. We searched PubMed, Web of Science and the Cochrane Library for original research papers published between January 1994 and May 2020 on dd-cfDNA fractions in blood of kidney allograft recipients. A single-group meta-analysis was performed by computing pooled estimates for dd-cfDNA fractions using the weighted median of medians or quantile estimation (QE) approach. Weighted median differences in medians (WMDMs) and median differences based on the QE method were used for pairwise comparisons. Despite heterogeneity among the selected studies, the meta-analysis revealed significantly higher median dd-cfDNA fractions in patients with antibody-mediated rejection (ABMR) than patients without rejection or patients with stable graft function. When comparing patients with T cell-mediated rejection (TCMR) and patients with ABMR, our two statistical approaches revealed conflicting results. Patients with TCMR did not have different median dd-cfDNA fractions than patients without rejection or patients with stable graft function. dd-cfDNA may be a useful marker for ABMR, but probably not for TCMR.
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Ácidos Nucleicos Livres , Transplante de Rim , Biomarcadores , Rejeição de Enxerto/diagnóstico , Humanos , Transplante de Rim/efeitos adversos , Doadores de TecidosRESUMO
Post-operative sepsis is a severe complication of surgery, which often worsens the clinical outcomes. While several risk factors have been identified, the importance of others remains uncertain. This systematic review and meta-analysis aimed to determine patient and surgery-related risk factors for post-operative sepsis. We reviewed Medline, the Web of Science, and the Cochrane library, systematically, for articles describing risk factors for sepsis. The role of eligible risk factors was investigated using a random-effects model, while analyzing univariate and multivariate data separately. Among 193 pro- and retrospective articles, comprising over 30 million patients, 38 eligible risk factors were selected for this meta-analysis. The patient-related risk factors associated with post-operative sepsis included male gender (odds ratio, OR 1.41), pre-existing heart failure (OR 2.53), diabetes (OR 1.41), and chronic kidney disease (OR 1.26). The surgery-related risk factors identified included emergency surgery (OR 3.38), peri-operative blood transfusion (OR 1.90), inpatient hospital stay (OR 2.31), and open surgery (OR 1.80). The adjusted overall incidence of surgical sepsis was 1.84%. In conclusion, multiple-patient and surgery-related risk factors are associated with the development of post-operative sepsis. Recognizing these risk factors could assist in the pre-operative identification of patients at risk of post-operative sepsis.
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Complicações Pós-Operatórias/etiologia , Sepse/etiologia , Transfusão de Sangue , Diabetes Mellitus , Tratamento de Emergência , Feminino , Insuficiência Cardíaca , Humanos , Tempo de Internação , Masculino , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/terapia , Insuficiência Renal Crônica , Fatores de Risco , Sepse/epidemiologia , Sepse/terapia , Fatores Sexuais , Procedimentos Cirúrgicos OperatóriosRESUMO
PURPOSE: Bariatric surgery candidates are frequently treated with antidepressants. Several of these drugs have been associated with weight gain and could potentially interfere with weight loss after bariatric surgery. This cohort study aimed to investigate the short-term effects of antidepressants on weight loss during the first 24 months after a Roux-en-Y gastric bypass. METHODS: Patients with a fully documented antidepressant treatment status for at least 12 months were retrospectively included. Weight loss was expressed as the percentage excess BMI loss (%EBMIL) or percentage total weight loss (%TWL). A mixed linear effects model was used to determine the impact of continued and discontinued treatment with antidepressants on weight loss. RESULTS: A total of 751 patients were included in this study. At 24 months, patients had lost 77.38 ± 30.10 %EBMIL (30.63 ± 13.12 %TWL). In patients treated with antidepressants (n = 125), the %EBMIL and %TWL was reduced with - 2.81% (p = 0.025) and - 1.36% (p = 0.002) respectively, and with - 5.52 %EBMIL (p < 0.001; - 1.05 %TWL, p = 0.012) after multivariate adjustment. Serotonin-norepinephrine reuptake inhibitors (- 12.47 %EBMIL, p < 0.001) and tricyclic antidepressants (- 11.01 %EBMIL, p = 0.042) were predominantly responsible for worse outcomes. Beyond 24 months, at 36 months (- 4.83%, p < 0.001) and 48 months (- 3.54%, p = 0.006), the %EBMIL was still reduced. No significant effects of antidepressants on metabolic outcomes after surgery were observed. CONCLUSIONS: Treatment with antidepressants was associated with reduced weight loss after gastric bypass surgery, but only if treatment was continued for at least 1 year postoperatively. Mainly tricyclic antidepressants and serotonin-norepinephrine reuptake inhibitors were responsible for this reduction in weight loss.
