Changes in the Epidemiology of Hepatocellular Carcinoma in Carinthia, Austria, 2012-2023.

BACKGROUND: Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related deaths and remains a major burden on healthcare systems worldwide. The incidence of HCC continues to rise globally, despite preventative efforts being made. AIMS: This study aimed to investigate epidemiological changes observed in the etiology and survival outcomes of HCC patients at Klinikum Klagenfurt am Wörthersee between 2012 and 2023. METHODS: This was a retrospective, single-center cohort study. Two time-periods (2012-2017 and 2018-2023) were created to enable comparison between the respective intervals. IBM SPSS was used to analyze statistical data. RESULTS: More patients were diagnosed with HCC during the second time period (n = 128, n = 148). The median age of diagnosis was 72.5 years (SD 8.6). Patients were on average 2 years younger in the second time period compared to the first (p = 0.042). Alcohol remained the leading underlying etiology of HCC and no statistically significant change was seen over time (p = 0.353). Nevertheless, a clear upward trend in the number of NASH cases was evident over time (n = 15, n = 28, respectively). Nearly half of the patient population had a normal AFP (<7 µg/L) level at the time of diagnosis (n = 116, 42.6%). The survival time for HCC patients remained similar between time periods, with a median overall survival time of 20.5 months (95% CI 16.8-24.2, p = 0.841), despite improvements in management strategies and the availability of new systemic treatments. More advanced-stage HCC cases were documented in the second period (BCLC-C, n = 23 to n = 46, p = 0.051). An increased number of HCC patients without liver cirrhosis were identified during the second time period (n = 22, n= 47, respectively, p = 0.005). NASH was the most common underlying etiology in patients without liver cirrhosis (50%) compared to alcohol use in being the primary cause in cirrhotic patients (65%, p < 0.001). CONCLUSION: HCC continues to be an important health concern in our society. The number of HCC patients without liver cirrhosis is steadily increasing, with NAFLD/NASH, due to underlying lifestyle diseases playing an important etiological role. Continued efforts should be made to prevent HCC and to screen at-risk population groups. Preventative strategies and screening techniques should be adjusted in light of the changing epidemiological landscape of HCC, where more focus will have to be placed on detecting HCC in patients without underlying cirrhosis.

Single-incision laparoscopic cholecystectomy: will it succeed as the future leading technique for gallbladder removal?

BACKGROUND: The quest for less traumatic abdominal approaches is changing paradigms in times of minimally invasive surgery. While natural orifice translumenal endoscopic surgery remains experimental, the single-incision approach could be the future of gallbladder surgery. METHODS: Prospectively collected data from 875 patients subjected to conventional single-incision laparoscopic cholecystectomy (SILC) or 4-port [laparoscopic cholecystectomy (LC)] were retrospectively analyzed and discussed with the current literature. RESULTS: Between 2008 and 2011, 201 (23%) SILCs and 674 (77%) LCs were performed. Mean age was 51.7±17.5 years (SILC: 45.1 vs. LC: 53.7 y). Patients were predominantly female (SILC: 75.1% vs. LC: 56.5%). Preoperative body mass index was 27.4±9.1 (SILC: 26.4 vs. LC: 27.8; P<0.05) and American Society of Anesthesiologists' score counted 1.67±0.57 in SILC and 1.86±0.7 in LC patients. Acute inflammation of the gallbladder (AIG) was not considered as a contraindication for SILC (AIG in SILC: 17.4% vs. LC: 35.5%). The mean operative time was significantly lower in the SILC group (SILC: 71±31 vs. LC: 79±27 min) and duration of postoperative hospital stay was shorter (SILC: 3.2±1.7 vs. LC: 4.5±2.6 d). No significant difference was observed between SILC and LC in any of the registered complications, including postoperative bleeding, trocar hernias, wound infection, abdominal abscess formation, bile duct injury, or cystic duct leakage. CONCLUSIONS: In the near future SILC could overrule conventional LC as the leading technique for gallbladder surgery. Our data reconfirm an excellent risk profile for SILC that is equal to that of LC. Large multicenter randomized controlled trials will be required to finally legitimize SILC as the succeeding principal method.

