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INTRODUCTION: During the COVID-19 pandemic, elective surgeries including hernia repairs, were postponed, or cancelled completely. However, it has been stated previously that the volume of surgical emergency hernia repairs did not drop during this period. Due to the disruption in elective surgeries, waiting lists have increased rapidly, causing a suspected treatment delay. To gain improved insight in preoperative patient prioritization, the aim of this multicenter study was to track volumes of hernia surgery before, during and after the pandemic to investigate for a shift from elective towards emergency hernia surgery. METHODS: A retrospective study using hernia databases from four regional hospitals to account for altered referral patterns (elective versus emergent), capturing patients' admissions and surgery times for both groin and ventral hernia repair was conducted. Study period was predefined from March 2019 to March 2023. Data are presented as descriptive statistics. RESULTS: During the historic period, 106 of 2267 hernia surgeries (4.7%) performed were defined as emergency repairs. During the pandemic, 3864 elective surgeries were executed, of which 213(5.5%) emergencies. During the current period, the portion of emergencies dropped to 4.9% (110 emergency hernia repairs); (p = 0.039). A non-significant increase in emergent incisional hernia repair during the pandemic period was found chronologically 9.9%, 11.8% and 11.6% emergent repairs(p = 0.75). There were no statistically significant differences across the hernia types in elective versus urgent rate. RESULTS: During the historic period, 106 of 2267 hernia surgeries (4.7%) performed were defined as emergency repairs. During the pandemic, 3864 elective surgeries were executed, of which 213(5.5%) emergencies. During the current period, the portion of emergencies dropped to 4.9% (110 emergency hernia repairs); (p = 0.039). A non-significant increase in emergent incisional hernia repair during the pandemic period was found chronologically 9.9%, 11.8% and 11.6% emergent repairs(p = 0.75). There were no statistically significant differences across the hernia types in elective versus urgent rate. DISCUSSION: Regionwide data showed a 15% decline in hernia repairs during the pandemic compared to historical levels, with an 0.8% increase in emergent repairs. Surgery rates are still convalescent after the pandemic, with a persistent proportion of emergent surgeries. These numbers emphasize the challenges in selecting patient whose hernia repair should not be postponed.
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AIM: To facilitate midline fascial closure in complex abdominal wall surgery, component separation techniques (CST) are usually required. However, CST is associated with an enlarged morbidity. Prehabilitation could increase the compliance of the abdominal wall and thereby decrease the necessity of myofascial release. This can be accomplished by administration of botulinum toxin type A (BTA) in the lateral abdominal wall musculature. The aim of this study was to determine the effect of BTA on the subsequent necessity to perform CST in patients with complex abdominal wall hernias. METHODS: Patients with a complex abdominal wall hernia, planned to undergo CST between July 2020 and November 2022 were included. Outcome of procedures with 300U of BTA 4 (2-6) weeks prior to surgery, were retrospectively analyzed by comparison with propensity matched subjects of an historical group. Hernia width difference was assessed by CT and operative details were included. RESULTS: A total of 13 patients with a median hernia width of 12 cm (IQR 9-14, range 24) were prehabilitated with BTA between July 2020 and November 2022. A CST was planned for all, however not required in 6/13 patients (46%) to accomplish midline fascial closure. A mean elongation of lateral abdominal wall musculature of 4.01 cm was seen in patients not requiring CST. Compared to the propensity score matched control group, a 27% reduction (p = 0.08) in the need for CST was observed. CONCLUSION: There is a tendency for decrease of necessity for CST by preoperatively administered BTA in patients with complex abdominal wall defects. Although small, as this study used propensity matched comparison, further exploration of BTA should be encouraged.
