Association between clinical and surgical variables with postoperative outcomes in patients treated for intestinal obstruction for non-malignant conditions: a cross-sectional study.

Intestinal obstruction is considered a frequent surgical pathology related to previous surgical procedures. Many different factors can lead to different outcomes when surgical management is needed. Therefore, we aim to describe the factors related to morbidity and mortality in surgical management of IO in a single-center experience. Retrospective observational study with a prospective database, in which we described patients who underwent surgical management due to intestinal obstruction between 2004 and 2015. Demographics, perioperative data, surgical outcomes, morbidity, and mortality were described. 366 patients were included. Female were 54.6%. Mean age was 61.26. Laparoscopic approach was done in 21.8% and the conversion rate was 17.2%. Intestinal resection was performed in 37.9% of the cases. Postoperative complications were observed in 18.85%. Reintervention and mortality were 9.5% and 4.1% respectively. Laparoscopic approach shows lesser time of intestinal transit (mean 28.67 vs. mean 41.95 h), and restart of oral intake after surgery (mean 96.06 vs. mean 119.65) compared with open approach. Increased heart rate and intensive care unit length of stay were related with mortality (p 0.01 and 0.000 respectively). For morbidity, laparotomy and need and duration of ICU stay were related with any complication statistically significant (p 0.02, 0.008, 0.000 respectively). Patients with increased heart rate in the emergency room, decreased amount of intravenous fluids, need and higher length of stay in the intensive care unit, and delay in resuming oral intake after surgery appear to have poor outcomes. Laparoscopic approach seems to be a safe and feasible approach for intestinal obstruction in selected patients.

Intermediate risk of choledocholithiasis: are we on the right path?

The risk of choledocholithiasis should be assessed in every patient undergoing cholecystectomy to define the next step. The American Society for Gastrointestinal Endoscopy proposed a stratified predictor scale of choledocholithiasis. Therefore, we aimed to describe our experience managing patients with an intermediate risk of choledocholithiasis according to the American Society for Gastrointestinal Endoscopy guidelines and the actual presence of bile duct stones in magnetic resonance cholangiopancreatography. Methods: A retrospective observational study with a prospective database was conducted. The analysis included sociodemographic data, laboratory values, and imaging. Bivariate, multivariate, and receiver operating characteristic analysis were performed. Results: Three hundred twenty-seven patients had an intermediate risk for choledocholithiasis. Half the patients were at least 65 years old. 24.77% were diagnosed with choledocholithiasis. Bile duct dilation was documented in only 3.06% of cases. Diagnosis of choledocholithiasis is associated with an age odds ratio (OR): 1.87 (P 0.02), alkaline phosphatase OR: 2.44 (P 0.02), and bile duct dilation greater than 6 mm OR: 14.65 (P 0.00). Conclusions: High variability in the accuracy of imaging techniques results in a large number of patients classified as intermediate risk without choledocholithiasis in cholangioresonance. Therefore, enhancing the criteria to define intermediate risk for patients in order to optimize resources is of paramount importance.

Variations in clinical course and surgical outcomes of acute appendicitis during COVID-19 Pandemic: a multicenter cohort study.