Single-incision laparoscopic sleeve gastrectomy versus multiport laparoscopic sleeve gastrectomy: analysis of 80 cases in a single center.

BACKGROUND: Through efficacy and improved safety, multiport laparoscopic sleeve gastrectomy (LAPS-G) has emerged as an important and broadly available treatment option for people with severe and complex obesity. Because a single-incision laparoscopic sleeve gastrectomy (SILS-G) would be less invasive, we applied this novel surgical technique for a selected number of patients enrolled into our minimally invasive bariatric program. SUBJECTS AND METHODS: A retrospective review of prospectively collected data from 80 morbidly obese patients who qualified for SILS-G or LAPS-G was performed from January 2011 to May 2012. RESULTS: SILS-G and LAPS-G were performed in 40 patients, respectively. All patients were female. Mean age was 41 (range, 19-73) years (SILS-G, 37 [19-62] years; LAPS-G, 43 [24-73] years; P=not significant). Preoperative body mass index was 40.8 (35.1-45.0) kg/m(2) in the SILS-G group and 43.8 (35.0-47.8) kg/m(2) in the LAPS-G group (P=not significant). Total operative time was significantly lower in the SILS-G group (85±21 minutes) compared with the LAPS-G group (97±26 minutes) (P<.05). Median percentage excess weight loss was comparable in both groups (SILS-G, 57.2%; LAPS-G, 53.7%) at 6.6 months after surgery. Mean hospital stay was 5 days (SILS-G, 5 [4-24] days; LAPS-G, 6 [4-14] days; P=not significant). Complication rates were low in both groups: leakage, 2.5% in SILS-G and 0% in LAPS-G; bleeding, 2.5% in SILS-G and 2.5% in LAPS-G; and trocar-site hernia, 0% in both groups. Patients operated on with single-incision laparoscopy had a significantly better cosmetic outcome as assessed by a scar satisfaction assessment questionnaire (P<.01). CONCLUSIONS: SILS-G is a feasible and safe operative procedure that leads to a significant reduction of total operative time compared with a multiport access procedure. Further potential benefits associated with single-incision laparoscopic surgery remain to be investigated objectively.

Routine upper gastrointestinal swallow studies after laparoscopic sleeve gastrectomy are unnecessary.

BACKGROUND: Laparoscopic sleeve gastrectomy has gained popularity among bariatric surgeons. The purpose of this study was to evaluate the usefulness of early upper gastrointestinal (UGI) contrast studies in the detection of postoperative complications. METHODS: Radiographic reports were reviewed from April 2006 to January 2013. During that time, 161 patients underwent laparoscopic sleeve gastrectomy. All patients were submitted to UGI examination on postoperative day (POD) 1. RESULTS: Among the 161 patients who underwent UGI, no contrast leaks were found on POD 1. Three patients (1.9%) developed stapler line leaks near the gastroesophageal junction, which were diagnosed on PODs 3, 4, and 10. Gastroesophageal reflux in 5 patients (3.1%) and delayed gastroesophageal transit in 10 patients (6.2%) were detected. CONCLUSIONS: The results of this study show that UGI series on POD 1 cannot assess the integrity of the gastric remnant. Early UGI series are not required as routine procedures in all operated patients. Computed tomographic swallow studies should be performed in patients who postoperatively develop clinical signs and symptoms of complications such as tachycardia, pain, or fever.

Results and complications after laparoscopic sleeve gastrectomy.

PURPOSE: Laparoscopic sleeve gastrectomy (SG) has gained popularity and acceptance among bariatric surgeons, mainly due its low morbidity and mortality. The purpose of the present study was to evaluate the efficacy of SG on weight loss, and to determine the postoperative course, clinical presentation and treatment of complications after SG. METHODS: Between January 2006 and October 2012, 153 consecutive patients underwent SG. All data were prospectively collected in a computerized database. RESULTS: This series comprised 119 females and 34 males with a median age of 46 years and a median preoperative BMI of 42.3 kg/m2. The median EWL was 53.0 % after 18.4 months of follow-up. The median postoperative BMI was 33.3 kg/m2 (range 19.7­56.1 kg/m2). Eight patients (5.2 %) required re-laparoscopy to manage postoperative hemorrhage (3.3 %) and leakage (1.9 %). Neither abdominal drains nor postoperative contrast-swallow studies were successful in diagnosing hemorrhage or leaks in our patients. CONCLUSION: SG is an effective procedure to achieve significant short-term weight loss. Clinical signs, such as tachycardia, pain, fever and hypotension, provide the best evidence of the presence of postoperative leakage or bleeding. An early diagnosis of these complications is the key to ensuring adequate treatment with immediate re-laparoscopy.

