Routine laboratory parameters in patients with necrotizing pancreatitis by the time of operative pancreatic debridement:Food for thought

BACKGROUND Timing of invasive intervention such as operative pancreatic debridement(OPD)in patients with acute necrotizing pancreatitis(ANP)is linked to the degree of encapsulation in necrotic collections and controlled inflammation.Additional markers of these processes might assist decision-making on the timing of surgical intervention.In our opinion,it is logical to search for such markers among routine laboratory parameters traditionally used in ANP patients,considering simplicity and cost-efficacy of routine laboratory methodologies.AIM To evaluate laboratory variables in ANP patients in the preoperative period for the purpose of their use in the timing of surgery.METHODS A retrospective analysis of routine laboratory parameters in 53 ANP patients undergoing OPD between 2017 and 2020 was performed.Dynamic changes of routine hematological and biochemical indices were examined in the preoperative period.Patients were divided into survivors and non-survivors.Survivors were divided into subgroups with short and long post-surgery length of stay(LOS)in hospital.Correlation analysis was used to evaluate association of laboratory variables with LOS.Logistic regression was used to assess risk factors for patient mortality.RESULTS Seven patients(15%)with severe acute pancreatitis(SAP)and 46 patients(85%)with moderately SAP(MSAP)were included in the study.Median age of participants was 43.2 years;33(62.3%)were male.Pancreatitis etiology included biliary(15%),alcohol(80%),and idiopathic/other(5%).Median time from diagnosis to OPD was≥4 wk.Median postoperative LOS was at the average of 53 d.Mortality was 19%.Progressive increase of platelet count in preoperative period was associated with shortened LOS.Increased aspartate aminotransferase and direct bilirubin(DB)levels the day before the OPD along with weak progressive decrease of DB in preoperative period were reliable predictors for ANP patient mortality.CONCLUSION Multifactorial analysis of dynamic changes of routine laboratory variables can be useful for a person-tailored timing of surgical intervention in ANP patients.

小儿外科手术中腹部疾病的产前诊断和治疗

Purpose The aim of this study was to investigate the prenatal courses and mana gement of abdominal surgical diseases. Methods Of the 327 patients registered wi th our fetal treatment board since March 2002, 83 fetuses referred to the surgic al department were enrolled for the current study. The prenatal diagnosis, seque ntial fetal images, and perinatal courses of these cases were reviewed retrospec tively. Results Of the 83 cases, abdominal diseases were suspected in 34, lung a nd thoracic diseases in 25, genitourinary diseases in 12, and other anomalies in 12.Meconium peritonitis (MP), intestinal obstruction, and abdominal wall defec ts accounted for approximately 65%of the abdominal diseases. Five patients with prenatally diagnosed lung diseases underwent fetal surgical intervention, and 1 7 of the 22 liveborn patients survived. In contrast, none of the patients with p renatally diagnosed abdominal anomalies underwent fetal surgical intervention, y et, 23 of the 24 liveborn patients survived. However, preterm labor and hydrops were seen frequently in the patients with giant cystic MP, suggesting a fetal cr itical condition. Conclusions Although the clinical outcome of abdominal disease s seemed favorable with postnatal treatment, the current results suggested the o ccurrence of hidden mortality in utero and the potential need for fetal interven tion for some abdominal conditions, such as MP.

Survival after laparoscopic versus open resection for colorectal liver metastases

Laparoscopic liver surgery has become standard of care in many specialized centers worldwide(1,2).Despite its well-known advantages over open approach in surgical outcomes,the evidence supporting its advantages in long-term oncologic outcomes is limited.

Difficult procedures,better outcomes

Despite the initial skepticism and challenges,minimally invasive liver surgery especially laparoscopic liver resections(LLR),has become a first-choice surgical treatment for various liver tumors in many specialized centers worldwide(1-3).It is a safe alternative to open surgery thanks to advantages such as reduced blood loss and complication rates,shorter hospital stay,and better quality of life(4-7).However,laparoscopy requires relatively long learning,and complex procedures are limited to high-volume expert centers(8).