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Pared Abdominal , Toxinas Botulínicas Tipo A , Hernia Ventral , Puntaje de Propensión , Humanos , Masculino , Toxinas Botulínicas Tipo A/administración & dosificación , Femenino , Persona de Mediana Edad , Estudios Retrospectivos , Anciano , Pared Abdominal/cirugía , Hernia Ventral/cirugía , Herniorrafia/métodos , Ejercicio Preoperatorio , Músculos Abdominales , Adulto , Técnicas de Cierre de Herida AbdominalRESUMEN
BACKGROUND: Patients often need admission at an Intensive Care Unit (ICU), immediately after complex abdominal wall reconstruction (CAWR). Lack of ICU resources requires adequate patient selection for a planned postoperative ICU admission. Risk stratification tools like Fischer score and Hernia Patient Wound (HPW) classification may improve patient selection. This study evaluates the decision-making process in a multidisciplinary team (MDT) on justified ICU admissions for patients after CAWR. METHODS: A pre-Covid-19 pandemic cohort of patients, discussed in a MDT and subsequently underwent CAWR between 2016 and 2019, was analyzed. A justified ICU admission was defined by any intervention within the first 24 h postoperatively, considered not suitable for a nursing ward. The Fischer score predicts postoperative respiratory failure by eight parameters and a high score (> 2) warrants ICU admission. The HPW classification ranks complexity of hernia (size), patient (comorbidities) and wound (infected surgical field) in four stages, with increasing risk for postoperative complications. Stages II-IV point to ICU admission. Accuracy of the MDT decision and (modifications of) risk-stratification tools on justified ICU admissions were analyzed by backward stepwise multivariate logistic regression analysis. RESULTS: Pre-operatively, the MDT decided a planned ICU admission in 38% of all 232 CAWR patients. Intra-operative events changed the MDT decision in 15% of all CAWR patients. MDT overestimated ICU need in 45% of ICU planned patients and underestimated in 10% of nursing ward planned patients. Ultimately, 42% went to the ICU and 27% of all 232 CAWR patients were justified ICU patients. MDT accuracy was higher than the Fischer score, HPW classification or any modification of these risk stratification tools. CONCLUSION: A MDT's decision for a planned ICU admission after complex abdominal wall reconstruction was more accurate than any of the other risk-stratifying tools. Fifteen percent of the patients experienced unexpected operative events that changed the MDT decision. This study demonstrated the added value of a MDT in the care pathway of patients with complex abdominal wall hernias.
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Pared Abdominal , COVID-19 , Humanos , Pared Abdominal/cirugía , Pandemias , Estudios Retrospectivos , Herniorrafia/efectos adversos , Unidades de Cuidados Intensivos , Hernia , Grupo de Atención al PacienteRESUMEN
IMPORTANCE: Implementation of bariatric surgery on an outpatient basis is hampered by concerns about timely detection of postoperative complications. Telemonitoring could enhance detection and support transition to an outpatient recovery pathway. OBJECTIVE: This study aimed to evaluate non-inferiority and feasibility of an outpatient recovery pathway after bariatric surgery, supported by remote monitoring compared to standard care. DESIGN: Preference-based non-inferiority randomized trial. SETTING: Center for obesity and metabolic surgery, Catharina hospital Eindhoven, the Netherlands. PARTICIPANTS: Adult patients scheduled for primary gastric bypass or sleeve gastrectomy. INTERVENTIONS: Same-day discharge with one week ongoing Remote Monitoring (RM) of vital parameters or Standard Care (SC) with discharge on postoperative day one. MAIN OUTCOMES: Primary outcome was a thirty-day composite Textbook Outcome score encompassing mortality, mild and severe complications, readmission and prolonged length-of-stay. Non-inferiority of same-day discharge and remote monitoring was accepted below the selected margin of 7% upper limit of confidence interval. Secondary outcomes included admission duration, post-discharge opioid use and patients' satisfaction. RESULTS: Textbook Outcome was achieved in 94% (n = 102) in RM versus 98% (n = 100) in SC (RR 2.9; 95% CI, 0.60-14.23, p = 0.22). The non-inferiority margin was exceeded which is a statistically inconclusive result. Both Textbook Outcome measures were above Dutch average (5% RM and 9% SC). Same-day discharge reduced hospitalization days by 61% (p<0.001) and by 58% with re-admission days included (p<0.001). Post-discharge opioid use and satisfaction scores were equal (p = 0.82 and p = 0.86). CONCLUSION: In conclusion, outpatient bariatric surgery supported with telemonitoring is clinically comparable to standard overnight bariatrics in terms of textbook-outcome. Both approaches reached primary endpoint results above Dutch average. However, statistically the outpatient surgery protocol was neither inferior, nor non-inferior to the standard pathway. Additionally, offering same-day discharge reduces the total hospitalization days while maintaining patient satisfaction and safety.
