Post-operative hypoparathyroidism is the most frequent complication after total thyroidectomy. The identification of preoperative predictors could be helpful to identify patients at risk. This study ...aimed to evaluate the potential influence of preoperative PTH levels and their perioperative dynamics as a predictor of transient, protracted, and permanent post-operative hypoparathyroidism.
A prospective, observational study that includes 100 patients who underwent total thyroidectomy between September 2018 and September 2020.
Transient hypoparathyroidism was present in 42% (42/100) of patients, 11% (11/100) developed protracted hypoparathyroidism, and 5% (5/100) permanent hypoparathyroidism. Patients who presented protracted hypoparathyroidism had higher preoperative PTH levels. The protracted and permanent hypoparathyroidism rate was higher in groups with greater preoperative PTH 0% group 1 (<40 pg/mL) vs. 5.7% group 2 (40-70 pg/mL) vs. 21.6% group 3 (>70 pg/mL); p = 0.03 and (0 vs. 8.3 vs. 20%; p = 0.442), respectively. The rate of protracted and permanent hypoparathyroidism was higher in patients with PTH at 24 h lower than 6.6 pg/mL and whose percentage of PTH decline was higher than 90%. The rate of transient hypoparathyroidism was higher in patients who showed a PTH decline rate of more than 60%. The percentage of PTH increase one week after surgery in patients with permanent hypoparathyroidism was significantly lower.
The prevalence of protracted hypoparathyroidism was higher in groups with higher preoperative PTH levels. PTH levels 24 h after surgery lower than 6.6 pg/mL and a decline of more than 90% predict protracted and permanent hypoparathyroidism. The percentage of PTH increase a week after surgery could predict permanent hypoparathyroidism.
Objective
This study aimed to investigate the influence of sarcopenic obesity on anastomotic leak following elective colon resection for non-metastatic colon cancer. Secondary outcomes included ...overall morbidity, mortality and length of hospital stay.
Methods
This retrospective observational study, conducted at a colorectal surgery referral centre, spanned from January 1, 2015, to January 1, 2020. A total of 544 consecutive patients who underwent elective colon resection were included in the analysis, excluding patients with rectal cancer, urgent surgery, absence of anastomosis, lack of imaging, multivisceral resections and synchronic tumours.
Results
Postoperative complications were observed in 177 (32.3%) patients, with 51 (9.31%) classified as severe (Clavien-Dindo > II). Sarcopenic obesity was identified in 9.39% of the sample and emerged as an independent predictor of increased overall morbidity OR 2.15 (1.14–3.69);
p
= 0.016 and 30-day mortality OR 5.07 (1.22–20.93);
p
= 0.03 and was significantly associated with the development of anastomotic leak OR 2.95 (1.41–6.18);
p
= 0.007. Furthermore, it increased the risk of reoperation and was linked to a prolonged length of hospital stay.
Conclusions
CT-measured sarcopenic obesity demonstrates a discernible correlation with an elevated risk of postoperative morbidity and mortality in the context of colon cancer surgery.
Introduction
Parastomal hernias are frequent and highly recurrent. The sandwich technique is a combination of the keyhole and Sugarbaker techniques, using a double intraperitoneal mesh. The objective ...of this study was to assess the outcomes of the sandwich technique, specifically focusing on recurrence rates.
Materials and methods
Observational retrospective study conducted in two tertiary referral centers in Catalonia, Spain. All consecutive patients who underwent parastomal hernia repair using the sandwich technique between 1st January 2016 and 31st December 2021 were included.
Results
A total of 38 patients underwent the laparoscopic sandwich technique for parastomal hernia repair. The overall recurrence rate was 7.9% (3/38), with a median follow-up of 39 months (IQR: 12.3–56.5). According to the EHS classification for parastomal hernia, there were 47.4% (18/38) type I defects, 10.5% (4/38) type II defects, 28.9% (11/38) type III defects, and 13.2% (5/38) type IV defects. The used mesh was predominantly TiMesh® (76.3%; 29/38), followed by DynaMesh® IPOM (23.7%; 9/38). Patients with recurrence exhibited higher rates of seroma, hematoma, surgical site infection, and one case of early recurrence attributed to mesh retraction. Consequently, postoperative complications emerged as the primary risk factor for hernia recurrence.
Conclusion
The sandwich technique demonstrated recurrence rates consistent with those reported in the existing literature.
