Surgical medicine

BACKGROUND: Laparoscopic Nissen fundoplication (LNF) is the most common standard technique worldwidely for Gastroesophageal reflux disease (GERD). Another type of fundoplication, laparoscopic Toupet fundoplication (LTF), intends to reduce incidence of postoperative complications. A systematic review and meta-analysis are required on short- and long-term outcomes based on randomized controlled trials (RCTs) between LNF and LTF. METHODS: We searched databases including PubMed, Cochrane, Embase, and Web of Knowledge for RCTs comparing LNF and LTF...

In this study, we present a case of Behcet's colitis that caused acute inflammation in the gallbladder and mimicked the clinical picture of an acute abdomen: severe right-sided abdominal pain, nausea, fever, and tenderness in the right hypochondrium, right flank, right loin, and right iliac fossa (RIF), with severely elevated white blood cell (WBC) count. The picture of acute acalculous cholecystitis and acute abdomen was resolved after three days of antibiotic therapy. Then, the pain mainly was localized in the right flank and loin, with mild pain in the right iliac fossa, with positive Rovsing's and psoas signs...

Gallbladder polyps (also known as polypoid lesions of the gallbladder) are a common incidental finding. The vast majority of gallbladder polyps smaller than 10 mm are not true neoplastic polyps but are benign cholesterol polyps with no inherent risk of malignancy. In addition, recent studies have shown that the overall risk of gallbladder cancer is not increased in patients with small gallbladder polyps, calling into question the rationale for frequent and prolonged follow-up of these common lesions. In 2021, a Society of Radiologists in Ultrasound, or SRU, consensus conference was convened to provide recommendations for the management of incidentally detected gallbladder polyps at US...

BACKGROUND: In comparison to delayed laparoscopic cholecystectomy, emergency laparoscopic cholecystectomy has a shorter length of stay and eliminates the risk of recurrent episodes of acute cholecystitis. Nevertheless, there is concern that emergency laparoscopic cholecystectomy is associated with higher morbidity in acute cholecystitis patients. The present large cohort study compares operation-related adverse outcomes between emergency and delayed laparoscopic cholecystectomy and determines the risk of readmission before delayed laparoscopic cholecystectomy to guide surgical decision-making...

Being one of the most common causes of the acute abdomen, acute appendicitis (AA) forms the bread and butter of any general surgeon's practice. With the recent advancements in AA's management, much controversy in diagnostic algorithms, possible differential diagnoses, and weighing the management options has been generated, with no absolute consensus in the literature. Since Alvarado described his eponymous clinical scoring system in 1986 to stratify AA risk, there has been a burgeoning of additional scores for guiding downstream management and mortality assessment...

No abstract text is available yet for this article.

INTRODUCTION: Malignant bowel obstruction from peritoneal carcinomatosis affects a significant proportion of luminal gastrointestinal and ovarian oncology patients, and portends poor long-term survival. The management approach for these patients includes a range of medical therapies and surgical options; however, how to select an optimal treatment strategy remains enigmatic. The goal of this narrative review was to summarize the latest evidence around multimodal malignant bowel obstruction treatment and to establish if and where progress has been made...

Acute mesenteric ischemia is considered uncommon, but it appears to be more frequent cause of acute abdomen than appendicitis or ruptured abdominal aortic aneurysm in elderly patients. Surgical treatment without revascularization is associated with high overall mortality, up to 80%. The modern treatment of acute mesenteric ischemia requires collaboration of gastrointestinal surgeons, vascular surgeons, and interventional radiologists. Early revascularization may reduce the overall mortality associated with acute mesenteric ischemia by up to 50%...

No abstract text is available yet for this article.

INTRODUCTION: The debate on the best surgical management strategy for acute malignant left-sided colonic obstruction is ongoing. Decompressing colostomy (DC) and stenting as a bridge to surgery (SBTS) are the currently proposed alternative approaches to emergency colectomy (EC). However, the results of a traditional meta-analysis were inconclusive. Therefore, a network meta-analysis (NMA) was conducted to compare the three approaches for acute left-sided colonic obstruction. METHODS: A systematic literature search of Embase, PubMed, Google Scholar and the Cochrane library was performed...

