Timing of surgical operation for patients with intra-abdominal infection:A systematic review and meta-analysis

BACKGROUND Intra-abdominal infections(IAIs)is the most common type of surgical infection,with high associated morbidity and mortality rates.In recent years,due to the use of antibiotics,various drug-resistant bacteria have emerged,making the treatment of abdominal infections more challenging.Early surgical exploration can reduce the mortality of patients with abdominal infection and the occurrence of complications.However,available evidence regarding the optimal timing of IAI surgery is still weak.In study,we compared the effects of operation time on patients with abdominal cavity infection and tried to confirm the best timing of surgery.AIM To assess the efficacy of early vs delayed surgical exploration in the treatment of IAI,in terms of overall mortality.METHODS A systematic literature search was performed using PubMed,EMBASE,Cochrane Central Register of Controlled Trials,Ovid,and ScienceDirect.The systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses method.Based on the timing of the surgical operation,we divided the literature into two groups:Early surgery and delayed surgery.For the early and delayed surgery groups,the intervention was performed with and after 12 h of the initial surgical intervention,respectively.The main outcome measure was the mortality rate.The literature search was performed from May 5 to 20,2021.We also searched the World Health Organization International Clinical Trials Registry Platform search portal and ClinicalTrials.gov on May 20,2021,for ongoing trials.This study was registered with the International Prospective Register of Systematic Reviews.RESULTS We identified nine eligible trial comparisons.Early surgical exploration of patients with IAIs(performed within 12 h)has significantly reduced the mortality and complications of patients,improved the survival rate,and shortened the hospital stay.CONCLUSION Early surgical exploration within 12 h may be more effective for the treatment of IAIs relative to a delayed operation.

The Popularization and Application of Cold Storage Red Blood Cells or Whole Blood at -80 ℃ of the Rh(D) Negative Patients in Surgical Operation

Summary: The efficiency of cold storage red blood cells (CSRBC) or whole blood at -80 ℃ used in 27 Rh(D) negative patients during surgical operation was reported. The Rh(D) negative patients received the transfusion of CSRBC or whole blood stored at -80 ℃ for 180 to 360 days. The changes in the indexes, such as blood TB, DB, K +, Na +, BUN, Cr, urine protein (URPO), UOB, Hb, HCT, serum total protein, relative to hemolytic reaction and blood volume before and after transfusion were observed. The results showed that after transfusion of CSRBC or whole blood 27 cases were negative for urine protein and UOB, and the levels of BUN and Cr were normal (P>0.05). Blood TB, DB, Hb, and HCT were increased, while pH, blood K + and blood Na + was normal with the difference being not significant before and after operation (P>0.05). Plasma protein was decreased, but there was no significant difference before and after operation (P>0.05). It was suggested that CSRBC or whole blood at -80 ℃ could be safely infused to the Rh(D) negative patients without side effects during the surgical operation.

Acupuncture Treatment for the 88 Cases of Retention of Urine After Surgical Operation

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Hepatolithiasis and surgical operation

Reply to the Editor: With the development of the treatment hepatolithiasis, I, as the responsible author of the article, has discussed the merits of the new operation dealing with regional hepatolithiasis-subcutaneous tunnel and hepatocholangioplasty with the use of the gallbladder (STHG).

The Use of 3D laparoscopy in Surgical Operation

Purpose： studying and analyzing the application effect of three dimensional （3D） laparoscopy m surgical operation. Method： We select 126 patients who were diagnosed celiac disease in our hospital between May 2015 and April 2016 as our research subjects. All of these patients have indications for laparoscopic surgery, and we divide them into two groups randomly （observation and control group）. While the observation group is treated by 3D laparoscopic operation system, and the control group is treated by 2D laparoscopic system. During the treatment ,we observe the operation time, intra-operative bleeding and hospitalization time between the two different methods. Result： During the operation, the operation time of observation is （135.5±23.84） minutes and intra-operative bleeding time is （130.2±20. 11） milliliters, which both them are significantly lower than control group （163.8±25.22）min, （146.3±27.42）ml. This difference is statistically significant （P 〈0.05）. On the other hand, there is no obvious difference between observation and conlrol about indwelling catheter time, postoperative hospitalization time and postoperative exhaust time. For the observation, the datum were （2.3±0.31） d, （8.1±1. 32） d, （3.2±0.58） d and they were no statistical significance. Conclusion： Compared with traditional laparoscopic surgery, the image of 3D laparoscopic surgery is more clear and stereoscopic. What＇s more, operators can have a good command of it easily to shorten operation time, which avoid surgery vascular damage and reduce bleeding amounts to some extent. It is a good assistant for clinical use.