BACKGROUND: COVID-19 pandemic has led to changes in the presentation and treatment of surgical pathologies. Therefore, we aim to describe the influence of the COVID-19 pandemic on the clinical presentation and management of acute appendicitis (AAp) and its surgical outcomes. STUDY DESIGN: A multicenter cohort study with prospectively collected databases. Three high-volume centers were included and all patients over 18 years of age who underwent appendectomy for AAp were included. Multiple logistic regression and multinomial logistic regression were performed, and odds ratio, relative risk, and B-coefficient were reported when appropriate, statistical significance was reached with p-values < 0.05. RESULTS: 1.468 patients were included (709 in the pre-pandemic group and 759 in the COVID-19 group). Female patients constituted 51.84%. Mean age was 38.13 ± 16.96 years. Mean Alvarado's score was 7.01 ± 1.59 points. Open surgical approach was preferred in 90.12%. Conversion rate of 1.29%. Mortality rate was 0.75%. There was an increase of perforated and localized peritonitis (p 0.01) in the COVID-19 group. Presence of any postoperative complication (p 0.00), requirement of right colectomy and ileostomy (p 0.00), and mortality (p 0.04) were higher in the COVID-19 group. Patients in the pre-pandemic group have a lesser risk of mortality (OR 0.14, p 0.02, 95% CI 0.02-0.81) and a lesser relative risk of having complicated appendicitis (RR 0.68, p 0.00, 95% CI 0.54-0.86). CONCLUSION: Complicated appendicitis was an unexpected consequence of the COVID-19 pandemic, due to surgical consultation delay, increased rates of morbidity, associated procedures, and mortality, influencing the clinical course and surgical outcomes of patients with AAp.

Survival Outcomes of Hepatectomy in Gastric Cancer Liver Metastasis: A Systematic Review and Meta-Analysis.

Gastric cancer liver metastasis (GCLM) is a contraindication for surgical treatment in current guidelines. However, the results of recent studies are questioning this paradigm. We assessed survival outcomes and their predictors following hepatectomy for GCLM in a systematic review of studies published from 2000 to 2022 according to PRISMA guidelines. We identified 42,160 references in four databases. Of these, 55 articles providing data from 1990 patients fulfilled our criteria and were included. We performed a meta-analysis using random-effects models to assess overall survival (OS) and disease-free survival (DFS) at one, three, and five years post-surgery. We studied the impact of potential prognostic factors on survival outcomes via meta-regression. One, three, and five years after surgery, OS was 69.79%, 34.79%, and 24.68%, whereas DFS was 41.39%, 23.23%, and 20.18%, respectively. Metachronous presentation, well-to-moderate differentiation, small hepatic tumoral size, early nodal stage, R0 resection, unilobar compromisation, and solitary lesions were associated with higher overall survival. Metachronous presentation, smaller primary tumoral size, and solitary metastasis were linked to longer DFS. The results of our meta-analysis suggest that hepatectomy leads to favorable survival outcomes in patients with GCLM and provides data that might help select patients who will benefit most from surgical treatment.

Transversus abdominis release (TAR) procedure: a retrospective analysis of an abdominal wall reconstruction group.

Complex abdominal wall defects are important conditions with high morbidity, leading to impairment of patients' physical condition and quality of life. In the last decade, the abdominal wall reconstruction paradigm has changed due to the formation of experienced and excellence groups, improving clinical outcomes after surgery. Therefore, our study shows the perspective and outcomes of an abdominal wall reconstruction group (AWRG) in Colombia, focused on the transverse abdominis release (TAR) procedure. A retrospective review of a prospectively collected database was conducted. All the patients older than 18 years old that underwent TAR procedures between January 2014-December 2020 were included. Analysis and description of postoperative outcomes (recurrence, surgical site infection (SSI), seroma, hematoma, and re-intervention) were performed. 47 patients underwent TAR procedure. 62% of patients were male. Mean age was 55 ± 13.4 years. Mean BMI was 27.8 ± 4.5 kg/m2. Abdominal wall defects were classified with EHS ventral Hernia classification having a W3 hernia in 72% of all defects (Mean gap size of 11.49 cm ± 4.03 cm). Mean CeDAR preoperative risk score was 20.5% ± 14.5%. Preoperative use of BOTOX Therapy (OR 1.0 P 0.00 95% CI 0.3-1.1) or pneumoperitoneum (OR 0.7 P 0.04 95% CI 0.3-0.89) are slightly associated with postoperative hematoma. In terms of hernia relapse, we have 12% of cases; all of them over a year after the surgery. TAR procedure for complex abdominal wall defects under specific clinical conditions including emergency scenarios is viable. Specialized and experienced groups show better postoperative outcomes; further studies are needed to confirm our results.