Transumbilical single-incision laparoscopic sleeve gastrectomy: Short-term results and technical considerations.

BACKGROUND: Laparoscopic sleeve gastrectomy (SG) has gained popularity and acceptance among bariatric surgeons, mainly due its low morbidity and mortality. Single-incision laparoscopic surgery has emerged as another modality of carrying out the bariatric procedures. While the single-incision transumbilical (SITU) approach represents an advance, especially for cosmetic reasons, its application in morbid obesity at present is limited. We describe our short-term surgical results and technical considerations with SITU-SG. MATERIALS AND METHODS: SITU-SG was performed in 10 patients between June 2010 and June 2011. SG was performed in a standard fashion and was started 6 cm from the pylorus using a 36 French bougie. RESULTS: They were all females with a mean age of 45 years. Preoperative BMI was 40 kg/m(2) (range, 35-45). The mean operative time was 98 min. No peri- or postoperative complications or deaths occurred. All patients were very satisfied with the cosmetic outcomes and excess weight loss. CONCLUSION: True SITU laparoscopic SG is safe and feasible and can be performed without changing the existing principles of the procedure.

Long-term follow-up evaluation of revisional gastric bypass after failed adjustable gastric banding.

BACKGROUND: Disappointing long-term results, frequent band failure, and high rates of band-related complications increasingly necessitate revisional surgery after adjustable gastric banding. Laparoscopic conversion to gastric bypass has been recommended as the procedure of choice. This single-center retrospective study aimed to evaluate the long-term results of revisional gastric bypass after failed adjustable gastric banding. METHODS: The study included 108 consecutive patients who underwent laparoscopic conversion of gastric banding to gastric bypass from 2002 to 2012. Indications for surgery, operative data, weight development, morbidity, and mortality were analyzed. The median follow-up period was 3.4 years (maximum, 10 years). RESULTS: The most common indications for band removal were band migration, insufficient weight loss, and pouch dilation. The median interval between gastric banding and gastric bypass was 6.6 years. In 52 % of the cases, band removal and gastric bypass surgery were performed simultaneously as a single-stage laparoscopic procedure. The early postoperative morbidity rate was 10.2 %. The body mass index before gastric banding (43.3 kg/m(2)) decreased significantly to 37.9 kg/m(2) before gastric bypass and to 28.8 kg/m(2) 5 years after gastric bypass. CONCLUSIONS: This is the first report on the long-term outcome after conversion of failed adjustable gastric banding to gastric bypass. Findings have shown revisional gastric bypass to be a feasible bariatric procedure particularly for patients with insufficient weight loss that guarantees a constant and long-lasting weight loss.

Single-incision laparoscopic sleeve gastrectomy.

Laparoscopic sleeve gastrectomy has gained popularity and acceptance among bariatric surgeons, mainly as a result of its low morbidity and mortality. Single-incision laparoscopic surgery (SILS), the most recent development in minimally invasive surgery, allows operations to be carried out through only a single incision using special ports. To further minimize the trauma of access incisions, we applied the SIL sleeve gastrectomy on a selected number of patients enrolled into our minimally invasive bariatric program. Between June 2010 and May 2012, 40 consecutive female patients underwent SIL sleeve gastrectomy. All data (demographic, morphologic, operative, and follow-up data) were prospectively collected in a computerized data bank. All patients were female. Mean age was 37 years (range, 19 to 62 years), preoperative body mass index was 40.8 kg/m(2) (range, 35.1 to 45.0 kg/m(2)), and excess weight loss was 57.2 per cent at 6.6 months after surgery. Total operative time was 85 ± 21 minutes and mean hospital stay was 5 days (range, 4 to 24 days). Of the patients, two (5%) sustained postoperative complications such as leakage from the suture line and hemorrhage one in each case. There was no trocar site hernia. SIL sleeve gastrectomy seems to be an effective surgical option for the treatment of morbid obesity. During the first 6 months after the operation, weight loss was excellent. These results are at present comparable to those of multiport sleeve gastrectomy. SIL sleeve gastrectomy is safe and feasible and can be performed without changing the existing principles of this procedure.

