Featured Articles in Apr 2022

Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations: A 2021 Update

 

Author list:   Erik Stenberg, Luiz Fernando dos Reis Falcão, Mary O’Kane, Ronald Liem, Dimitri J. Pournaras, Paulina Salminen, Richard D. Urman, Anupama Wadhwa, Ulf O. Gustafsson & Anders Thorell

Abstract:

Background

This is the second updated Enhanced Recovery After Surgery (ERAS®) Society guideline, presenting a consensus for optimal perioperative care in bariatric surgery and providing recommendations for each ERAS item within the ERAS® protocol.

Methods

A principal literature search was performed utilizing the Pubmed, EMBASE, Cochrane databases and ClinicalTrials.gov through December 2020, with particular attention paid to meta-analyses, randomized controlled trials and large prospective cohort studies. Selected studies were examined, reviewed and graded according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. After critical appraisal of these studies, the group of authors reached consensus regarding recommendations.

Results

The quality of evidence for many ERAS interventions remains relatively low in a bariatric setting and evidence-based practices may need to be extrapolated from other surgeries.

Conclusion

A comprehensive, updated evidence-based consensus was reached and is presented in this review by the ERAS® Society.

Free Link: https://rdcu.be/cHWLz

 


Societal Preferences for Gender of Surgeons: A Cross-Sectional Study in the General Population of Pakistan

 

Author list:   Russell Seth Martins, Mishal Gillani, Samreen Jawaid, Syeda Maryam Zehra Zaidi & Mahim Akmal Malik

Abstract

Background

Sociocultural norms and gender biases may result in surgeon gender preferences among the general public. This study aimed to understand preferences and perceptions related to surgeon gender among the general population in Pakistan, a lower-middle-income country.

Methods

A cross-sectional study was conducted by the Aga Khan University, Karachi, among the adult general population in Pakistan. Sequential mixed-mode data collection was performed via online dissemination on social media platforms and in-person surveying at different geographic locations in Karachi.

Results

Among 1604 respondents, 50% did not report having surgeon gender preferences in general. Among respondents with gender preferences, there was a highly significant preference for gender concordance across all surgical subspecialties (p <0.001) except cardiothoracic surgery and neurosurgery. Exceptions where women preferred a male surgeon were neurosurgery (59.7% vs. 40.3%; p <0.001) and cardiothoracic surgery (53.1% vs. 46.9%; p <0.001). Moreover, respondents felt more comfortable communicating with (67.6%) and being examined by (73.3%) gender concordant surgeons. Men more commonly perceived male surgeons as more competent (26% vs. 14.5%; p <0.001) and warmer (18.3% vs. 9.8%; p <0.001) than female surgeons. Nevertheless, the most important factors influencing selection of a surgeon were the surgeon’s reputation (69.6%) and experience (50.5%). Most respondents (84.5%) believed that more females should practice surgery.

Conclusion

While around half of respondents do not have gender preferences, a significant proportion prefers a gender concordant surgeon across subspecialties. In a society where conservative sociocultural norms play a significant role when seeking health care, this makes yet another compelling argument for gender parity in surgery.


Free Link: https://rdcu.be/cHWLk

 


Understanding Societal Preferences Can Inform the Discussion Seeking to Promote Gender Equity in Surgery

Author list:   Savio George Barreto

Abstract: NA
Free Link https://rdcu.be/cHWLe


Comparison of Parathyroid Autofluorescence Signals in Different Types of Hyperparathyroidism

 

 

Author list:   Eren Berber, Serkan Akbulut, Seyma Avci & Gizem Isiktas

Abstract:

Background

There are scant data in the literature regarding whether parathyroid autofluorescence (AF) signal patterns vary based on the etiology of hyperparathyroidism. The aim of this study was to compare AF signals of parathyroid glands across different etiologies of hyperparathyroidism.

Methods

As a prospective institutional review board-approved study between 2016 and 2019, AF intensities and heterogeneity indexes (HIs) of parathyroid glands in patients who underwent parathyroidectomy using AF were calculated and compared using Chi-square, Kruskal Wallis, Mann Whitney U, and logistic regression tests.

