The impact of the preoperative red blood cell distribution width on weight loss prediction after sleeve gastrectomy.

AIM: We aimed to evaluate whether RDW has a predictive impact on weight loss after obesity surgery. MATERIAL AND METHODS: This was a single-institution retrospective study. Multiple linear regression analysis was used to determine the variables affecting the %EBMIL and %EWL values. Surgery of patients with %EMBIL > 50% and %EWL > 25% was considered successful. RESULTS: Hundred and ten patients were included in the study. The %EBMIL and %EWL values of patients with RDW>14.5% were lower. In the evaluation of successful surgeries, the probability of failure for those with RDW>14.5% is 10.93 times higher for %EBMIL and 21.55 times for %EWL. DISCUSSION: After the linear regression analysis, it was observed that the %EBMIL and %EWL were higher in the patients whose RDW values were 14.5 and below in the preoperative period. In these patients, it is an indication that more weight loss has occurred. Similar to our study, Wise et al. showed that weight loss was greater with a decrease in the RDW value 10. CONCLUSION: Preoperative RDW value can be used as a predictor of weight loss and surgical success. It can provide an idea about whether the patient will lose enough weight and the success of the surgery. KEY WORDS: Prediction, RDW, Sleeve Gastrectomy.

Posterior retroperitoneal versus transperitoneal laparoscopic adrenalectomy in adults: results from the EUROCRINE® surgical registry.

PURPOSE: This study aims to compare posterior retroperitoneal laparoscopic adrenalectomy (PRLA) and laparoscopic transperitoneal adrenalectomy (LTA) in adults using pan-European data as conflicting results have been published regarding length of hospital stay, institutional volume, and morbidity. METHODS: This retrospective cohort study analyzed data from the surgical registry EUROCRINE®. All patients undergoing PRLA and TLA for adrenal tumours and registered between 2015 and 2020 were included and compared for morbidity, length of hospital stay, and conversion to open surgery. RESULTS: A total of 2660 patients from 11 different countries and 69 different hospitals were analyzed and 1696 LTA were compared to 964 PRLA. Length of hospital stay was shorter after RPLA, with less patients (N = 434, 45.5%, vs N = 1094, 65.0%, p < 0.001) staying more than 2 days. In total, 96 patients (3.6%) developed a complication Clavien-Dindo grade 2 or higher. No statistical difference was found between both study groups. After propensity score matching, length of hospital stay was shorter after PRLA (> 2 days 45.2% vs 63.0%, p < 0.001). After multivariable logistic regression, factors associated with morbidity were age (OR 1.03), male sex (OR 1.52), and conversion to open surgery (OR 5.73). CONCLUSION: This study presents the largest retrospective observational analysis comparing LTA and PRLA. Our findings confirm the shorter length of hospital stay after PRLA. Both techniques are safe leading to comparable morbidity and conversion rates.

Prediction of short-term results after laparoscopic right hemicolectomy. Is sarcopenia superior to other methods?

Background: Complication treatment in colorectal cancer can be carried out quickly with the prediction and early diagnosis. However, there is no apparent predictive factor for this. Objective: We aimed to determine the factors that predict early mortality and morbidity in patients who underwent laparoscopic right hemicolectomy and their superiority over each other. Method: Demographic data, age-adjusted Charlson Comorbidity Index, American Society of Anesthesiologists Score, body mass index, modified-Glasgow Prognostic Score (mGPS), stage of disease, and sarcopenia were evaluated in patients who underwent right hemicolectomy between 2010-2022. Their superiority in predicting short-term outcomes was compared. Results: 78 patients were included in the study. The complication rate was higher in sarcopenic patients (p = 0.002). A high mGPS score was associated with increased mortality risk (p = 0.012). Other methods were not found to be related to short-term results. Conclusion: Sarcopenia is useful for the prediction of complications, and the mortality rate can be estimated by the mGPS score. These are superior to the other short-term results prediction methods. However, randomized controlled studies are needed.