Results and complications after Swedish adjustable gastric banding-10 years experience.

BACKGROUND: Bariatric surgery is currently the only effective treatment for morbid obesity. The main advantage of laparoscopic adjustable gastric banding is that this operation is minimally invasive to the stomach and adjustable to the patient's needs. Few long-term studies on Swedish adjustable gastric banding (SAGB) have been published. We here report our 10-year experience with 785 SAGB procedures. METHODS: Between January 1996 and January 2006, 785 consecutive patients (81% women, 19% men) underwent laparoscopic SAGB. All data (demographic and morphologic, operative, and annual follow-up data) were prospectively collected in a computerized data bank. The postoperative follow-up program was performed largely by residents while 30 different surgeons performed the operation. RESULTS: Follow up data were available for 733 patients (98.3%); 52 patients (6.6%) were lost to follow-up. The median follow-up was 3.0 years (range, 1-10 years). The median total weight loss was 26 kg after 1 year and 40.5 kg after 8 years with a median EWL of 65.5% after 8 years. The median BMI decreased from 42.9 to 28.3 kg/m2. A total number of 688 complications occurred in 396 patients (50.4%). The most common complications were esophagitis (28.8%), pouch dilation (15.3%), esophageal dilation (12.5%), port problems (11%), band migration (6.5%), and band leakage (6.4%). Overall, 251 reoperations (32%) were performed. There was no mortality. CONCLUSIONS: From our 10-year experience, we can state that SAGB is an effective bariatric procedure for achieving weight loss. Because of the high complication and reoperation rate, it is necessary to select patients according to specific criteria for gastric banding.

High complication rate after Swedish adjustable gastric banding in younger patients < or =25 years.

BACKGROUND: Swedish adjustable gastric banding (SAGB) is an effective treatment for morbid obesity. The main advantage of this procedure is that this operation is minimally invasive to the stomach and totally reversible and adjustable to the patient's needs. The aim of this observational study is to present our experience with patients < or =25 years old. METHODS: Between January 1996 and January 2006, 107 patients (85 women, 22 men) of 785 consecutive patients who underwent SAGB during the study period were aged < or =25 years (13.6%). All data (demographic and morphologic data, operative data, and follow-up data) were prospectively collected in a computerized data bank. The postoperative follow-up program was performed most of the time by residents, and 17 different surgeons performed the operation. RESULTS: The mean total weight loss was 27 kg after 1 year, reaching a total of 40 kg after 8 years. The mean EWL was 65.5% after 8 years, and the BMI decreased from 43.3 to 28.2 kg/m(2). In the 107 patients, there were 50 patients with 72 complications (46.7%) and 57 patients with no complication (53.3%). The most common complications were esophagitis (25.2%), pouch dilation (16.8%), port problems (6.5%), esophageal dilation (5.6%) and band leakage (4.7%). Overall, 31 patients (29%) needed a reoperation. There was no mortality. CONCLUSION: SAGB operation and the follow-up should only be performed by a small team of bariatric surgeons. Because of the high complication and reoperation rate, a gastric-band-specific patient selection will be necessary. On the basis of 8 years follow-up, SAGB is an effective bariatric procedure for achieving weight loss.

Results and complications after Swedish adjustable gastric banding in older patients.

