Naples Prognostic Score to Predict Postoperative Complications After Colectomy for Diverticulitis.

BACKGROUND: The Naples Prognostic Score (NPS) has proven efficacy as a prognostic tool for postoperative outcomes in patients undergoing surgery for neoplastic diseases. However, the role of the NPS score in inflammatory surgical diseases has not yet been studied. We aimed to evaluate NPS predictive value in patients undergoing colectomy due to diverticulitis. METHODS: A single-center retrospective study including all patients who underwent colectomy for diverticulitis between July 2008 and March 2020 was established. Patients' demographics, clinical and surgical data were recorded and analyzed. Patients were scored on a scale of 0-4 and received one point for preoperation albumin <4 g/dL, cholesterol ≤180 mg/dL, Neutrophil to Lymphocyte Ratio >2.96, and Lymphocyte to Monocyte ≤4.44. RESULTS: Out of 3292 patients admitted because of diverticulitis during the study period, 159 patients (4.83%) underwent colectomy. Of those patients, fifty patients were eligible for NPS analysis. 35 patients (70%) were females with a mean age of 62.81 ± 14.51. Thirty-two (64%) patients underwent an elective operation. The postoperative complications rate was 36% (N = 18). The mortality rate was 6% (N = 3). ROC showed a strong association between the NPS and mortality (area = .88, P = .03) and wound infection (area = .78, P = .01). In patients who underwent urgent surgery, there was an association between NPS and re-operation (P = .04). There was a correlation between NPS and Clavien-Dindo score (Spearman's coefficient = .284, P = .045). CONCLUSIONS/DISCUSSION: The Naples prognostic score is an effective tool for predicting postoperative complications in patients undergoing colectomy for diverticulitis. It may assist the surgeon in deciding on extent of the operation for diverticulitis and in elective cases also on timing.

Predisposing factors for high output stoma in patients with a diverting loop ileostomy after colorectal surgeries

Purpose@#One of the most common ileostomy-related complications is high output stoma (HOS) which causes significant fluids and electrolytes disturbances. We aimed to analyze the incidence, severity, and risk factors for readmission for HOS. @*Methods@#We reviewed all patients who underwent loop ileostomy closure in a single institution between 2010 and 2020. Patients that were readmitted for dehydration due to HOS during the time interval between the creation and the closure of the stoma were identified and divided into a study (HOS) group. The remaining patients constructed the control group. @*Results@#A total of 307 patients were included in this study, out of which, 41 patients were readmitted 73 times (23.7% readmission rate) for the HOS group, and the remaining 266 patients constructed the control group. Multivariate analysis identified; advanced American Society of Anesthesiologists (ASA) physical status (PS) classification, elevated baseline creatinine, and open surgery as risk factors for HOS. Renal function worsened among the entire cohort between the construction of the stoma to its closure (mean creatinine of 0.82 vs. 0.96, P<0.0001). @*Conclusion@#Loop ileostomy formation is associated with a substantial readmission rate for dehydration as a result of HOS, and increasing the risk for renal impairment during the duration of the diversion. We identified advanced ASA PS classification, open surgery, and elevated baseline creatinine as predictors for HOS.

Learning curve of robotic inguinal hernia repair in the hands of an experienced laparoscopic surgeon: a comparative study.

BACKGROUND: Since its introduction, robotic surgery has been utilized in different types of surgeries over various specialties. However, studies done thus far comparing robotic (Rob. IHR) and laparoscopic inguinal hernia repair (Lap. IHR) yielded contrasting results. OBJECTIVES: This study evaluates the outcomes of adapting the robotic platform for IHR by a single experienced surgeon, comparing it to laparoscopic inguinal hernia repair (Lap. IHR) performed at same time period. METHODS: Retrospective analysis of a prospectively maintained database including all patients that underwent IHR between 2017 and 2019 (n = 188) was performed. Analyzed data included patient demographics, hernia characteristics, intraoperative data and postoperative outcomes. RESULTS: Patients (n = 188) underwent a total of 120 Rob. IHR and 157 Lap. IHR. Age, sex, BMI, ASA score and length of hospital stay were similar in both groups. Recurring hernias were repaired more often robotically (p = 0.001). Operative time was significantly longer using the robot. (78.8 ± 24 min vs 55.4 ± 17.4 min for unilateral) and (107.9 ± 30 min vs 62.6 ± 20.2 min for bilateral) Rob. IHR vs Lap. IHR respectively, p < 0.001. Rob. IHR operative time decreased while building a learning curve. Rates of simple and severe postoperative complications were similar, p = 0.414. Recurrence occurred once in Rob. IHR group (1.4%) and 3 times in the Lap. IHR (1.9%) (p = 0.642). CONCLUSION: Our series shows that Rob. IHR is safe with comparable outcomes to Lap. IHR even in early learning curve. Robotic inguinal hernia repair allows the buildup of a short, safe and efficacious robotic learning experience for the minimally invasive surgeons for future more complex robotic surgeries.

Associations of novel inflammatory markers with long-term outcomes and recurrence of diverticulitis.

BACKGROUND: The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have emerged as markers of various outcomes of inflammatory and malignant diseases. The association of those markers with short-term outcomes of acute diverticulitis has been discussed in recent studies. This study aimed at evaluation of the association of NLR and PLR with long-term outcomes in patients presenting with acute diverticulitis. METHODS: A retrospective single institute study included patients admitted with acute diverticulitis between 2012 and 2016. Associations were analysed of NLR and PLR values at admission with patient outcomes. RESULTS: A total of 456 patients were included in the study. High NLR and PLR values were associated with complicated disease (P < 0.01 for both). Among patients with complicated diverticulitis, for those with high NLR, the interval to a recurrent episode of acute diverticulitis was shorter (68.3 days versus 83.7 days, P = 0.044). Patients with high NLR had higher mean number of readmissions (0.54 versus 0.34, P = 0.035). High NLR (10.06 ± 11.23 versus 7.6 ± 8.04, P = 0.012) and PLR (9.64 days ±10.56 versus 7.47 days ±8.225, P = 0.018) were associated with longer cumulative hospital stay due to acute diverticulitis. CONCLUSIONS: High NLR and PLR values were associated with recurrence in acute diverticulitis in terms of shorter interval between recurrent episodes and longer cumulative hospitalization days.