Recovery of injured fornical crura following neurosurgical operation of a brain tumor: a case report

The fornix, which is involved in transfer of episodic memory, is an important structure of the Papez circuit between the medial diencephalon and the medial temporal lobe. Many studies using DTI have reported on injury of the fornix in patients with brain injury （Nakayama et al., 2006; Sugiyama et al., 2007; Wang et al., 2008; Chang et al., 2010）. However, only a few studies on recov- ery of an injured fornix in patients with brain injury, including traumatic brain injury and stroke, have been reported （Yeo et al., 2011; Yeo and Jang, 2013a, b）. In this study, using follow up DTT images, we reported on a patient who showed recovery of injured fornical crura following a neurosurgical operation for a brain tumor.

Surgical operation of a massive retroperitoneal tumor

Summarize the surgical cooperation of a massive retroperitoneal tumor. The main surgical cooperation points include: clos e observation of the patient's vital signs and condition changes, strengthen ing the prevention of potential complications, mak ing full preoperative preparation, master ing the coordination points of hand washing, itinerant nurses, and effective massive bleeding treatment plan, etc. Through perfect surgical cooperation and nursing, the patient's condition was stable and discharged smoothly.

Three-dimensional virtual operations can facilitate complicated surgical planning for the treatment of patients with jaw deformities associated with facial asymmetry: a case report

This article describes a case we experienced in which good postsurgical facial profiles were obtained for a patient with jaw deformities associated with facial asymmetry,by implementing surgical planning with SimPlant OMS.Using this method,we conducted LF1 osteotomy,intraoral vertical ramus osteotomy（IVRO）,sagittal split ramus osteotomy（SSRO）,mandibular constriction and mandibular border genioplasty.Not only did we obtain a class I occlusal relationship,but the complicated surgery also improved the asymmetry of the frontal view,as well as of the profile view,of the patient.The virtual operation using three-dimensional computed tomography（3D-CT）could be especially useful for the treatment of patients with jaw deformities associated with facial asymmetry.

Surgical Treatment of Ascending Aortic Dissecting Aneurysm－Clinical Application of Modified Cabrol＇s Operation

This paper reported 3 cases of ascending aortic dissecting aneurysm treated by modified Cabrol's operation. An 8 mm Gore-Tex connected with coronary arteries was employed to prevent high tension, intimal tearing and bleeding of anastomosis. Unremoved aneurysmal wall used as a sac for enclosing conduit graft could minimize the bleeding and oozing so that leaked blood can be drained to right atrium via a bypass.

Successful Surgical Treatment of a Giant Mediastinal False Aneurysm 30 Years after Bentall Operation

False aneurysm occurring after replacement of ascending aorta by a vascular prosthesis is a rare, but life-threatening complication. In spite of advances in endovascular techniques, surgery remains the treatment of choice in the majority of cases. We report the case of a huge pseudoaneurysm caused by late dehiscence of the right coronary ostium-aortic tubular graft anastomosis, occurred 30 years after replacement of aortic valve and ascending aorta by classical Bentall operation. A fistula originating from the aneurysmal sac extended across the sternum into the thoracic subcutaneous soft tissues and gave rise to a pulsatile mass well appreciable on the anterior chest wall. The surgical treatment, consisting of partial resection of the aortic tubular graft and sternal reconstruction was effective and uneventful.

Surgical Operations Bring The Blind Out of Darkness

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ARTERIAL SWITCH OPERATION FOR COMPLETE D-TRANSPOSITION OF THE GREAT ARTERIES: SURGICAL RESULTS AND ANALYSIS

Objective To review and analyze the surgical results of arterial switch operations in complete D-transposition of the great arteries （TGA）. Methods A total of 113 patients underwent arterial switch operation from Jan. 2001 to Dec. 2005. There were 60 patients with transposition of the great arteries and intact ventricular septum （TGA/IVS） and 53 patients with transposition of the great arteries and ventricular septal defect （TGA/VSD）. The lowest body weight was 2. 3 kg and the smallest age was 6 h. The arterial switch operation was performed under deep hypothermia with circulatory arrest and low-flow perfusion. Results The total mortality was 9. 73%. There were 5 deaths in TGA/IVS （8.3%）, 6 deaths in TGA/VSD （ 11.3% ）. With the development of surgical technique, peri-operative management and cardiopulmonary bypass, the total mortality significantly decreased from 16. 65% in the early times to 5. 5% lately. Conclusion The vital risk of the operation is coronary artery malformation. The incidence of coronary artery malformation is higher in TGA/VSD than in TGA/ [VS. The positional relationship of the great arteries does not affect the results of the operation. The arterial switch operation should be prevented when the pressure ratio between the left and right ventricle is less than 0.6, otherwise it is great likely to cause severe low cardiac output postoperatively.