Purpose
The COVID-19 pandemic caused a lockdown in many countries, which induced negative dietary habits and sedentary behavior. Studies suggest that weight loss of patients undergoing bariatric ...surgery was equally affected. The aim was to evaluate the impact of COVID-19 on weight loss, obesity-related comorbidities, and nutritional status at 1-year follow-up after gastric bypass (GB).
Methods
Retrospective observational case–control study of patients undergoing primary GB in a tertiary referral Belgian center. COVID-19 period group was composed by those whose 1-year postoperative period was affected by the COVID-19 pandemic and lockdown: from October 1, 2019, to March 31, 2020. The control group was composed of patients operated from October 1, 2018, to March 31, 2019. Electronic clinical records were reviewed searching: baseline characteristics, weight and comorbidities evolution, and biochemical values.
Results
A total of 47 patients in the COVID-19 period group and 66 in the non-COVID-19 period group were analyzed. There were no significant differences in baseline characteristics. A reduced weight loss was observed at 1-year follow-up, in terms of percentage of excess weight loss (%EWL) (82.4% SD: 21.6 vs. 82.4% SD: 21.6;
p
: 0.043) and body mass index (BMI) (27.8 kg/m
2
IQR: 25.8–30.0 vs. 26.2 kg/m
2
IQR: 24.6–28.6;
p
: 0.029) for COVID-19 period group vs. non-COVID-19 period group, respectively. There was a similar reduction of obesity-related comorbidities, without clinically significant differences in the nutritional follow-up.
Conclusion
The COVID-19 pandemic and lockdown had an impact on weight loss at 1-year follow-up after gastric bypass.
Graphical abstract
Incisional hernia (IH) is common after open abdominal aortic aneurysm (AAA) repair. Recent studies reported incidence rates higher than previously stated. The aim of this study was to quantify the IH ...incidence after open AAA surgery. The secondary outcome was to identify the risk factors associated with the development of an IH.
Retrospective observational study of all consecutive patients who underwent an open repair of AAA, from January 2010 to June 2018, at our institution. Patients were free of abdominal wall hernias at the moment of inclusion in the study. Data were extracted from electronic records: baseline characteristics, surgical factors, and postoperative events. Computed tomography (CT) scans performed during follow-up were analyzed.
A total of 157 patients were analysed. The IH incidence after open repair of AAA was 46.5% (73 patients). The median time for IH development was 24.43 months (IQR: 10.40-45.27), while the median follow-up time was 37.20 months (IQR: 20.53-64.12). The risk factors linked to IH were: active (HR: 4.535; 95% CI: 1.369-15.022) or previous smoking habit (HR: 4.652; 95% CI: 1.430-15.131), chronic kidney disease (HR: 2.007; 95% CI: 1.162-3.467) and previous abdominal surgery (HR: 1.653; 95% CI: 1.014-2.695).
The incisional hernia after open abdominal aortic aneurysm repair affected a high proportion of the intervened patients. Previous abdominal surgery, chronic kidney disease, and smoking habit were independent factors for the development of an incisional hernia.
Preoperative administration of a saturated solution of potassium iodide (SSKI) is recommended in the guidelines for the management of hyperthyroidism due to Graves’ disease. Studies addressing its ...effect on complications after thyroidectomy are inconclusive.
Retrospective multicenter Propensity Score study of patients undergoing total thyroidectomy for Graves’ disease, from January 2013 to September 2019 in two tertiary centers in Madrid, Spain. Patients were given SSKI prior to surgery or not according to surgeons’ preferences.
Electronic clinical records were reviewed searching: baseline characteristics surgical variables, pathological findings, and postoperative complications.
Ninety patients were analyzed: 44 received SSKI and 46 were not given SSKI.
No significant differences were found in the main postoperative complications with or without SSKI: transient hypoparathyroidism (40.9% vs. 50%), permanent hypoparathyroidism (6.8% vs. 13%), transient recurrent laryngeal nerve (RLN) palsy (2.3% vs. 8.7%), definitive RLN palsy (2.3% vs. 2.2%), or cervical hematoma (2.3% vs. 4.3%).
Preoperative administration of SSKI had no impact on postoperative complications after thyroidectomy for Graves’ disease.
•The preoperative administration of potassium iodide is currently recommended.•The impact of SSKI on Graves’ disease thyroidectomy was evaluated.•No differences were found on the main postoperative complications.