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Antidepressivos/uso terapêutico , Derivação Gástrica , Transtornos Mentais/tratamento farmacológico , Obesidade Mórbida/cirurgia , Redução de Peso , Adulto , Feminino , Humanos , Masculino , Transtornos Mentais/complicações , Pessoa de Meia-Idade , Obesidade Mórbida/psicologia , Estudos Retrospectivos , Fatores de Risco , Resultado do TratamentoRESUMO
The aim of this study was to find a relationship between tibial overhang, malpositioning and oversizing, and the functional outcome. 188 patients were included in this retrospective study. All patients completed an Oxford knee score questionnaire at mean followup of 5 years. Anteroposterior radiographs of the total knee replacements were reviewed for medial and lateral overhang and oversizing. Lateral overhang was seen in 32.9% of patients with a mean Oxford knee score of 24.7. However lateral overhang proved no significant correlation with the functional outcome. Oversizing was seen in 31.9% of patients and, with a mean of 25.6, oversizing did have a correlation with Oxford Knee score. This study confirms that neither medial or lateral overhang of the tibial component influences functional outcome, independent of the severity of overhang. Oversizing the tibial component however, does show worse functional outcome scores at a 5 year review.
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Artroplastia do Joelho/instrumentação , Articulação do Joelho/fisiopatologia , Prótese do Joelho , Desenho de Prótese , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Articulação do Joelho/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do TratamentoRESUMO
PURPOSE: To report on the use of intraoperative optical coherence tomography (OCT) imaging of the vitreolenticular interface (VLI) during pediatric cataract surgery and to determine the incidence of VLI dysgenesis and surgical difficulties. SETTING: Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium. DESIGN: Retrospective cohort study. METHODS: This study included 51 pediatric patients who underwent cataract surgery between April 2016 and December 2018. Video recordings and OCT images of the VLI were analyzed and compared. VLI dysgenesis was considered present when intraoperative OCT images demonstrated partial or total adhesions between the posterior lens capsule and the anterior hyaloid membrane. Video recordings were analyzed to describe surgical difficulties, more specifically: inability to create a calibrated primary posterior continuous curvilinear capsulorhexis (PPCCC), occurrence of vitreous prolapse, need for anterior vitrectomy, and complicated IOL implantation. RESULTS: Of the 51 patients included, VLI dysgenesis was demonstrated in 27 patients (52.9%). The incidence of VLI dysgenesis was greater in children with unilateral cataract (72.4%), and children with a posterior capsule plaque (90%). PPCCC was challenging in 20 patients. A defect of the anterior hyaloid membrane was found in 16 patients. Anterior vitrectomy or cutting vitreous strands with scissors was necessary in 10 patients. CONCLUSIONS: Intraoperative OCT images were an excellent tool to evaluate the VLI and to demonstrate the presence of VLI dysgenesis during pediatric cataract surgery. Performing a calibrated PPCCC was more challenging in the presence of VLI dysgenesis. This can subsequently expose a defect in the anterior hyaloid membrane, which may result in vitreous prolapse.