BACKGROUND: Enhanced Recovery After Surgery (ERAS) protocols reduce length of stay, complications and costs for a large number of elective surgical procedures. A similar, structured approach appears to improve outcomes, including mortality, for patients undergoing high-risk emergency general surgery, and specifically emergency laparotomy. These are the first consensus guidelines for optimal care of these patients using an ERAS approach. METHODS: Experts in aspects of management of the high-risk and emergency general surgical patient were invited to contribute by the International ERAS® Society...

No abstract text is available yet for this article.

BACKGROUND: In adults, the gold standard for surgical repair of an inguinal hernia is a mesh repair, whereas, in children, the standard is high ligation of the hernia sac. However, adolescents represent a "gray zone" between children and adults, and there is no consensus on the most appropriate operation for inguinal hernias in these patients. We aimed to describe the outcomes in adolescents undergoing high ligation for inguinal hernia repair and determine what factors may portend an increased risk of recurrence in this population...

BACKGROUND: Acute pancreatitis (AP) is defined as an acute inflammatory attack of the pancreas of sudden onset. Around 25% of patients have either moderately severe or severe disease with a mortality rate of 15-20%. PURPOSE: The aim of this article was to summarize the advances being made in the understanding of this disease and the important role of surgery. RESULTS AND CONCLUSIONS: An accurate diagnosis should be made a soon as possible, initiating resuscitation with large volume intravenous fluids and oxygen by mask...

No abstract text is available yet for this article.

Dumping syndrome is a common but underdiagnosed complication of gastric and oesophageal surgery. We initiated a Delphi consensus process with international multidisciplinary experts. We defined the scope, proposed statements and searched electronic databases to survey the literature. Eighteen experts participated in the literature summary and voting process evaluating 62 statements. We evaluated the quality of evidence using grading of recommendations assessment, development and evaluation (GRADE) criteria...

After acute treatment of deep vein thrombosis, not only the risk but also associated side effects of postthrombotic syndrome (PTS) are often underestimated.There are essentially two main types of PTS.1. Obstructive type-no sufficient recanalization of the deep vein.2. Refluctive type-sufficient recanalization of the deep vein, but insufficient venous valves in conjunction with venous reflux.A statement regarding deep vein recanalization and venous valve function can be made at the earliest after 6 months.PTS is often diagnosed without appropriate medical history...

BACKGROUND: Iron deficiency anemia and iron deficiency are commonly seen after bariatric surgery. Gastroesophageal reflux disease is commonly associated with sleeve resections and warrants postoperative acid reducing therapy. OBJECTIVE: To analyze the impact of long-term proton pump inhibitors on iron deficiency or iron deficiency anemia in laparoscopic sleeve gastrectomy (LSG) patients. SETTING: University hospital, USA. METHODS: A single-institution case control study included 2 groups of bariatric patients who underwent LSG...

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has raised several issues regarding the management of surgical patients. The aim of the current study was to clarify the management of oncologic and surgical patients during the pandemic. METHODS: Relevant publications reporting on the epidemiology of the pandemic, the diagnosis of the severe acute respiratory syndrome coronavirus 2 infection, and the clinical management of cancer and surgical patients, as well as studies concerning health care workers' safety, were included...

BACKGROUND: In gallbladder cancer, stage T2 is subdivided by tumour location into lesions on the peritoneal side (T2a) or hepatic side (T2b). For tumours on the peritoneal side (T2a), it has been suggested that liver resection may be omitted without compromising the prognosis. However, data to validate this argument are lacking. This study aimed to investigate the prognostic value of tumour location in T2 gallbladder cancer, and to clarify the adequate extent of surgical resection. METHODS: Clinical data from patients who underwent surgery for gallbladder cancer were collected from 14 hospitals in Korea, Japan, Chile and the USA...