Antecedentes: El tratamiento de complicaciones en el cáncer colorrectal puede llevarse a cabo rápidamente mediante la predicción y el diagnóstico temprano. Sin embargo, no existe un factor predictivo claro para esto. Objetivo: Determinar los factores que predicen la mortalidad y la morbilidad precoces en pacientes sometidos a hemicolectomía derecha laparoscópica y su superioridad entre ellos. Método: Se evaluaron datos demográficos, el índice de comorbilidad de Charlson ajustado por edad, el puntaje de la American Society of Anesthesiologists, el índice de masa corporal, el puntaje de pronóstico de Glasgow modificado (mGPS), el estadio de la enfermedad y la sarcopenia en pacientes que se sometieron a hemicolectomía derecha entre 2010 y 2022. Se comparó su superioridad en la predicción de resultados a corto plazo. Resultados: Se incluyeron en el estudio 78 pacientes. La tasa de complicaciones fue mayor en los pacientes sarcopénicos (p = 0.002). Una puntuación mGPS alta se asoció con un mayor riesgo de mortalidad (p = 0.012). No se encontró que otros métodos estuvieran relacionados con los resultados a corto plazo. Conclusiones: La sarcopenia es útil para la predicción de complicaciones y la tasa de mortalidad puede estimarse mediante la puntuación mGPS. Estos son superiores a los otros métodos de predicción de resultados a corto plazo. Sin embargo, se necesitan estudios controlados aleatorizados.

Concurrent Living Donor Liver Transplantation and Off-Pump Coronary Artery Bypass in a Five-Year-Old Child With Homozygous Familial Hypercholesterolemia: A Case Report.

BACKGROUND: Homozygous familial hypercholesterolemia (FH) is a rare disease that causes serious cardiovascular problems and may be fatal even at an early age. Because this disease variant is rather aggressive, the effect of lipid-lowering agents and lipid apheresis remains inadequate in most cases. In patients who are not responding or tolerating available treatments, liver transplantation (LT) is the last and definitive solution. In addition to LT, the need for cardiac surgery is often substantial. CASE REPORT: This study presents the first pediatric case of FH who underwent off-pump coronary artery bypass (OPCAB) surgery concurrent with live-donor LT (LDLT). The early postoperative period was uneventful. After a 1-year follow-up period, the patient is alive and well with normal liver functions and cholesterol levels remaining within the normal range without any lipid-lowering medical therapy. CONCLUSION: Performing simultaneous coronary bypass and LT may be safe and feasible even for pediatric patients.

Simultaneous Live Donor Liver Transplantation, Aortic Valve Replacement, and Atrial Septal Defect Repair in a Patient With End Stage Liver Disease: A Case Report.

Valvular heart disease creates an important barrier for orthotopic liver transplantation in patients with end-stage liver disease and increases mortality. Selection of the appropriate surgical scheme and adequate postoperative management can be lifesaving in these cases. This study presents a 32-year-old man diagnosed with hepatitis C-associated cirrhosis and severe aortic regurgitation due to subacute bacterial endocarditis. Initially, simultaneous aortic valve replacement (AVR) and live donor liver transplantation (LDLT) was planned. However, intraoperative transesophageal echocardiography revealed an additional atrial septal defect (ASD) and AVR, ASD repair, and LDLT surgery were performed. During the 2-year follow-up period, there were no early or late complications. To the best of our knowledge, this is the first patient to have simultaneous AVR, ASD repair, and LDLT surgery. Additionally, the present case is also unique in being the first person in the Republic of Azerbaijan to undergo concomitant cardiac surgery and LDLT.

Efficacy of PET-CT in the prediction of metastatic adrenal masses that are detected on follow-up of the patients with prior nonadrenal malignancy: A nationwide multicenter case-control study.