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Extração de Catarata , Catarata , Capsulorrexe , Criança , Humanos , Implante de Lente Intraocular , Estudos Retrospectivos , Tomografia de Coerência Óptica , VitrectomiaRESUMO
PURPOSE: The majority of patients with type 2 diabetes (T2DM) achieve remission after bariatric surgery. Several models are available to preoperatively predict T2DM remission. This study compares the performance of these models in a Western population one year after surgery and explores their predictive value in comparison to a model specifically designed for our study population. MATERIALS AND METHODS: Prediction models were retrieved using a literature search. Patients were retrospectively selected from a database of the Antwerp University Hospital. Performance of the models was assessed by determining the area under the receiver operating characteristic curve (AUROC), the accuracy, and the goodness of fit, and by comparing them to a custom-made logistic model. RESULTS: The probability of T2DM remission was calculated using 11 predictive scoring models and 8 regression models in a cohort of 250 patients. Complete T2DM remission occurred in 64.0% of patients. The IMS score (AUROC = 0.912; accuracy = 83.6%), DiaBetter score (0.907; 82.0%), and Ad-DiaRem score (0.903; 82.8%) best predicted T2DM remission and closely approached the performance of the custom-constructed model (0.917; 84.0%). The model by Ioffe et al. (0.630; 69.2%), Umemura et al. (0.692; 71.4%), and the ABCD score (0.757; 72.8%) were the least accurate. CONCLUSION: Most T2DM remission models reliably predicted one-year T2DM remission, with limited inter-model differences. The accuracy of most models approached that of the custom-constructed model, indicating a high predictive capability and performance in our patient cohort. To date, most models are only validated to estimate T2DM remission one year after surgery and they do not predict long-term remission.
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Cirurgia Bariátrica , Diabetes Mellitus Tipo 2 , Obesidade Mórbida , Diabetes Mellitus Tipo 2/cirurgia , Humanos , Obesidade Mórbida/cirurgia , Indução de Remissão , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: Sepsis is a severe pathological condition associated with systemic inflammation, intestinal inflammation, and gastrointestinal barrier dysfunction. Intestinal alkaline phosphatase (IAP) has been demonstrated to detoxify lipopolysaccharide, an important mediator in the pathophysiology of sepsis. We investigated the effect of treatment with IAP on intestinal permeability, intestinal inflammation, and bacterial translocation. METHODS: OF-1 mice were divided into 4 groups (n = 12/group), undergoing either a sham or cecal ligation and puncture (CLP) procedure to induce sepsis. Mice received IAP or a vehicle intraperitoneally 5 minutes prior to the onset of the CLP or sham procedure, which was repeated every 12 hours for two consecutive days. After two days, in vivo intestinal permeability, intestinal inflammation, and bacterial translocation were determined. KEY RESULTS: CLP-induced sepsis resulted in significantly more weight loss, worse clinical disease scores, bacterial translocation, and elevated inflammatory cytokines. Intestinal permeability was increased up to 5-fold (P < .001). IAP activity was significantly increased in septic animals. Treatment with IAP had no effect on clinical outcomes but reduced the increased permeability of the small intestine by 50% (P = .005). This reduction in permeability was accompanied by a modified gene expression of claudin-1 (P = .025), claudin-14 (P = .035), and interleukin 12 (P = .015). A discriminant analysis showed that treatment with IAP is linked to modified mRNA levels of several tight junction proteins and cytokines. CONCLUSIONS AND INFERENCES: Treatment with IAP diminished CLP-induced intestinal barrier disruption, associated with modified expression of several cytokines and claudins. Nevertheless, this effect did not translate into better clinical outcomes in our experimental setup.