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Cirugía Bariátrica , Obesidad Mórbida , Adulto , Humanos , Tiempo de Internación , Alta del Paciente , Cuidados Posteriores , Analgésicos Opioides , Pacientes Ambulatorios , Cirugía Bariátrica/métodos , Complicaciones Posoperatorias/etiología , Atención Perioperativa/efectos adversos , Obesidad Mórbida/cirugía , Resultado del Tratamiento , Estudios RetrospectivosRESUMEN
BACKGROUND: As part of a randomized phase II trial in patients with isolated resectable colorectal peritoneal metastases (CPMs), the present study compared patient-reported outcomes (PROs) of patients treated with perioperative systemic therapy versus cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) alone. Also, PROs of patients receiving perioperative systemic therapy were explored. PATIENTS AND METHODS: Eligible patients were randomized to perioperative systemic therapy (experimental) or CRS-HIPEC alone (control). PROs were assessed using EORTC QLQ-C30, QLQ-CR29, and EQ-5D-5L questionnaires at baseline, after neoadjuvant treatment (experimental), and at 3 and 6 months postoperatively. Linear mixed modeling was used to compare five predefined PROs (visual analog scale, global health status, physical functioning, fatigue, C30 summary score) between arms and to longitudinally analyze PROs in the experimental arm. RESULTS: Of 79 analyzed patients, 37 (47%) received perioperative systemic therapy. All predefined PROs were comparable between arms at all timepoints and returned to baseline at 3 or 6 months postoperatively. The experimental arm had worsening of fatigue [mean difference (MD) + 14, p = 0.001], loss of appetite (MD + 15, p = 0.003), hair loss (MD + 18, p < 0.001), and loss of taste (MD + 27, p < 0.001) after neoadjuvant treatment. Except for loss of appetite, these PROs returned to baseline at 3 or 6 months postoperatively. CONCLUSIONS: In patients with resectable CPM randomized to perioperative systemic therapy or CRS-HIPEC alone, PROs were comparable between arms and returned to baseline postoperatively. Together with the trial's previously reported feasibility and safety data, these findings show acceptable tolerability of perioperative systemic therapy in this setting.
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Neoplasias Colorrectales , Hipertermia Inducida , Neoplasias Peritoneales , Humanos , Quimioterapia Intraperitoneal Hipertérmica , Neoplasias Peritoneales/secundario , Neoplasias Colorrectales/patología , Procedimientos Quirúrgicos de Citorreducción , Terapia Combinada , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Medición de Resultados Informados por el Paciente , Tasa de SupervivenciaRESUMEN
PURPOSE: Surgical site occurrences after transversus abdominis release in ventral hernia repair are still reported up to 15%. Evidence is rising that preoperative improvement of risk factors might contribute to optimal patient recovery. A reduction of complication rates up to 40% has been reported. The aim of this study was to determine whether prehabilitation has a favorable effect on the risk on wound and medical complications as well as on length of stay. METHODS: A retrospective cohort study was performed in a tertiary referral center for abdominal wall surgery. All patients undergoing ventral hernia repair discussed at multidisciplinary team (MDT) meetings between 2015 and 2019 were included. Patients referred for a preconditioning program by the MDT were compared to patients who were deemed fit for operative repair by the MDT, without such a program. Endpoints were patients, hernia, and procedure characteristics as well as length of hospital stay, wound and general complications. RESULTS: A total of 259 patients were included of which 126 received a preconditioning program. Baseline characteristics between the two groups were statistically significantly different as the prehabilitated group had higher median BMI (28 vs 30, p < 0.001), higher HbA1c (41 vs 48, p = 0.014), more smokers (4% vs 25%, p < 0.001) and higher HPW classes due to more patient factors (14% vs 48%, p < 0.001). There were no significant differences in intra-operative and postoperative outcome measures. CONCLUSIONS: This study showed prehabilitation facilitates patients with relevant comorbidities achieving the same results as patients without those risk factors. The indication of a preconditioning program might be effective at the discretion of an MDT meeting. Further research could focus on the extent of such program to assess its value.
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Pared Abdominal , Hernia Ventral , Humanos , Estudios Retrospectivos , Ejercicio Preoperatorio , Herniorrafia/efectos adversos , Herniorrafia/métodos , Hernia Ventral/cirugía , Hernia Ventral/etiología , Músculos Abdominales/cirugía , Grupo de Atención al Paciente , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/cirugía , Pared Abdominal/cirugíaRESUMEN
Obesity seems to adversely affect oral health-related quality of life. Remakably, several studies show a further decrease of oral health-related quality of life after bariatric surgery despite the weight loss. The objective of this study was to assess the perceived oral health-related quality of life in dentulous, obese patients and in dentulous, bariatric patients at least one year after they underwent surgery. This was assessed using the validated Dutch short version of the Oral Health Impact Profile questionnaire, consisting of 14 questions divided into 7 categories. A higher score on this questionnaire indicate a lower oral health-related quality of life. Based on the collected data of 440 patients, the overall oral health-related quality of life seems unaffected by bariatric surgery: a decrease was however seen regarding the functional limitation subcategory compared to preoperative patients with obesity.