Postoperative outcomes of minimally invasive adrenalectomy: do body mass index and tumor size matter? A single-center experience.

BACKGROUND: Since Gagner performed the first laparoscopic adrenalectomy in 1992, laparoscopy has become the gold-standard procedure in the treatment of adrenal surgical diseases. A review of the literature indicates that the rate of intra- and postoperative complications are not negligible. This study aims to describe the single-center experience of adrenalectomies; and explore the associations between body mass index (BMI) and tumor volume in main postoperative outcomes. METHODS: Retrospective observational study with a prospective database in which we described patients who underwent adrenalectomy between January 2015 and December 2020. Operative time, intraoperative blood loss, conversion rate, complications, length of hospital stay, and comparison of the number of antihypertensive drugs used before and after surgery were analyzed. Analysis of BMI and tumor volume with postoperative outcomes such as anti-hypertensive change (AHC) in drug usage and pre-operative conditions were performed. RESULTS: Forty-five adrenalectomies were performed, and all of them were carried out laparoscopically. Four were performed as a robot-assisted laparoscopy approach. Nineteen were women and 26 were men. Mean age was 54.9 ± 13.8 years. Mean tumor volume was 95.698 mm3 (3.75-1010.87). Mean operative time was shorter in right tumors (2.64 ± 0.75 h) than in left tumors (3.33 ± 2.73 h). Pearson correlation was performed to assess the relationship between BMI and AHC showing a direct relationship between increased BMI and higher change in anti-hypertensive drug usage at postoperative period r(45) = 0.92, p > 0.05 CI 95%. Higher tumor volume showed a longer operative time, r(45) = 0.6 (p = 0.000 CI 95%). CONCLUSIONS: Obese patients could have an increased impact with surgery with an increased change in postoperative anti-hypertensive management. Tumor volume is associated with increased operative time and blood loss, our data suggest that it could be associated with increased rates of morbidity. However, further prospective studies with larger sample sizes are needed to validate our results.

Intestinal Paracoccidioidomycosis: Case report and literature review.

INTRODUCTION AND IMPORTANCE: Paracoccidioidomycosis (PCM) is a systemic fungal infection, primarily affecting the respiratory tract. Extra pulmonary presentation is rare, representing less than 1% of cases (about 1 in every 200 cases). CASE PRESENTATION: We present a case of a 73-year-old male with acute surgical abdomen secondary to Intestinal Paracoccidioidomycosis requiring intestinal resection and postoperative antifungal therapy. CONCLUSION: Intestinal Paracoccidioidomycosis represents a rare pathology with challenging diagnostic approach due to its frequency and nonspecific clinical manifestations. Extra pulmonary presentation is rare, but it should be considered in endemic regions.

Morbimortality assessment in abdominal surgery: are we predicting or overreacting?

BACKGROUND: High-risk surgical procedures represent a fundamental part of general surgery practice due to its significant rates of morbidity and mortality. Different predictive tools have been created in order to quantify perioperative morbidity and mortality risk. POSSUM (Physiological and Operative Severity Score for the enumeration of Mortality and morbidity) is one of the most widely validated predictive scores considering physiological and operative variables to precisely define morbimortality risk. Nevertheless, seeking greater accuracy in predictions P-POSSUM was proposed. We aimed to compare POSSUM and P-POSSUM for patients undergoing abdominal surgery. METHODS: A retrospective observational study with a prospective database was conducted. Patients over 18 years old who complied with inclusion criteria between 2015 and 2016 were included. Variables included in the POSSUM and P-POSSUM Scores were analyzed. Descriptive statistics of all study parameters were provided. The analysis included socio-demographic data, laboratory values ​​, and imaging. Bivariate analysis was performed. RESULTS: 350 Patients were included in the analysis, 55.1% were female. The mean age was 55.9 ± 20.4 years old. POSSUM revealed a moderated index score in 61.7% of the patients, mean score of 12.85 points ± 5.61. 89.1% of patients had no neoplastic diagnosis associated. Overall morbidity and mortality rate was 14.2% and 7.1%. P-POSSUM could predict more precisely mortality (p < 0.00). CONCLUSIONS: The POSSUM score is likely to overestimate the risk of morbidity and mortality in patients with high/moderate risk, while the P-POSSUM score seems to be a more accurate predictor of mortality risk. Further studies are needed to confirm our results.