Results

Of the total of 183 patients, 127 patients had sporadic classic primary hyperparathyroidism, 30 patients had sporadic normohormonal primary hyperparathyroidism, 10 patients had sporadic normocalcemic primary hyperparathyroidism, 12 patients had tertiary hyperparathyroidism, and 4 patients had familial primary hyperparathyroidism related to multiple endocrine neoplasia (MEN) 2A. There were no statistical differences in AF signals of abnormal parathyroid glands in classic, normohormonal or normocalcemic sporadic hyperparathyroidism. Parathyroid glands in patients with tertiary hyperparathyroidism were similar in intensity, but more homogenous compared to those in sporadic primary hyperparathyroidism.

Conclusions

The pattern of AF exhibited by abnormal parathyroid glands was similar across different spectrums of primary hyperparathyroidism, in accordance with observations in the literature. However, parathyroid glands in tertiary hyperparathyroidism were more homogeneous, despite exhibiting a similar intensity of AF compared to those in sporadic primary hyperparathyroidism. These differences should be kept in mind when using the AF pattern as an adjunct to visual assessment in parathyroid exploration.


Free Link https://rdcu.be/cHWLd

 


Inspirational Women in Surgery: Simone Hofer MD, Successful—But Not Always Easy Going—Professional Career as a Female Vascular Surgeon and Mother of Four Sons:

 

Author list: Markus Furrer

Abstract:  NA
Free Link: https://rdcu.be/cHWKO


Inspirational Women in Surgery: Olga Jonasson, the Legacy of the First Female Chair of an Academic Department of Surgery

 

 

Author list: Carrie A. Sims, Joy Leemaster & Timothy M. Pawlik

Abstract:  NA
Free Link: https://rdcu.be/cHWK8

 


We Asked the Experts: Toward Personalized Immunosuppression for Liver Transplant Recipients

 

Author list: Joey Lew, Emily R. Perito & Sandy Feng

Abstract: NA
Free Link:
https://rdcu.be/cHWMa

 


Systematic Reviews and Meta-Analyses: Analgesia in the Initial Management of Acute Pancreatitis: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

 

 

Author list: Navamayooran Thavanesan, Sophie White, Shiela Lee, Bathiya Ratnayake, Kofi W. Oppong, Manu K. Nayar, Linda Sharp, Asbjørn Mohr Drewes, Gabriele Capurso, Enrique De-Madaria, Ajith K. Siriwardena, John A. Windsor & Sanjay Pandanaboyana

Abstract:

Background

The optimal analgesic strategy for patients with acute pancreatitis (AP) remains unknown.

Objective

The present systematic review and meta-analysis aims to compare the efficacy of different analgesic modalities trialled in AP.

Methods

A systematic search of PubMed, MEDLINE, EMBASE, CENTRAL, SCOPUS and Web of Science conducted up until June 2021, identified all randomised control trials (RCTs) comparing analgesic modalities in AP. A pooled analysis was undertaken of the improvement in pain scores as reported on visual analogue scale (VAS) on day 0, day 1 and day 2.

Results

Twelve RCTs were identified including 542 patients. Seven trial drugs were compared: opiates, non-steroidal anti-inflammatories (NSAIDs), metamizole, local anaesthetic, epidural, paracetamol, and placebo. Across all modalities, the pooled VAS scores showed global improvement from baseline to day 2. Epidural analgesia appears to provide the greatest improvement in VAS within the first 24 h but is equivalent to opiates by 48 h. Within 24 h, NSAIDs offered similar pain-relief to opiates, while placebo also showed equivalence to other modalities but then plateaued. Local anaesthetics demonstrated least overall efficacy. VAS scores for opiate and non-opiate analgesics were comparable at baseline and day 1. The identified RCTs demonstrated significant statistical and methodological heterogeneity in pain-relief reporting.

Conclusions

There is remarkable paucity of level 1 evidence to guide pain management in AP with small datasets per study. Epidural administration appears effective within the first 24 h of AP although infrequently used and featured in only a single RCT. NSAIDs are an effective opiate sparing alternative during the first 24 h.