Metastasis is the second most common type of adrenal gland mass. In patients undergoing follow-up for nonadrenal malignancy, adrenalectomy is performed when metastasis to adrenal gland is suspected on the basis of positron emission tomography-computed tomography (PET-CT) imaging. This study investigated the efficacy of PET-CT in the discrimination of metastatic lesions from nonmetastatic lesions in the adrenal glands. In this multicentric study, data was collected from enrolled centers. Forty-one patients who underwent surgery for suspected adrenal metastases were evaluated retrospectively. The following data types were collected: demographic, primary tumor, maximum standardized uptake value of adrenal mass (a-SUVx) and detectability in computed tomography and/or magnetic resonance imaging, and specimen size and histopathology. Six patients were excluded due to unavailability of PET-CT reports and 4 for being primary adrenal malignancy. The rest were divided into 2 groups (metastatic: n = 17, 55% and nonmetastatic: n = 14, 45%) according to histopathology reports. There was no statistical difference between the analyzed values, except the a-SUVx (P < .05). The a-SUVx cutoff value was defined as 5.50 by receiver operating characteristic curves and compared with literature. There was no statistical difference when each group was divided as low and high (P > .05). It was found that PET-CT was able to discriminate metastatic lesions from primary benign lesions (P = .022). PET-CT can discriminate primary benign lesions and metastatic lesions by cutoff 5.5 value for a-SUVx.

Robot-assisted versus conventional laparoscopic adrenalectomy: Results from the EUROCRINE Surgical Registry.

BACKGROUND: Adrenalectomy is routinely performed via the minimally invasive approach. Safety of adrenalectomy using the robot-assisted technique has been widely demonstrated by several series, but the literature is scarce regarding the comparison of conventional laparoscopic versus robot-assisted approach. We decided to carry out a multicenter study to compare clinical and surgical outcomes between laparoscopic and robotic adrenalectomy. METHODS: This is a retrospective case-control study, including data from centers affiliated to the Surgical Registry EUROCRINE. Patients undergoing laparoscopic surgery for adrenal tumors and registered between 2015 and 2018 were included. Robot-assisted versus laparoscopic adrenalectomy was compared. All comparisons were carried out in terms of complication rate, conversion rate and duration of stay. RESULTS: A total of 1,005 patients from 46 clinics underwent robotic or conventional laparoscopic adrenalectomy. Median age was 55 (interquartile range: 45-65) years. Robotic adrenalectomy was performed in 189 (18.8%) patients. According to Clavien-Dindo classification, complication rate was lower in the robotic surgery group (1.6% vs 16.5%, P < .001). Laparoscopic surgery and active hormonal status were significantly correlated with complications, both in univariate and multivariate analysis. There was no significant difference between laparoscopic and robotic surgery groups, in terms of conversion rate (2.1% vs 0.5%, respectively, P = .147). Duration of stay was shorter in the robotic adrenalectomy group (82.1% vs 28.8%, P < .001). CONCLUSION: Analysis of the EUROCRINE database supports that robotic adrenalectomy resulted in a lower complication rate and shorter duration of stay, compared with laparoscopic adrenalectomy. Granular data to support this is warranted.

Patient-centered oncosurgical planning with cancer models in subspecialty education.

BACKGROUND: A fundamental aspect of oncosurgical planning in organ resections is the identification of feeder vessel details to preserve healthy organ tissue while fully resecting the tumors. The purpose of this study was to determine whether three-dimensional (3D) cancer case models of computed tomography (CT) images will assist resident-level trainees in making appropriate operative plans for organ resection surgery. METHODS: This study was based on the perception of surgery residents who were presented with 5 different oncosurgical scenarios. A five-station carousel including cases of liver mass, stomach mass, annular pancreas, pelvic mass and mediastinal mass was formed for the study. The residents were required to compare their perception level of the cases with their CT images, and 3D models in terms of identifying the invasion of the mass, making differential diagnosis and preoperative planning stage. RESULTS: All residents have given higher scores for models. 3D models provided better understanding of oncopathological anatomy and improved surgical planning. In all scenarios, 70-80% of the residents preferred the model for preoperative planning. For surgical choice, compared to the CT, the model provided a statistically significant difference in terms of visual assessment, such as tumor location, distal or proximal organotomy (p:0.009). In the evaluation of presacral mass, the perception of model was significantly better than the CT in terms of bone-foramen relationship of chondrosarcoma, its origin, geometric shape, localization, invasion, and surgical preference (p:0.004). The model statistically significantly provided help to evaluate and prepare the case together with the colleagues performing surgery (p:0.007). Commenting on the open-ended question, they stated that the tumor-vessel relationship was clearly demonstrated in the 3D model, which has been very useful. CONCLUSIONS: With the help of 3D printing technology in this study, it is possible to implement and evaluate a well-structured real patient scenario setup in cancer surgery training. It can be used to improve the understanding of pathoanatomical changes of multidisciplinary oncologic cases. Namely, it is used in guiding the surgical strategy and determining whether patient-specific 3D models change pre-operative planning decisions made by surgeons in complex cancer mass surgical procedures.