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Cirugía Bariátrica , Obesidad Mórbida , Salud Bucal , Humanos , Obesidad , Obesidad Mórbida/cirugía , Calidad de Vida , Pérdida de PesoRESUMEN
PURPOSE: More interest in the treatment of rectus diastasis has been evoked lately. Following the postpartum females from a great distance, the middle-aged males living with obesity are the second most common group of rectus diastasis patients. Although gender differences are considered frequently in regard to cosmetic appearance and symptoms, it is less obvious in classifications and subsequent treatment strategies. Is a unisex approach of rectus diastasis still applicable? The lack of a firm answer warrants this review of the current literature. METHODS: An explorative free-text multi-database bibliographic search (Pubmed/CENTRAL/EMBASE/PEDro/Scholar) was performed with the focus on the rectus diastasis in males. Anticipating the limited references, the design was a non-systematic review. All studies, regardless of study type, language or time period, describing etiology, symptoms, classification and/or treatment options were eligible for inclusion. From the articles retrieved out of this search, additional references were identified by a manual search among the cited references. RESULTS: The multi-database search resulted in a total of 7633 records. Based on the title and abstract 95 records were full text assessed for eligibility. Eleven studies were identified as relevant, six by cross-reference and another four by hand-search were added to provide an insight in gender-specific aspects in rectus diastase. Hereditary causes are differences in collagen-like composition of types and concomitant abdominal aneurysm as well as gender differences in the linea alba architecture. Acquired etiology is distributed into both absolute pressure by visceral obesity and relative pressure caused by weight lifting or improper exercises. Furthermore, the impact of muscle thickness and age are considered as influencers of biomechanics. Gender differences can also play a role in symptoms of body image and core stability. It is known that there are anatomical differences between male and female persons; more transverse fibers are found in infra-umbilical region in women. In classifications the awareness of male rectus diastasis is limited, treatment outcome studies are scarce on males. CONCLUSION: An overview of male-specific aspects of rectus diastasis is provided, underlining that key aspects surrounding rectus diastasis in males differ from females. Although males are the minority of rectus diastasis patients, we recommend that the male rectus diastasis as a concept should be specifically acknowledged in classifications systems and study outcome reporting to evaluate this subgroup more accurately in the future.
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Pared Abdominal , Recto del Abdomen , Pared Abdominal/cirugía , Ejercicio Físico , Femenino , Herniorrafia , Humanos , Masculino , Persona de Mediana Edad , Recto del Abdomen/cirugíaRESUMEN
BACKGROUND: This study aimed to compare treatment strategies and survival of patients with synchronous colorectal peritoneal metastases (CPM) and patients with metachronous CPM in a nationwide cohort. METHODS: All patients from the Netherlands Cancer Registry with synchronous or metachronous CPM whose primary colorectal cancer (CRC) was diagnosed between 1 January and 30 June 2015 were included in the study. Treatments were categorized as (A) cytoreductive surgery and hyperthermic intraperitoneal chemotherapy [CRS-HIPEC]; (B) palliative treatment; or (C) best supportive care. Overall survival (OS) for all the patients and disease-free survival (DFS) for those who underwent CRS-HIPEC were compared between the two groups. RESULTS: Of 7233 patients, 743 had a diagnosis of CPM, including 409 patients with synchronous CPM and 334 patients with metachronous CPM. The median OS was 8.1 months for the patients with synchronous CPM versus 12 months for the patients with metachronous CPM (p = 0.003). After multivariable correction, OS no longer differed between the patients with synchronous CPM and those with metachronous CPM (HR 1.03 [0.83-1.27]). The patients with metachronous CPM more often underwent CRS-HIPEC than the patients with synchronous CPM (16 % vs 8 %; p = 0.001). The two groups did not differ statistically in terms of DFS and OS (median DFS, 21.5 vs 14.1 months, respectively; p = 0.094; median OS, 37.8 vs. 35.8 months, respectively; p = 0.553). CONCLUSION: This population-based study showed that survival for the patients with synchronous CPM and patients with metachronous CPM did not significantly differ. This suggests that a similar prognosis may be expected for patients selected for treatment regardless of the onset of CPM.
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Neoplasias Colorrectales , Hipertermia Inducida , Neoplasias Peritoneales , Neoplasias Colorrectales/terapia , Terapia Combinada , Procedimientos Quirúrgicos de Citorreducción , Humanos , Neoplasias Peritoneales/terapia , Pronóstico , Tasa de SupervivenciaRESUMEN
INTRODUCTION: - To investigate the incidence of, factors associated with, and differences between synchronous and metachronous colorectal peritoneal metastases (CPM) in a population-based cohort. METHODS: - Data from the Netherlands Cancer Registry were used. All patients diagnosed with colorectal cancer (CRC) between 1 January and June 30, 2015 were evaluated for synchronous or metachronous CPM (diagnosis ≤90 or >90 days after surgery for primary CRC), and survival in 2019 (median follow-up 38.4 months). RESULTS: - Of 7233 included patients, 409 (5.7%) were diagnosed with synchronous CPM. Factors associated with synchronous CPM were mucinous (OR 2.72 [1.90-3.90]) or signet ring cell (SRC) histology (OR 6.58 [3.66-11.81]), T4 (OR 4.82 [3.68-6.32]), N1 (OR 1.66 [1.20-2.30]), or N2 stage (OR 3.27 [2.36-4.52]), and synchronous systemic metastases (SM) (OR 3.13 [2.37-4.14]). After surgery for primary CRC, 326 patients developed metachronous CPM after a median time of 14.7 months (3-year cumulative incidence: 5.5%). Factors associated with metachronous CPM were younger age (HR 1.63 [1.10-2.42]), mucinous (HR 1.84 [1.20-2.82]) or SRC histology (HR 2.43 [1.11-5.32]), T4 (HR 2.77 [2.07-3.70]), N1 (HR 2.90 [2.18-3.85]), N2 (HR 3.19 [2.26-4.50]), and synchronous SM (HR 1.95 [1.43-2.66]). CONCLUSION: - This population-based study found the highest incidence of CPM currently reported in literature and a strong association between the presence of synchronous SM and both synchronous and metachronous CPM. These findings may contribute to a tailored approach in the follow-up after primary CRC surgery and guide future clinical trials investigating new strategies regarding risk-reduction or early detection of metachronous CPM.