BACKGROUND: Swedish adjustable gastric banding (SAGB) is an effective treatment for morbid obesity. The aim of this study was to assess the efficacy and safety of SAGB in older patients aged >or=50 years. METHODS: Between January 1996 and January 2006, 134 patients (102 women, 32 men) of 785 consecutive patients who underwent SAGB during the study period were aged >or=50 years. Two groups of patients were analyzed: Group 50 (n=107) patients aged 50-59 years and Group 60 (n=27) patients aged 60-69 years. All data (demographic and morphologic data, operative data, and follow-up data) were prospectively collected in a computerized databank. RESULTS: One hundred thirty-four patients (17.1%) out of 785 entered the study. Mean percentage of excess weight loss (%EWL) was 37.5 at 1 year and 48.8 at 7 years, body mass index (BMI) fell from 43.3 to 33.1 at 7 years. In the 134 patients, there were 65 patients with 121 complications (48.5%) and 69 patients with no complication (51.5%). The most common complications were esophagitis (27%), esophageal dilation (16%), port problems (11%), pouch dilation (11%), band leakage (9%), and band migration (7%). Overall, 46 patients (34%) needed a reoperation. In Group 50, mean %EWL was 38.4 at 1 year and 54.9 at 7 years. BMI fell from 42.9 to 33.1 at 7 years. In the 107 patients, there were 55 patients with 99 complications (51%) and a reoperation rate of 35.5%. In Group 60, mean %EWL was 32.8 at 1 year and 41.2 at 7 years. BMI fell from 44.3 to 34 at 7 years. In the 27 patients, there were ten patients with 22 complications (37%) and a reoperation rate of 29.6%. There was no mortality. CONCLUSIONS: At 7-year follow-up, for older patients, SAGB is an effective bariatric procedure for achieving weight loss. Nevertheless, based on the high complication and reoperation rate, a gastric band-specific patient selection will be necessary.

Intraoperative colonoscopy for anastomosis assessment in laparoscopically assisted left-sided colon resection: is it worthwhile?

BACKGROUND: The aim of our study was to evaluate the use of intraoperative colonoscopy in laparoscopically assisted left-sided colon resection for the assessment of anastomosis. MATERIALS AND METHODS: All consecutive laparoscopically assisted left-sided colon resections performed at our department between May 2001 and February 2006 were included in this study. After colon resection and reanastomosis, an intraoperative colonoscopy was performed to detect anastomosis risk. RESULTS: A total of 122 patients were enrolled in this study. In 73 patients (59.84%), the anastomosis was checked via colonoscopy (the study group, (SG), whereas the control group (CG) consisted of 49 (40.16%) patients without colonoscopy. Of the 122 patients, 65 (53.28%) underwent a laparoscopically assisted sigmoid resection, 45 (36.89%) a laparoscopically assisted sigmoid rectum resection, 4 (3.28%) a laparoscopically assisted anterior rectum resection, and 8 (6.56%) a laparoscopically assisted left hemicolectomy. In the study group, 5 (6.85%) anastomotic leakages were intraoperatively detected and oversewn. A total of 6 (4.92%) anastomotic leakages occurred in the early postoperative period (SG: 4 [5.47%] vs. CG: 2 [4.08%]; P = 0.541). CONCLUSIONS: Intraoperative evaluation of anastomosis prevents early anastomotic insufficiency because intraoperative identification of leaks allows for repair during surgery. Nevertheless, a certain rate of anastomotic dehiscence occurs in every kind of colon resection. The sometimes increased rate of dehiscence in laparoscopic-assisted colon resection can be reduced by intraoperative colonoscopy.

Intragastric injection of botulinum toxin A for the treatment of obesity.

BACKGROUND: Botulinum toxin A (BTX-A) is a powerful and long-acting inhibitor of muscular contractions in both striated and smooth muscles. Hypothetically, BTX-A should inhibit the acetylcholine-mediated peristalsis, which is mainly responsible for gastric motility, and thereby induce slowed gastric emptying, earlier satiety and weight loss. The aim of this study was to observe the effects of endoscopic intragastric injections of BTX-A in obese patients. METHODS: After approval by the University Ethics Committee, 10 female patients with class I obesity (body mass index 30-35) were double-blind randomized into 2 groups (BTX-A and 0.9% Saline). In Group 1, 200 U BTX-A were injected endoscopically into the antrum and the distal gastric body. In Group 2, 0.9% saline was injected endoscopically into the antrum and the distal gastric body. Body weight and feeling of satiety were recorded monthly over a period of 6 months. RESULTS: Both groups (BTX-A and 0.9% Saline) showed no significant weight reduction (P>0.05). One patient in Group 1 and two patients in Group 2 reported a feeling of early satiety. No adverse effects related to BTX-A or complications resulting from the endoscopic procedure were observed. CONCLUSION: Intragastric injection of BTX-A for the treatment of obesity does not seem to reduce body weight.