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Fosfatase Alcalina/farmacologia , Permeabilidade da Membrana Celular/efeitos dos fármacos , Mucosa Intestinal/efeitos dos fármacos , Sepse/patologia , Animais , Modelos Animais de Doenças , Mucosa Intestinal/enzimologia , Masculino , Camundongos , Sepse/enzimologiaRESUMO
BACKGROUND: The sleeve gastrectomy (SG) has gained popularity which has resulted in a rising number of patients with T2DM to undergo this procedure. This systematic review and meta-analysis aimed to compare the long-term effects of SG on T2DM remission with remission seen after Roux-en-Y gastric bypass (RYGB) or gastric banding (GB). METHODS: A literature search was performed in PubMed and Cochrane Library using the following search terms: 'sleeve gastrectomy', 'diabetes', 'gastric bypass' and 'gastric banding'. Studies published between January 2000 and April 2018, and with following inclusion criteria were selected for this review: BMI ≥ 35 kg/m2, age ≥ 18 years, follow-up ≥ 1 year, T2DM. Data was statistically analysed using a random-effects model and results were expressed as odds ratio with 95% confidence interval. RESULTS: After exclusion, 35 out of an initial 748 studies, consisting of 18 138 T2DM patients, remained for inclusion. Of these patients, 2480 underwent a SG. The remaining patients underwent a RYGB (n = 10,597) or GB (n = 5061). One year postoperatively, SG patients reached significantly (OR 0.71, p = 0.003) less T2DM remission than RYGB. After stratifying for different criteria for remission, RYGB still tended to result in higher remission rates, but the difference was not statistically significant. Beyond 1 year of follow-up, the difference between RYGB and SG in terms of T2DM remission decreased. SG was superior to the GB (OR 2.17, p = 0.001) after 1 year of follow-up. CONCLUSION: This review demonstrates important remission of T2DM following SG. Nevertheless, as remission was significantly more often observed following RYGB surgery, the latter procedure remains the gold standard for reaching T2DM remission in patients with concurrent obesity.
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Diabetes Mellitus Tipo 2/terapia , Gastrectomia , Derivação Gástrica , Gastroplastia , Indução de Remissão , Humanos , Obesidade Mórbida/cirurgia , Redução de PesoRESUMO
Endoscopic gastric plication or gastroplasty for morbid obesity is gaining worldwide recognition. Data concerning safety and efficacy are rather scarce. Furthermore, clear guidelines are yet to be established. The objective of this meta-analysis is to update the data and investigate the efficacy and safety of the procedure. An online comprehensive search using Cochrane, Google Scholar, PubMed, Web of Science, and Embase on endoscopic gastric plication was completed. The primary outcome was defined as weight loss at 6 months or more after the procedure. Secondary outcomes were defined as the occurrence of adverse events or complications including insufficient weight loss or regain. I2 statistic was used to define the heterogeneity across studies. Twenty-two cohort studies on 7 different devices met the inclusion criteria, with a total of 2475 patients. The mean baseline BMI was 37.8 ± 4.1 kg/m2 (median 37.9; range 28.0-60.2). Either a transoral endoluminal stapling or (suction based) (full-thickness) stitching and/or anchor device was used to obtain gastric volume reduction and/or alter gastric outlet. The mean follow-up was 13 months (median 12; range 6-24) for the specified outcomes of each study. Two active, FDA-approved devices were taken into account for meta-analysis: Endoscopic sleeve gastroplasty (ESG) and the primary obesity surgery endolumenal (POSE™). Average pooled %EWL at 6 months (p = 0.02) and 12 months (p = 0.04) in favor of ESG was 57.9 ± 3.8% (50.5-65.5, I2 = 0.0), 44.4 ± 2.1% (40.2-48.5, I2 = 0.0), and 68.3 ± 3.8% (60.9-75.7, I2 = 5.8), 44.9 ± 2.1% (40.9-49.0, I2 = N/A) for ESG and POSE respectively. Major adverse events without mortality were described in 25 patients (9 studies, p = 0.63). ESG and POSE are both safe and feasible procedures with good short-term weight loss. ESG seems to be superior in terms of weight loss at this point. Few major adverse events are reported and long-term results are awaited.