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Neoplasias Colorrectales/patología , Neoplasias Primarias Múltiples/epidemiología , Neoplasias Primarias Secundarias/epidemiología , Neoplasias Peritoneales/secundario , Anciano , Anciano de 80 o más Años , Neoplasias Colorrectales/cirugía , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Neoplasias Primarias Múltiples/patología , Neoplasias Primarias Secundarias/patología , Neoplasias Peritoneales/epidemiología , Neoplasias Peritoneales/patologíaRESUMEN
PURPOSE: Complex ventral hernia repair (CVHR) encompasses patient optimization, primary fascial closure (PFC), mesh reinforcement and component separation technique (CST), if needed. High rates of complications after CST are still reported. Prehabilitation by managing pre-operative modifiable risk factors, like abdominal wall compliance, possibly reduces these rates. Compliance can be modified by intramuscular injection of Botulinum in the lateral abdominal wall muscles (LAWM). Paralysis leads to elongation of these muscles, which may facilitate PFC and/or prevent CST. Evidence to use Botulinum in hernia patients is scarce and fragmented. An update of evidence for the effect of Botulinum is presented. METHODS: A multi-database search was conducted for Botulinum studies in ventral hernia patients. A systematic review was performed to describe its primary effect on compliance (LAWM elongation) and secondary effects like PFC ± CST rate, complications and recurrence. RESULTS: 14 studies were included (377 patients) with a HDW of median 12 (10-15) cm. A typical intervention consisted of 200-300 U Botulinum in 3 points per hemi-abdomen under US guidance, > 2 weeks pre-operatively and evaluated by CT just before the operation. The primary effect was a median LAWM elongation of 4.0 cm per side without complications of the injection (four studies, 107 patients). The median PFC rate was 100%, CST rate 38%, wound-related complications 19%, medical complications 18% and recurrence 0% (14 studies). CONCLUSION: Botulinum safely elongates the abdominal wall muscles, but the level of evidence available remains low. Any patient in whom PFC is expected to be difficult, could be a candidate for prehabilitation with Botulinum.
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Pared Abdominal , Toxinas Botulínicas Tipo A , Clostridium botulinum , Hernia Ventral , Fármacos Neuromusculares , Pared Abdominal/cirugía , Hernia Ventral/cirugía , Herniorrafia/efectos adversos , Herniorrafia/métodos , Humanos , Cuidados Preoperatorios/métodos , Ejercicio Preoperatorio , Estudios Prospectivos , Estudios Retrospectivos , Mallas QuirúrgicasRESUMEN
BACKGROUND: Extent of peritoneal metastases (PM) is among the most powerful prognostic factors for survival after cytoreductive surgery (CRS). This study aimed to compare the Peritoneal Cancer Index (PCI) and the Dutch region count as tools for staging PM of colorectal cancer. The Dutch region count is a simpler classification that distinguishes seven rather than 13 abdominal regions. Presence or absence of PM is recorded. METHODS: This was a retrospective cohort study in two tertiary referral centres in the Netherlands. Consecutive patients with colorectal PM who were intentionally treated with CRS and subsequent hyperthermic intraperitoneal chemotherapy in 2016 and 2017 were included. The PCI and Dutch region count were both recorded during laparotomy. Correlation between scoring tools was calculated using Spearman's rank correlation coefficient. Diagnostic values were calculated for different cut-off values of the PCI, alongside the Dutch region count. The correlation of both scores was determined for the exploration and validation cohorts separately. RESULTS: In the exploration and validation cohorts, 73 and 85 patients respectively were included. Spearman's correlation coefficients of 0·897 and 0·961 were observed for continuous scores of the Dutch region count and PCI in the exploration and validation group respectively. A cut-off value of 20 for the PCI score and 5 for the Dutch region count showed 91·9 and 94·5 per cent sensitivity, and 81·8 and 91·7 per cent specificity, respectively. CONCLUSION: The Dutch region count correlated well with the PCI score, and may help to simplify reporting of the extent of peritoneal disease.