Backgrounds
Ventral hernia repair with a preformed device is a frequent intervention, but few reports exist with Parietex™ Composite Ventral Patch. The aim was to evaluate the results of this mesh ...with the open intraperitoneal onlay mesh (open IPOM) technique.
Methods
Observational retrospective single institution study of all consecutive patients intervened for ventral or incisional hernia with a diameter inferior to 4 cm, from January 2013 to June 2020. The surgical repair was performed according to the open IPOM technique with Parietex™ Composite Ventral Patch.
Results
A total of 146 patients were intervened: 61.6% with umbilical hernias, 8.2% with epigastric hernias, 26.7% with trocar incisional hernias, and 3.4% with other incisional hernias.
The global recurrence rate was 7.5% (11/146). Specifically, it was 7.8% in umbilical hernias, 0% in epigastric hernias, 7.7% in trocar incisional hernias and 20% (1/5) in other incisional hernias. The median time for recurrence was 14 months (IQR: 4.4–18.7). The median indirect follow‐up was 36.9 months (IQR: 27.2–49.6), and the median presential follow‐up was 17.4 months (IQR: 6.5–27.3).
Conclusion
The open IPOM technique with a preformed patch offered satisfactory results for the treatment of ventral and incisional hernias.
This observational retrospective single institution study analysed the results of the open intraperitoneal onlay mesh technique with Parietex™ Composite Ventral Patch for the treatment of ventral or incisional hernia, finding a 7.5% recurrence rate. Thus, we concluded that this technique offered satisfactory results for the treatment of these hernias.
Every year hundreds of medical residents choose their specialization in various surgical fields. However, these numbers have been poorly analyzed. The objective of this study was to evaluate the ...selection of General and Digestive Surgery by medical residents and compare these results with the selection of other surgical specialties.
Cross-sectional observational study. The data from the selection of the medical residents from surgical specialties and the top 10 most demanded specialties between the years 2018 and 2022 were included. An analysis of adjusted ranking numbers based on the number of available positions was also conducted.
The number of available positions in General and Digestive Surgery increased by 17.7% during the study period. However, the selection of our specialty has been delayed, with a median ranking number of 2419 (IQR: 1621-3284) in 2018, and 3484 (IQR: 2306-4156) in 2022 (p: .000). These differences remained significant after adjusting for the number of available positions (p: .000). The choice of Urology, Thoracic Surgery, Cardiovascular Surgery, Gastroenterology, and Paediatrics also declined during this period, while Plastic Surgery, Dermatology, Ophthalmology, Anesthesiology, and Endocrinology improved their numbers.
The choice of General and Digestive Surgery has been delayed according to the data from the MIR selection of 2018-2022. The increase in the number of available positions has not been associated with a proportional increase in demand.
INTRODUCTIONFour-dimensional computerized tomography (4D-CT) offers a good sensitivity for the localization of the pathological gland responsible of primary hyperparathyroidism. The aim was to ...evaluate its results as a second line preoperative localization test after inconclusive or discordant results of usual preoperative studies. MATERIAL AND METHODSObservational retrospective study that included all patients intervened for primary hyperparathyroidism with 4D-CT scan as preoperative study, from 1st October 2016 to 1st October 2021, in a tertiary referral centre. The results of 4D-CT, cervical ultrasound, and Nuclear Medicine explorations (scintigraphy, SPECT and SPECT-CT) were compared with the gold standard of the surgical exploration and the pathological result. The correct lateralization and the approximate localization rates of the pathological gland were evaluated. RESULTSA total of 64 patients were analysed, with a 93,8% (60/64) remission rate. 4DCT showed a correct lateralization in 57,8% (37/64) of the cases and revealed the approximate localization of the gland in 48,4% (31/64) of the cases. The cervical ultrasound had a rate of 31,1% (19/61) and 18% (11/61) for the correct lateralization and approximate localization, respectively, compared to 34,9% (22/63) and 28,6% (18/63) in Nuclear Medicine explorations, and 32,7% (16/49) and 24,5% (12/49) in SPECT-CT. These differences were statistically significant. CONCLUSION4D-CT demonstrated acceptable results for the localization of the lesions responsible of primary hyperparathyroidism, thus its use should be considered with the absence of localization in routinely studies.
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