An unusual complication of gastric bypass: perforated duodenal ulcer.

Peptic ulcer in the excluded segment of a gastric bypass has been reported in the literature in only 17 cases. We report a 54-year-old woman with a perforated duodenal ulcer, who had undergone laparoscopic Roux-en-Y gastric bypass surgery for morbid obesity 15 months previously. She was successfully treated by a laparoscopic repair of the perforated duodenal ulcer.

Results and complications after laparoscopic adjustable gastric banding in super-obese patients, using the Swedish band.

BACKGROUND: Laparoscopic adjustable gastric banding is effective in inducing weight loss, as well as being minimally invasive, totally reversible, and adjustable to the patient's needs. The aim of this study was to assess the efficacy and safety of adjustable gastric banding with the Swedish band (SAGB) in super-obese patients. PATIENTS AND METHODS: Between January 1996 and December 2003, 682 patients (570 women, 112 men) underwent SABG implantation. In these patients, there were 60 super-obese patients with a BMI >/= 50 kg/m(2). Two groups of patients were analyzed: Group 50 (n = 30 patients) with a BMI 50-54 kg/m(2) and Group 55 (n = 30 patients) with a BMI >/= 55 kg/m(2). 13 different surgeons (9 general and 4 bariatric surgeons) performed the SAGB. All data (demographic and morphologic data, operative data, and follow-up data) were prospectively collected in a computerized data bank. RESULTS: 60 patients (8.8%) out of 682 were super-obese and entered the study. Mean %EWL was 39.2 at 1 year and 60.4 at 4 years, BMI fell from 55.5 to 34.7 at 4 years. The complication rate was 26.7% (16/60). General surgeons 12/60 (20%) had more complications than bariatric surgeons 4/60 (6.7%). In Group 50, mean %EWL was 42.1 at 1 year, 55.9 at 2 years, 61.5 at 3 years and 59.9 at 4 years. BMI fell from 51.8 to 33.2 at 4 years. Postoperative complications occurred in 6/30 patients (20%): pouch dilatation (n=2), band migration (n=2) and band leakage (n=2). In Group 55, mean %EWL was 36.8 at 1 year, 55.3 at 2 years, 55.8 at 3 years, and 59.4 at 4 years. BMI fell from 59.1 to 36.4 at 4 years. Postoperative complications occurred in 10/30 patients (33.3%): pouch dilatation (n=2), band migration (n=3) and band leakage (n=5). There was no mortality. CONCLUSION: SAGB is an effective procedure for the surgical treatment of super-obesity. Because of the high complication rate, super-obese patients should only be treated by experienced bariatric surgeons.

Accuracy of preoperative pinhole subtraction single photon emission computed tomography for patients with primary and recurrent hyperparathyroidism in an endemic goiter area.

PURPOSE: Bilateral parathyroid exploration is still the standard therapeutic procedure for primary and recurrent hyperparathyroidism (HPTH). Since a unilateral surgical strategy that reduces surgical complications should not increase the risk of missing enlarged parathyroid glands, reliable preoperative imaging is the first requirement for this approach. This study was conducted to assess the accuracy of preoperative (99m)TcO(4)-(201)T1 pinhole subtraction single photon emission computed tomography (SPECT) compared with sonography. METHODS: The study population consisted of 15 patients with primary (n = 13) or recurrent (n = 2) HPTH who underwent preoperative (99m)TcO(4)-(201)T1 pinhole subtraction SPECT. Preoperative sonography was also done in 14 of these patients. RESULTS: (99m)TcO(4)-(201)T1 pinhole subtraction SPECT was significantly more accurate than sonography. It had an overall accuracy of 80% in detection of enlarged parathyroid glands. The accuracy of localization increased to 92.3% in patients with solitary adenomas, and to 100% in those with solitary adenomas and no previous parathyroid exploration. CONCLUSIONS: The high accuracy of preoperative localization with (99m)TcO(4)-(201)T1 pinhole subtraction SPECT in patients with primary and recurrent HPTH allows for an imaging-guided unilateral operative strategy in most patients, even those with concomitant nodular goiters. This may reduce the risk of surgical complications and expand the use of minimally invasive techniques in parathyroid surgery.