ANTECEDENTES: La extensión de las metástasis peritoneales (peritoneal metastases, PM) es uno de los factores pronósticos más importantes para la supervivencia después de la cirugía citorreductora (cytoreductive surgery, CRS). El objetivo de este estudio fue comparar el índice de carcinomatosis peritoneal (Peritoneal Cancer Index, PCI) y el recuento holandés por regiones como herramientas para la estadificación de las PM del cáncer colorrectal. El recuento holandés por regiones es una clasificación más simple que distingue 7 regiones abdominales en lugar de 13. En dichas regiones abdominales se registró la presencia o ausencia de PM. MÉTODOS: Se llevó a cabo un estudio de cohortes retrospectivo en dos centros de referencia terciarios en los Países Bajos. Se incluyeron pacientes consecutivos con PM de origen colorrectal que fueron tratados con CRS seguida de quimioterapia intraperitoneal hipertérmica (hyperthermic intraperitoneal chemotherapy, HIPEC) en 2016 y 2017. Durante la laparotomía se recogieron datos del índice PCI y de la clasificación de las regiones abdominales. Se utilizó el coeficiente de correlación de Spearman para analizar la correlación entre estas dos herramientas de puntuación. Se calculó la precisión diagnóstica en función de diferentes umbrales del índice PCI junto con los datos del recuento por regiones. Asimismo, se calcularon las correlaciones entre ambas puntuaciones en las cohortes de exploración y validación por separado. RESULTADOS: Se incluyeron 73 pacientes en la cohorte de exploración y 85 en la de validación. Los coeficientes de correlación de Spearman eran de 0,987 para puntuaciones continuas del recuento holandés por regiones abdominales y del PCI en la cohorte de exploración y de 0,961 en la cohorte de validación. Los umbrales de corte de 20 para el índice PCI y de 5 para el recuento por regiones demostraron sensibilidades de 91,9% y 94,5%, y especificidades de 81,8% y 91,7%, respectivamente. CONCLUSIÓN: El recuento holandés por regiones abdominales se correlacionó bien con el PCI y puede ser útil para simplificar la extensión de la enfermedad peritoneal.
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OBJECTIVES: In the Netherlands, limited variability exists in performance of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) among centers treating colorectal peritoneal metastases (PM), except for the intraperitoneal drug administration. This offers a unique opportunity to investigate any disparities in survival between the two most frequently used HIPEC regimens worldwide: mitomycin C (MMC) and oxaliplatin. METHODS: This was a comparative, population-based cohort study of all Dutch patients diagnosed with synchronous colorectal PM who underwent CRS-HIPEC between 2014 and 2017. They were retrieved from the Netherlands Cancer Registry. Main outcome was overall survival (OS). The effect of the intraperitoneal drug on OS was investigated using multivariable Cox regression analysis. RESULTS: In total, 297 patients treated between 2014 and 2017 were included. Among them, 177 (59.6%) received MMC and 120 (40.4%) received oxaliplatin. Only primary tumor location was different between the two groups: more left-sided colon in the Oxaliplatin group (47.5% vs. 33.3%, respectively, p=0.048). The 1-, 2- and 3-year OS were 84.6% vs. 85.8%, 61.6% vs. 63.9% and 44.7% vs. 53.5% in patients treated with MMC and oxaliplatin, respectively. Median OS was 30.7 months in the MMC group vs. 46.6 months in the oxaliplatin group (p=0.181). In multivariable analysis, no influence of intraperitoneal drug on survival was observed (adjusted HR 0.77 [0.53-1.13]). CONCLUSIONS: Long-term survival between patients treated with either MMC or oxaliplatin during CRS-HIPEC was not significantly different.