Understanding surgical care delivery in Sub-Saharan Africa:a cross-sectional analysis of surgical volume,operations,and financing at a tertiary referral hospital in rural Tanzania

Background:Access to surgical care in Low-and Middle-Income Countries(LMICs)such as Tanzania is extremely limited.Northern Tanzania is served by a single tertiary referral hospital,Kilimanjaro Christian Medical Centre(KCMC).The surgical volumes,workflow,and payment mechanisms in this region have not been characterized.Understanding these factors is critical in expanding access to healthcare.The authors sought to evaluate the operations and financing of the main operating theaters at KCMC in Sub-Saharan Africa.Methods:The 2018 case volume and specialty distribution(general,orthopaedic,and gynecology)in the main operating theaters at KCMC was retrieved through retrospective review of operating report books.Detailed workflow(i.e.planned and cancelled cases,lengths of procedures,lengths of operating days)and financing data(patient payment methods)from the five KCMC operating theater logs were retrospectively reviewed for the available fivemonth period of March 2018 to July 2018.Descriptive statistics and statistical analysis were performed.Results:In 2018,the main operating theaters at KCMC performed 3817 total procedures,with elective procedures(2385)outnumbering emergency procedures(1432).General surgery(1927)was the most operated specialty,followed by orthopaedics(1371)and gynecology(519).In the five-month subset analysis period,just 54.6%of planned operating days were fully completed.There were 238 cancellations(20.8%of planned operations).Time constraints(31.1%,74 cases)was the largest reason;lack of patient payment accounted for as many cancellations as unavailable equipment(6.3%,15 cases each).Financing for elective theater cases included insurance 45.5%(418 patients),and cash 48.4%(445 patients).Conclusion:While surgical volume is high,there are non-physical inefficiencies in the system that can be addressed to reduce cancellations and improve capacity.Improving physical resources is not enough to improve access to care in this region,and likely in many LMIC settings.Patient financing and workflow will be critical considerations to truly improve access to surgical care.

Navigating medial patellotibial ligament reconstruction:Clinical perspectives and surgical strategies

The surgical approach for patellar instability usually refers to reconstruction of the medial patellofemoral ligament associated with an osteotomy of the tibial tuberosity or a trochleoplasty when required.The medial patellotibial ligament and the medial patellomeniscal ligament are secondary stabilizers of the patella.Despite this,both the medial patellotibial and patellofemoral ligaments aid in patellar rotation and tilt when the knee is flexed beyond 45°.The medial patellotibial ligament plays a particularly important role in the final stages of stretching in extension and between 40 degrees to 90 degrees of flexion.The clinical relevance and surgical indications for medial patellotibial ligament reconstruction associated with medial patellofemoral ligament reconstruction are still controversial.This editorial explores the surgical indications and clinical results for medial patellotibial ligament reconstruction to improve readers’understanding of this technique,especially because reported clinical outcomes have remained sparse.

Prediction and stratification for the surgical adverse events after minimally invasive esophagectomy:A two-center retrospective study

BACKGROUND Minimally invasive esophagectomy(MIE)is a widely accepted treatment for esophageal cancer,yet it is associated with a significant risk of surgical adverse events(SAEs),which can compromise patient recovery and long-term survival.Accurate preoperative identification of high-risk patients is critical for improving outcomes.AIM To establish and validate a risk prediction and stratification model for the risk of SAEs in patients with MIE.METHODS This retrospective study included 747 patients who underwent MIE at two centers from January 2019 to February 2024.Patients were separated into a train set(n=549)and a validation set(n=198).After screening by least absolute shrinkage and selection operator regression,multivariate logistic regression analyzed clinical and intraoperative variables to identify independent risk factors for SAEs.A risk stratification model was constructed and validated to predict the probability of SAEs.RESULTS SAEs occurred in 10.2%of patients in train set and 13.6%in the validation set.Patients with SAE had significantly higher complication rate and a longer hospital stay after surgery.The key independent risk factors identified included chronic obstructive pulmonary disease,a history of alcohol consumption,low forced expiratory volume in the first second,and low albumin levels.The stratification model has excellent prediction accuracy,with an area under the curve of 0.889 for the training set and an area under the curve of 0.793 for the validation set.CONCLUSION The developed risk stratification model effectively predicts the risk of SAEs in patients undergoing MIE,facilitating targeted preoperative interventions and improving perioperative management.