Prevalence and factors affecting REM and slow wave sleep rebound on CPAP titration styudy in patients with obstructive sleep apnea / Prevalencia de los factores que afectan el sueño REM y el brote de ondas lentas en los estudios con CPAP en apnea obstructiva del sueño

Background: In patients with obstructive sleep apnea syndrome (OSAS) treatment with CPAP results in an increase of REM sleep and slow wave sleep, but there is limited information about the prevalence of REM rebound in patients with OSAS and possible factors related to the rebound. Objective. REM rebound (RR) and slow wave sleep rebound (SWSR) has been described as a frequent phenomenon that occurs during CPAP titration, but the quantity that qualify for RR has not been mentioned in literature. The objective of our study was to determine the prevalence of REM rebound and slow wave sleep rebound in our sleep disorders center, to attempt to define RR and look for factors that may affect RR and SWSR on the first night of CPAP titration. Materials and methods. We included patients who had both baseline polysomnogram (bPSG) and CPAP polysomnogram (cPSG) studies done in the same laboratory. We included 179 patients>18 years with Apnea hypopnea index (AHI)>10/hr on the baseline study, with an adequate CPAP titration study. We compared the percentages of REM sleep and slow wave sleep during bPSG and cPSG. We analyzed the frequency of presentation and looked for the factors affecting RR and SWSR. Results. 179 patients were enrolled (M/F:118/61), with a mean age of 48.6±4 for men, and 51.6±12.9 for women. The mean interval between the bPSG and cPSG was 45 days. The mean REM percentage during the bPSG was 15.55 percent and during cPSG study it was 21.57 percent. We took 6 percent as our differential point as the results became statistically significant at this point (p:0001). We therefore present our data by dividing our patients population with RR<6 percent and RR>6 percent. The mean SWS percentage during the bPSG was 8.11±9.68 and during the cPSG was 13.17±10, with a p:0.35 which is not statistically significant...

Antecedentes: En pacientes con síndrome de apnea obstructiva del sueño (SAOS) el tratamiento con CPAPproduce un incremento en el sueño REM y el sueño profundo, pero no hay suficiente información acerca de laprevalencia del rebote de sueño REM en pacientes con SAOS y los posibles factores relacionados con este fenómeno. Objetivo. El rebote de sueño REM (RR) y del sueño deondas lentas (RSOL) ha sido descrito como un fenómeno de frecuente presentación que ocurre durante la titulación de la presión del CPAP, pero la cantidad en el incrementodel estado de sueño que lo califique como rebote no ha sido mencionado en la literatura. El objetivo del estudiofue determinar la prevalencia de RR y RSOL en nuestro centro de sueño e intentar definir RR y buscar los factoresque puedan afectar el RR y el RSOL en la primera noche de titulación de CPAP.Material y métodos. Se incluyeron pacientes que tenían polisomnograma de base (bPSG) y PSG con CPAP (cPAG)realizados en un laboratorio del sueño. Se incluyeron 179 pacientes mayores de 18 años con índice de apneashipopneas (IAH) mayor de 10/hora en el estudio de base,con titulación de CPAP adecuada. Se comparó los porcentajes de sueño REM y sueño profundo durante el bPSSG y cPSG. Se analizó la frecuencia de presentación y los factores que afectan el RR y el RSOL. Resultados. Se incluyeron 179 pacientes (M/F 118/61), con edad promedio de 48.6 años ±12.9 para hombres y...