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Endoscopia Gastrointestinal/métodos , Gastroplastia/métodos , Obesidade Mórbida/cirurgia , Cirurgia Bariátrica/efeitos adversos , Cirurgia Bariátrica/métodos , Endoscopia Gastrointestinal/efeitos adversos , Seguimentos , Gastroplastia/efeitos adversos , Humanos , Obesidade Mórbida/epidemiologia , Estômago/patologia , Estômago/fisiologia , Fatores de Tempo , Resultado do Tratamento , Redução de Peso/fisiologiaRESUMO
BACKGROUND: No real consensus regarding the definition of dumping syndrome (DS) seems to exist and few subtyping is used in clinical practice. Knowledge is needed for correct design of trials and establishment of uniform treatment strategies. The aim of this study is to explore the distribution of clinical characteristics related to the subtypes of DS. METHODS: A comprehensive search was performed in Cochrane, Google Scholar, PubMed, and ResearchGate. Data were collected on the definition and diagnostics of DS used in each study. RESULTS: Twenty-seven clinical trials were included. Seventeen articles clearly provided a definition of DS and ten of these differentiated between early and late DS. Diagnose of DS was based on clinical symptoms (24 articles), hemodynamic parameters (e.g., tachycardia, hypotension; 9 articles), and biochemical analysis (e.g., blood sugar level; 12 articles). Questionnaires were used in 13 articles. A total of 67 different symptoms were correlated with dumping syndrome. Two symptoms were exclusively correlated with early and nine with late DS. Nine articles differentiated between early and late dumping based on timing since the last meal. Hypoglycemia was correlated with late DS in ten articles. CONCLUSIONS: This study reveals a vast heterogeneity in the definition and clinical characteristics of DS after RYGB. We feel that a standardized definition is required to provide a firm parameter in the evaluation and setup of clinical trials. A better understanding and description of the definition and diagnostic criteria of DS after RYGB is crucial to improve scientific reporting.
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Técnicas de Diagnóstico do Sistema Digestório , Síndrome de Esvaziamento Rápido/classificação , Síndrome de Esvaziamento Rápido/diagnóstico , Terminologia como Assunto , Ensaios Clínicos como Assunto/normas , Ensaios Clínicos como Assunto/estatística & dados numéricos , Consenso , Diagnóstico Diferencial , Técnicas de Diagnóstico do Sistema Digestório/classificação , Técnicas de Diagnóstico do Sistema Digestório/normas , Síndrome de Esvaziamento Rápido/patologia , Humanos , Obesidade Mórbida/cirurgia , Guias de Prática Clínica como Assunto , Inquéritos e QuestionáriosRESUMO
BACKGROUND AND OBJECTIVES: During sepsis, gastrointestinal ileus, mucosal barrier dysfunction and bacterial translocation are accepted to be important triggers that can maintain or exacerbate the septic state. In the caecal ligation and puncture animal model of sepsis, we demonstrated that systemic and colonic interleukin-6 levels are significantly increased coinciding with an impaired colonic barrier function. We therefore aimed to study the effect of therapeutic or curative administration of anti-IL6 antibodies on overall GI motility, colonic permeability and translocation of intestinal bacteria in blood and mesenteric lymph nodes in the mouse caecal ligation and puncture model. METHODS: OF-1 mice were randomized to either the preventive or curative protocol, in which they received 1 mg/kg of antibodies to interleukin-6, or its IgG isotype control solution. They subsequently underwent either the caecal ligation and puncture procedure, or sham-surgery. GI motility was assessed 48 h following the procedure, as well as colonic permeability, serum and colon cytokines, colonic tight junction proteins at the mRNA level; cultures of blood and mesenteric lymph nodes were performed. RESULTS: Preventive administration of anti-interleukin-6 antibodies successfully counteracted the gastrointestinal motility disturbances and impaired colonic barrier function that could be observed in vehicle-treated septic animals. Serum and colonic levels of proinflammatory cytokines were significantly lower when animals were preventively treated with anti-interleukin-6 antibodies. A repetitive injection 24 h later resulted in the most pronounced effects. Curative treatment significantly lowered systemic and colonic inflammation markers while the effects on transit and permeability were unfortunately no longer significant. CONCLUSIONS: Caecal ligation and puncture resulted in septic ileus with an increased colonic permeability. Antibodies to interleukin-6 were able to ameliorate gastro-intestinal motility, suppress inflammation and normalize the permeability of the colonic wall, with the preventive administration combined with a repeat injection being far more efficacious than the sole preventive or curative one.