Enhancing postoperative pain control by surgically-initiated rectus sheath block in abdominal aortic aneurysm open repair: A case report

BACKGROUND Abdominal aortic aneurysm(AAA)repair often involves significant postoperative pain,traditionally managed with systemic opioids,which can cause undesirable side effects.This case report explores the novel use of a surgically-initiated rectus sheath block with a catheter-over-needle assembly for pain management in AAA repair.CASE SUMMARY A 67-year-old female with hypertension and previous aortic dissection underwent elective open repair of an infrarenal AAA,which had grown from 3.4 cm to 4.3 cm over 14 months.A rectus sheath block was initiated surgically for postoperative pain control.The patient reported low pain scores and did not require systemic intravenous opioids,enabling early ambulation and discharge on postoperative day seven without complications.By preventing complications of systemic opi-oids,the method indicating a promising direction for postoperative pain management in major vascular surgeries.CONCLUSION Surgically-initiated rectus sheath block as a valuable tool for managing postoperative pain in AAA repair.

Surgical site soft tissue thickness as a predictor of complications following arthroplasty

Appreciation of soft-tissue thickness(STT)at surgical sites is an increasingly recognized aspect of arthroplasty procedures as it may potentially impacting postoperative outcomes.Recent research has focused on the predictive value of preoperative STT measurements for complications following various forms of arthroplasty,particularly infections,across procedures such as total knee,hip,shoulder,and ankle replacements.Several studies have indicated that increased STT is associated with a higher risk of complications,including infection and wound healing issues.The assessment of STT before surgery could play a crucial role in identifying patients at a higher risk of complications and may be instru-mental in guiding preoperative planning to optimize outcomes in arthroplasty procedures.Standardized measurement techniques and further research are essential to enhance the reliability and clinical utility of STT assessment for arthro-plasty surgery.

Effect of hyperthermia combined with opioids on cancer pain control and surgical stress in patients with gastrointestinal cancer

BACKGROUND Surgical palliative surgery is a common method for treating patients with middle and late stage gastrointestinal tumors.However,these patients generally expe-rience high levels of cancer pain,which can in turn stimulate the body’s stress and undermine the effect of external surgery.Although opioid drugs have a signifi-cantly positive effect on controlling cancer pain,they can induce adverse drug reactions and potential damage to the body’s immune function.Hyperthermia therapy produces a thermal effect that shrinks tumor tissues.However,its effect on relieving the pain of middle and late stage gastrointestinal tumors but also the stress of surgical palliative surgery remains unclear.AIM To investigate the effect of hyperthermia combined with opioids on controlling cancer pain in patients with middle and late stage gastrointestinal cancer and evaluate its impact on surgical palliative surgical stress.METHODS This was a retrospective study using the data of 70 patients with middle and late stage gastrointestinal tumors who underwent cancer pain treatment and surgical palliative surgery in the Ninth People’s Hospital of Suzhou,China from January 2021 to June 2024.Patients were grouped according to different cancer pain control regimens before surgical palliative surgery,with n=35 cases in each group,as follows:Patients who solely used opioid drugs to control cancer pain were included in Group S,while patients who received hyperthermia treatment combined with opioid drugs were included in Group L.In both groups,we compared the effectiveness of cancer pain control(pain score,burst pain score,24-hour burst pain frequency,immune function,daily dosage of opioid drugs,and adverse reactions),surgical palliative indicators(surgery time,intraoperative bleeding,stress response),and postoperative recovery time,including first oral feeding time,postoperative hospital stay).RESULTS Analgesic treatment resulted in a significant decrease in the average pain score,burst pain score,and 24-hour burst pain frequency in both Groups L and S;however,these scores were statistically significantly lower in Group L than in Group S group(P<0.001).Analgesic treatment also resulted in significant differences,namely serum CD4+(29.18±5.64 vs 26.05±4.76,P=0.014),CD8+(26.28±3.75 vs 29.23±3.89,P=0.002),CD4+/CD8+(0.97±0.12 vs 0.83±0.17,P<0.001),between Group L and Group S,respectively.The daily dosage of opioid drugs incidence of adverse reactions such as nausea,vomiting,constipation,and difficulty urinating were statistically significantly lower in Group L than those in group S(P<0.05).Furthermore,palliative surgery time and intraoperative blood loss in Group L were slightly lower than those in Group S;however,the difference was not statistically significant(P>0.05).On the first day after surgery,serum cortisol and C-reactive protein levels of patients in group L and group S were 161.43±21.07 vs 179.35±27.86 ug/L(P=0.003)and 10.51±2.05 vs 13.49±2.17 mg/L(P<0.001),respectively.Finally,the first oral feeding time and hospitalization time after surgery in group L were statistically significantly shorter than those in group S(P<0.05).CONCLUSION Our findings showed that hyperthermia combined with opioids is effective in controlling cancer pain in patients with middle and late stage gastrointestinal tumors.Furthermore,this method can reduce the dosage of opioids used and minimize potential adverse drug reactions,reduce the patient’s surgical palliative surgical stress response,and shorten the overall postoperative recovery time required.