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Adenocarcinoma/terapia , Antineoplásicos/uso terapéutico , Neoplasias Colorrectales/terapia , Procedimientos Quirúrgicos de Citorreducción , Quimioterapia Intraperitoneal Hipertérmica/métodos , Mitomicina/uso terapéutico , Oxaliplatino/uso terapéutico , Neoplasias Peritoneales/terapia , Adenocarcinoma/patología , Adenocarcinoma/secundario , Adenocarcinoma Mucinoso/patología , Adenocarcinoma Mucinoso/secundario , Adenocarcinoma Mucinoso/terapia , Anciano , Neoplasias Colorrectales/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Países Bajos , Neoplasias Peritoneales/secundario , Modelos de Riesgos Proporcionales , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
PURPOSE: Weight loss is one of the desired outcomes after a gastric bypass, in order to reduce co-morbidity, and even mortality. However, weight loss might contribute to a serious complication: internal herniation (IH). Pre-operative diagnosis of IH is demanding. This study was conducted to investigate if percentage total weight loss (%TWL) is clinically usable in recognizing patients with IH. MATERIALS AND METHODS: Patients who had undergone a gastric bypass between 2011 and 2014 were included retrospectively if a CT scan or reoperation was performed for suspected IH between 2011 and 2016. Differences in %TWL were calculated in patients with IH and without (NO-IH). A sub analysis was done in patients with complaints. A multivariate analysis to identify risk factors for IH was performed. RESULTS: Out of 1007 patients, 31 patients were diagnosed with an IH (3.1%) after a median time of 16.5 months (range 6.5-46.1). The %TWL was higher in patients with an IH (34.2% ± 12.7) vs. NO-IH (30.8% ± 9.6). This result was also seen in patients presenting with symptoms (IH 34.2% ± 12.7 vs. NO-IH 27.0% ± 14.8). If %TWL is above 30%, IH is significantly more diagnosed in patients presenting with symptoms. A multivariate logistic model for IH in patients presenting with symptoms identified both ≥ 30%TWL (adjusted OR 3.1, 95% CI 1.1-8.8, p = 0.036) and abdominal cramping (adjusted OR 3.2, 95% CI 1.2-8.5, p = 0.0021) as risk factors. CONCLUSION: Our study showed significant more %TWL in patients with an IH. Both ≥ 30%TWL and cramping abdominal pain result in a threefold higher risk of presence of IH.
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Derivación Gástrica , Laparoscopía , Obesidad Mórbida , Derivación Gástrica/efectos adversos , Humanos , Obesidad Mórbida/cirugía , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Pérdida de PesoRESUMEN
PURPOSE: In The Netherlands, the quality of abdominal wall hernia surgery is largely unknown due to the lack of a hernia registry. This study was designed to assess the current state of abdominal wall hernia surgery in The Netherlands, to create a starting point for future evaluation of new quality measures. METHODS: Dutch hernia management indicators and recently proposed European Hernia Society (EHS) requirements for accredited/certified hernia centers were used. The number of Dutch hospitals that meet the four main EHS requirements (on volume, experience, use of a registry and quality control) was assessed by analyzing governmental information and the results of a survey amongst all 1.554 Dutch general surgeons. RESULTS: The survey was representative with 426 respondents (27%) from all 75 hospitals. Fifty-one percent of the hospitals had a median inguinal repair volume of more than 290 (14-1.238) per year. An open or laparo-endoscopic inguinal repair technique was not related to hospital volume. Experienced hernia surgeons, use of a registry and a structured quality control were reported to be present in, respectively, 97%, 39%, and 15% of the hospitals. Consensus in answers between the respondents per hospital was low (< 20%). Two hospitals (3%) met all four requirements for accreditation. CONCLUSION: This descriptive analysis demonstrates that hernia surgery in the Netherlands is performed in every hospital, by all types of surgeons, using many different techniques. If the suggested EHS requirements are used as a measuring rod, only 3% of the Dutch hospitals could be accredited as a hernia center.
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Hernia Abdominal , Herniorrafia , Hospitales Especializados/normas , Pared Abdominal/cirugía , Acreditación/normas , Endoscopía , Encuestas de Atención de la Salud/estadística & datos numéricos , Hernia Abdominal/clasificación , Hernia Abdominal/epidemiología , Hernia Abdominal/cirugía , Herniorrafia/métodos , Herniorrafia/normas , Herniorrafia/estadística & datos numéricos , Hospitales Especializados/estadística & datos numéricos , Humanos , Hernia Incisional/epidemiología , Hernia Incisional/cirugía , Países Bajos/epidemiología , Garantía de la Calidad de Atención de Salud , Calidad de la Atención de Salud/estadística & datos numéricos , Sistema de RegistrosRESUMEN
This multicentre retrospective cohort study included 447 patients with Hinchey Ib and II diverticular abscesses, who were treated with antibiotics, with or without percutaneous drainage. Abscesses of 3 and 5 cm in size were at higher risk of short-term treatment failure and emergency surgery respectively. Initial non-surgical treatment of Hinchey Ib and II diverticular abscesses was comparable between patients treated with antibiotics only and those who underwent percutaneous drainage in combination with antibiotics, with regard to short- and long-term outcomes. Most do not need drainage.