Influence of rocuronium on achieving optimal vagal stimulation during intraoperative nerve monitoring in thyroid surgery.

BACKGROUND: In the present study we determine the feasibility of intraoperative neuromonitoring following the administration of a nondepolarizing neuromuscular blocking agent during thyroid operations, as well as the influence of rocuronium on the achievement of optimal vagal stimulation during intraoperative neuromonitoring in thyroid surgery. We further investigate whether accelerometry is a reliable approach to obtaining an ipsilateral vagus signal prior to recurrent laryngeal nerve dissection. METHODS: Included in the study were 61 thyroidectomized patients whose demographic data, indications, type of surgery, vagus, and recurrent nerve values before and after resection were obtained. We created five groups of patients based on the twitch values recorded during ipsilateral vagus stimulation prior to the recurrent laryngeal nerve dissection: (1) <10%, (2) 11-25%, (3) 26-50%, (4) 51-75% and (5) >75%. RESULTS: The average electromyography amplitudes of the vagus nerve prior to the determination of the recurrent laryngeal nerve for each group were 552 µV, 463 µV, 543 µV, 513 µV and 551 µV, respectively. No difference between the groups was observed in this regard (p > 0.05). CONCLUSION: It can be expected that as soon as the effects of neuromuscular blockers on the peripheral muscles begin to abate, it will be possible to obtain the ipsilateral vagus signal prior to recurrent laryngeal nerve dissection at the desired levels. It can be concluded from this study that accelerometry using the pollicis muscle is an unreliable tool for the interpretation of the proper electromyography signals of the vagus nerve prior to the determination of the recurrent laryngeal nerve.

Surgical planning with patient-specific three-dimensional printed pancreaticobiliary disease models - Cross-sectional study.

BACKGROUND: Three-dimensional (3D) printing has been increasingly used in medical applications with the creation of accurate patient-specific 3D printed models in medical imaging data. This study has been planned based on the fact that research on 3D printing in pancreaticobiliary disease is limited due to lack of studies on validation of model accuracy. METHODS: This is an innovative study where general surgery residents are presented 5 distinct hepatopancreatobiliary disease scenarios to generate a perception and required to compare their perception level of these cases with magnetic resonance cholangiopancreatography (MRCP), 3D images and 1:1 solid models that the pathology, diverse diagnosis and presurgery diagnosis stages can be observed. This study is single-centered. RESULTS: The dilated pancreaticobiliary intervention based on scenarios for general surgery residency was more original since there was no prior study that includes both model building and the evaluation of the perception created by the model. Five scenarios provided qualitative assessment with results showing the usefulness of 3D models when used as clinical tools in preoperative planning, simulation of interventional procedures, surgical education, and training. The perception level in the 3D model, MRCP (Z: 3.854, p: 0.000) and the 3D image (Z: 2.865, p: 0.004) was higher; likewise, the 3D-STL image was higher compared to the MRCP image (Z: 3.779, p: 0.000). All subspecialists agree that 3D models provided better understanding of dilated pancreaticobiliary pathoanatomy and improved surgical planning. CONCLUSIONS: A thoroughly outlined genuine patient situation layout aimed for general surgery training can be installed and monitored with the support of 3D printing technology of this study. This can be utilized to develop the comprehension of pathoanatomical variations of complex pancreaticobiliary illness and to adopt a surgical approach.