Comparative study of laparoscopic ventral mesh rectopexy versus perineal stapler resection for external full-thickness rectal prolapse in elderly patients: enhanced outcomes and reduced recurrence rates-a retrospective cohort study.

BACKGROUND: In elderly patients with external full-thickness rectal prolapse (EFTRP), the exact differences in postoperative recurrence and functional outcomes between laparoscopic ventral mesh rectopexy (LVMR) and perineal stapler resection (PSR) have not yet been investigated. METHODS: We conducted a retrospective multicenter study on 330 elderly patients divided into LVMR group (n = 250) and PSR (n = 80) from April 2012 to April 2019. Patients were evaluated before and after surgery by Wexner incontinence scale, Altomare constipation scale, and patient satisfaction questionnaire. The primary outcomes were incidence and risk factors for EFTRP recurrence. Secondary outcomes were postoperative incontinence, constipation, and patient satisfaction. RESULTS: LVMR was associated with fewer postoperative complications (p < 0.001), lower prolapse recurrence (p < 0.001), lower Wexner incontinence score (p = 0.03), and lower Altomare's score (p = 0.047). Furthermore, LVMR demonstrated a significantly higher surgery-recurrence interval (p < 0.001), incontinence improvement (p = 0.019), and patient satisfaction (p < 0.001) than PSR. Three and 13 patients developed new symptoms in LVMR and PSR, respectively. The predictors for prolapse recurrence were LVMR (associated with 93% risk reduction of recurrence, OR 0.067, 95% CI 0.03-0.347, p = 0.001), symptom duration (prolonged duration was associated with an increased risk of recurrence, OR 1.131, 95% CI 1.036-1.236, p = 0.006), and length of prolapse (increased length was associated with a high recurrence risk (OR = 1.407, 95% CI = 1.197-1.655, p < 0.001). CONCLUSIONS: LVMR is safe for EFTRP treatment in elderly patients with low recurrence, and improved postoperative functional outcomes. TRIAL REGISTRATION: Clinical Trial.gov (NCT05915936), retrospectively registered on June 14, 2023.

Risk factors for postoperative pancreatic fistula following non-traumatic, pancreatic surgery. Retrospective observational study.

Pancreatic surgery e pancreatic fistula (POPF) is a potentially fatal sequela with substantial morbidity and mortality. POPF incidence and risk factors vary. This study aimed to evaluate the incidence and risk factors of patients with pancreatic fistula (PF) from patients undergoing various pancreatic surgeries for different pancreatic diseases. MATERIAL AND METHODS: A retrospective observational study was conducted in the surgical unit of our university hospitals from July 2014 to July 2019. Three hundred forty-seven patients were admitted with a clinical diagnosis of pancreatic fistula following both open and laparoscopic approaches for pancreatic benign and malignant tumors. RESULTS: The most prevalent age was >60 years (67%), with a male predominance (83%). The most common diagnosis before surgery was pancreatic head adenocarcinoma (32%), followed by duodenal neoplasm (19%) and true epithelial pancreatic cystic neoplasms (18%), ampullary neoplasms (15%), bile duct neoplasms (12%), neuroendocrine neoplasms (2%), and chronic pancreatitis (2%). The most prevalent site of the pancreatic tumor was the head (87%), while accompanied Jaundice (47%) and epigastric discomfort (37%) were the commonest presentations before surgery. Pancreatic duct diameter greater than 3 mm was present in 208 patients (60%), tumor size greater than 3 cm in 63%, hard pancreatic texture in 67%, and preoperative ERCP with a stent in 37% of cases. Tumor in the tail of the pancreas was found in 5% (17 patients) of cases. The commonest operations performed were open pylorus-preserving pancreaticoduodenectomy, open pancreaticoduodenectomy without pylorus-preserving, and open distal pancreatectomy with splenic preservation. Postoperative pancreatic fistula occurred in 8% of cases (27), with ISPGF grade A (biochemical leak) occurring in 17 patients (17/27) and clinically significant POPF occurring in 10 patients (10/27). POPF occurred in 13 patients after distal pancreatectomy, 11 patients after pancreaticoduodenectomy, two cases followed central pancreatectomy, and one. Grade B after pancreaticoduodenectomy and two after distal pancreatectomy. Grade C POPF occurred in four patients after pancreaticoduodenectomy but not after distal pancreatectomy. Age >55 (p=0.00), male (p=0.03), presence of symptom (p=0.0008), location at Head of the pancreas (p=0.0004), elevated CA19-9 (p=0.0004), jaundice (p=0.0001) and pancreatic texture (p=0.00**). CONCLUSION: Pancreatic fistula occurred in 27 patients (8%), a comparatively low incidence. POPF was linked to age, Jaundice, gender, pancreatic head cancer, symptoms, high CA 19-9, jaundice, and a soft pancreas. POPF incidence was higher after distal pancreatectomy, whereas POPF severity was higher after pancreaticoduodenectomy KEY WORDS: Pancreaticoduodenectomy, Pancreatic Fistula, Pancreatic Resection, Postoperative Complications.