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Absceso Abdominal/tratamiento farmacológico , Absceso Abdominal/cirugía , Colectomía/métodos , Diverticulitis del Colon/tratamiento farmacológico , Diverticulitis del Colon/cirugía , Absceso Abdominal/diagnóstico , Adulto , Antibacterianos/uso terapéutico , Estudios de Cohortes , Diverticulitis del Colon/diagnóstico , Drenaje/métodos , Femenino , Estudios de Seguimiento , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Países Bajos , Modelos de Riesgos Proporcionales , Recurrencia , Estudios Retrospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Insuficiencia del Tratamiento , Resultado del TratamientoRESUMEN
AIM: Laparoscopic peritoneal lavage has increasingly been investigated as a promising alternative to sigmoidectomy for perforated diverticulitis with purulent peritonitis. Most studies only reported outcomes up to 12 months. Therefore, the objective of this study was to evaluate long-term outcomes of patients treated with laparoscopic lavage. METHODS: Between 2008 and 2010, 38 patients treated with laparoscopic lavage for perforated diverticulitis in 10 Dutch teaching hospitals were included. Long-term follow-up data on patient outcomes, e.g. diverticulitis recurrence, reoperations and readmissions, were collected retrospectively. The characteristics of patients with recurrent diverticulitis or complications requiring surgery or leading to death, categorized as 'overall complicated outcome', were compared with patients who developed no complications or complications not requiring surgery. RESULTS: The median follow-up was 46 months (interquartile range 7-77), during which 17 episodes of recurrent diverticulitis (seven complicated) in 12 patients (32%) occurred. Twelve patients (32%) required additional surgery with a total of 29 procedures. Fifteen patients (39%) had a total of 50 readmissions. Of initially successfully treated patients (n = 31), 12 (31%) had recurrent diverticulitis or other complications. At 90 days, 32 (84%) patients were alive without undergoing a sigmoidectomy. However, seven (22%) of these patients eventually had a sigmoidectomy after 90 days. Diverticulitis-related events occurred up to 6 years after the index procedure. CONCLUSION: Long-term diverticulitis recurrence, re-intervention and readmission rates after laparoscopic lavage were high. A complicated outcome was also seen in patients who had initially been treated successfully with laparoscopic lavage with relevant events occurring up to 6 years after initial surgery.
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Diverticulitis/terapia , Perforación Intestinal/terapia , Laparoscopía/métodos , Lavado Peritoneal/métodos , Peritonitis/terapia , Anciano , Diverticulitis/complicaciones , Femenino , Estudios de Seguimiento , Humanos , Perforación Intestinal/complicaciones , Masculino , Persona de Mediana Edad , Readmisión del Paciente/estadística & datos numéricos , Peritonitis/etiología , Recurrencia , Estudios Retrospectivos , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: Transversus abdominis release (TAR), as a type of posterior component separation, is a new myofascial release technique in complex ventral hernia repair. TAR preserves rectus muscle innervation, creates an immense retromuscular plane and allows bilaminar ingrowth of the mesh. The place of the TAR within the range of established anterior component separation techniques (CST) is unclear. Aim of this systematic literature review is to estimate the position of the TAR in the scope of ventral hernia repair techniques. METHODS: MEDLINE, Embase, Pubmed and the Cochrane controlled trials register and Science citation index were searched using the following terms: 'posterior component separation', 'transversus abdominis release', 'ventral hernia repair', 'complex abdominal wall reconstruction'. To prevent duplication bias, only studies with a unique cohort of patients who underwent transversus abdominis release for complex abdominal wall reconstruction were eligible. Postoperative complications and recurrences had to be registered adequately. The rate of surgical site occurrences and recurrences of the TAR were compared with those after anterior CST, published earlier in two meta-analyses. RESULTS: Five articles met our strict inclusion criteria, describing 646 TAR patients. Methodological quality per study was good. Mean hernia surface was 509 cm2 and 88% of the hernias were located in the midline. Preoperative risk stratification was distributed in low risk (10%), co-morbid (55%), potentially contaminated (32%) and infected (3%). Pooled calculations demonstrated a mean SSO rate of 15% after TAR (20-35% after anterior CST) and a mean 2-year hernia recurrence rate of 4% (13% after anterior CST). Mean hernia surface was 300 cm2 in anterior component separation studies. CONCLUSION: This review demonstrates that the transversus abdominis release is a good alternative for anterior CST in terms of SSO and recurrence, especially in very large midline ventral hernias.
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Músculos Abdominales/cirugía , Pared Abdominal/cirugía , Abdominoplastia/métodos , Hernia Ventral/cirugía , Herniorrafia/efectos adversos , Complicaciones Posoperatorias/cirugía , Humanos , Recurrencia , ReoperaciónRESUMEN
Obesity, defined as a body mass index of ≥30 kg/m2 , is the most common chronic metabolic disease worldwide and its prevalence has been strongly increasing. Obesity has deleterious effects on cardiac function. The purpose of this review is to evaluate the effects of obesity and excessive weight loss due to bariatric surgery on cardiac function, structural changes and haemodynamic responses of both the left and right ventricle.