Estimation of Physiologic Ability and Surgical Stress scoring system for predicting complications following abdominal surgery: A metaanalysis spanning 2004 to 2022

BACKGROUND Postoperative complications remain a paramount concern for surgeons and healthcare practitioners.AIM To present a comprehensive analysis of the Estimation of Physiologic Ability and Surgical Stress(E-PASS)scoring system’s efficacy in predicting postoperative complications following abdominal surgery.METHODS A systematic search of published studies was conducted,yielding 17 studies with pertinent data.Parameters such as preoperative risk score(PRS),surgical stress score(SSS),comprehensive risk score(CRS),postoperative complications,post-operative mortality,and other clinical data were collected for meta-analysis.Forest plots were employed for continuous and binary variables,withχ2 tests assessing heterogeneity(P value).RESULTS Patients experiencing complications after abdominal surgery exhibited significantly higher E-PASS scores compared to those without complications[mean difference and 95%confidence interval(CI)of PRS:0.10(0.05-0.15);SSS:0.04(0.001-0.08);CRS:0.19(0.07-0.31)].Following the exclusion of low-quality studies,results remained valid with no discernible heterogeneity.Subgroup analysis indicated that variations in sample size and age may contribute to hetero-geneity in CRS analysis.Binary variable meta-analysis demonstrated a correlation between high CRS and increased postoperative complication rates[odds ratio(OR)(95%CI):3.01(1.83-4.95)],with a significant association observed between high CRS and postoperative mortality[OR(95%CI):15.49(3.75-64.01)].CONCLUSION In summary,postoperative complications in abdominal surgery,as assessed by the E-PASS scoring system,are consistently linked to elevated PRS,SSS,and CRS scores.High CRS scores emerge as risk factors for heightened morbidity and mortality.This study establishes the accuracy of the E-PASS scoring system in predicting postoperative morbidity and mortality in abdominal surgery,underscoring its potential for widespread adoption in effective risk assessment.

Surgical treatment of liver cancer and pancreatic cancer under the China Healthcare Security Diagnosis Related Groups payment system

BACKGROUND Data from the World Health Organization’s International Agency for Research on Cancer reported that China had the highest prevalence of cancer and cancer deaths in 2022.Liver and pancreatic cancers accounted for the highest number of new cases.Real-world data(RWD)is now widely preferred to traditional clinical trials in various fields of medicine and healthcare,as the traditional research approach often involves highly selected populations and interventions and controls that are strictly regulated.Additionally,research results from the RWD match global reality better than those from traditional clinical trials.AIM To analyze the cost disparity between surgical treatments for liver and pancreatic cancer under various factors.METHODS This study analyzed RWD 1137 cases within the HB1 group(patients who underwent pancreatectomy,hepatectomy,and/or shunt surgery)in 2023.It distinguished different expenditure categories,including medical,nursing,technical,management,drug,and consumable costs.Additionally,it assessed the contribution of each expenditure category to total hospital costs and performed cross-group comparisons using the non-parametric Kruskal–Wallis test.This study used the Steel–Dwass test for post-hoc multiple comparisons and the Spearman correlation coefficient to examine the relationships between variables.RESULTS The study found that in HB11 and HB13,the total hospitalization costs were significantly higher for pancreaticoduodenectomy than for pancreatectomy and hepatectomy.Although no significant difference was observed in the length of hospital stay between patients who underwent pancreaticoduodenectomy and pancreatectomy,both were significantly longer than those who underwent liver resection.In HB15,no significant difference was observed in the total cost of hospitalization between pancreaticoduodenectomy and pancreatectomy;however,both were significantly higher than those in hepatectomy.Additionally,the length of hospital stay was significantly longer for patients who underwent pancreaticoduodenectomy than for those who underwent pancreatectomy or liver resection.CONCLUSION China Healthcare Security Diagnosis Related Groups payment system positively impacts liver and pancreatic cancer surgeries by improving medical quality and controlling costs.Further research could refine this grouping system and ensure continuous effectiveness and sustainability.