Biliary fistula and late recurrence of liver hydatid cyst: Role of cysto-biliary communication: A prospective multicenter study.

BACKGROUND: Hydatid cyst disease (HCD) is common in certain locations. Surgery is associated with postoperative biliary fistula (POBF) and recurrence. The primary aim of this study was to identify whether occult cysto-biliary communication (CBC) can predict recurrent HCD. The secondary aim was to assess the role of cystic fluid bilirubin and alkaline phosphatase (ALP) levels in predicting POBF and recurrent HCD. AIM: To identify whether occult CBC can predict recurrent HCD. The secondary aim was to assess the role of cystic fluid bilirubin and ALP levels in predicting POBF and recurrent HCD. METHODS: From September 2010 to September 2016, a prospective multicenter study was undertaken involving 244 patients with solitary primary superficial stage cystic echinococcosis 2 and cystic echinococcosis 3b HCD who underwent laparoscopic partial cystectomy with omentoplasty. Univariable logistic regression analysis assessed independent factors determining biliary complications and recurrence. RESULTS: There was a highly statistically significant association (P ≤ 0.001) between cystic fluid biochemical indices and the development of biliary complications (of 16 patients with POBF, 15 patients had high cyst fluid bilirubin and ALP levels), where patients with high bilirubin-ALP levels were 3405 times more likely to have biliary complications. There was a highly statistically significant association (P ≤ 0.001) between biliary complications, biochemical indices, and the occurrence of recurrent HCD (of 30 patients with recurrent HCD, 15 patients had high cyst fluid bilirubin and ALP; all 16 patients who had POBF later developed recurrent HCD), where patients who developed biliary complications and high bilirubin-ALP were 244.6 and 214 times more likely to have recurrent hydatid cysts, respectively. CONCLUSION: Occult CBC can predict recurrent HCD. Elevated cyst fluid bilirubin and ALP levels predicted POBF and recurrent HCD.

Intraoperative endomanometric laparoscopic Nissen fundoplication improves postoperative outcomes in large sliding hiatus hernias with severe gastroesophageal reflux disease: a retrospective cohort study.

BACKGROUND: Laparoscopic Nissen fundoplication (LNF) is the gold standard surgical intervention for gastroesophageal reflux disease (GERD). LNF can be followed by recurrent symptoms or complications affecting patient satisfaction. The aim of this study is to assess the value of the intraoperative endomanometric evaluation of esophagogastric competence and pressure combined with LNF in patients with large sliding hiatus hernia (>5 cm) with severe GERD (DeMeester score >100). MATERIALS AND METHODS: This is a retrospective, multicenter cohort study. Baseline characteristics, postoperative dysphagia and gas bloat syndrome, recurrent symptoms, and satisfaction were collected from a prospectively maintained database. Outcomes analyzed included recurrent reflux symptoms, postoperative side effects, and satisfaction with surgery. RESULTS: Three hundred sixty patients were stratified into endomanometric LNF (180 patients, LNF+) and LNF alone (180 patients, LNF). Recurrent heartburn (3.9 vs. 8.3%) and recurrent regurgitation (2.2 vs. 5%) showed a lower incidence in the LNF+ group ( P =0.012). Postoperative score III recurrent heartburn and score III regurgitations occurred in 0 vs. 3.3% and 0 vs. 2.8% cases in the LNF+ and LNF groups, respectively ( P =0.005). Postoperative persistent dysphagia and gas bloat syndrome occurred in 1.75 vs. 5.6% and 0 vs. 3.9% of patients ( P =0.001). Score III postoperative persistent dysphagia was 0 vs. 2.8% in the two groups ( P =0.007). There was no redo surgery for dysphagia after LNF+. Patient satisfaction at the end of the study was 93.3 vs. 86.7% in both cohorts, respectively ( P =0.05). CONCLUSIONS: Intraoperative high-resolution manometry and endoscopic were feasible in all patients, and the outcomes were favorable from an effectiveness and safety standpoint.