Free Link: https://rdcu.be/cHWMg

 


Systematic Reviews and Meta-Analyses: Hybrid Laparoscopic Versus Open Pancreatoduodenectomy. A Meta-Analysis

Author list: Miljana Vladimirov, Dirk Bausch, Hubert J. Stein, Tobias Keck & Ulrich Wellner

Abstract:

Introduction

Hybrid laparoscopic techniques have been proposed as a good transition from open to complete minimally invasive approach especially in complex surgical procedures. This meta-analysis aimed to compare the outcomes of hybrid laparoscopic pancreatoduodenectomy versus open pancreatoduodenectomy.

 

Methods

A systematic literature research was performed according to PRISMA guidelines. A broad search strategy with terms “laparoscopy” and “pancreatoduodenectomy” was used. Included studies were analyzed by quantitative meta-analysis using the metafor package for R software.

Results

Of 655 identified articles, 627 were excluded and 28 articles fully assessed, including 14 comparative studies, 8 case series and 6 case reports. Extracted data included intraoperative variables and postoperative outcome parameters. The predefined inclusion criteria were met by 14 comparative studies, and 371 patients were pooled in the meta-analysis. Hybrid laparoscopic pacreatoduodenectomy was associated with significantly longer operative time (I2 0%, p = 0,01, Mean HPD 494,6 min, Mean OPD 421,6 min, WMD 67 min, 95% CI 14–120 min). For all other postoperative outcome parameters, no statistically significant differences were found. A nonsignificant reduction in intraoperative transfusion rate (I2 20%, p = 0,2, proportion HPD 2%, proportion OPD 1,6%, OR 0,44, 95% CI 0,16–1,27) and blood loss (I2 95%, p = 0,1, Mean HPD 397,2 ml, Mean OPD 1017,8 ml, MD − 601 ml, 95% CI − 1311–108) was observed for hybrid pancreatoduodenectomy in comparison to open surgery.

Conclusions

This meta-analysis demonstrates significantly increased operation time for hybrid laparoscopic compared to open pancreatoduodenectomy. Intraoperative variables as well as postoperative parameters and major morbidity were comparable for both techniques. Overall results of this meta-analysis demonstrated the hybrid technique as a safe procedure in high-volume centers offering aspects of a safe transition to fully laparoscopic pancreatoduodenectomy.

Free Link: https://rdcu.be/cHWMm


Effects of Gastric Bypass and Sleeve Gastrectomy on Bone Mineral Density and Bone Turnover Markers: A Systematic Review and Meta-Analysis

Author list: Mohamed AbdAlla Salman, Mohammed Aradaib, Ahmed Salman, Ahmed Elewa, Mohamed Tourky & Hossam El-Din Shaaban

Abstract:

Background

There is a growing interest in the post-operative bone-related effects of bariatric surgery. However, little is known about the comparative effects of the most commonly performed bariatric procedures, namely Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG).

Objectives

To systematically assess the differences in areal bone mineral density (aBMD) and biochemical and hormonal markers of bone metabolism among patients undergoing RYGB and SG.

Methods

We conducted a systematic review and meta-analysis of studies aBMD at different sites, as well as bone-specific alkaline phosphatase (BALP), 25-OH-vitamin D, calcium and parathyroid hormone (PTH) after RYGB and SG.

Results

Fourteen studies were included (717 patients, 50.63% in the RYGB arm). Based on data collected at 1 year, 2 years and > 2 years, there were no significant differences in aBMD measurements at the total hip, lumbar spine, femoral neck, and the whole body with no statistical heterogeneity among different comparisons. Patients in the RYGB group showed significantly higher concentrations of BALP at 1 year (SMD = 0.52, 95%CI, 0.23–0.81, p = 0.0004) and PTH at > 2 years of follow-up (SMD = 0.68, 95%CI, 0.31–1.05, p = 0.0003) compared to the SG group.

Conclusion

There were no significant differences in aBMD measurements at the hip, lumbar spine, femoral neck, and the total body following RYGB and SG procedures. However, BALP and PTH concentrations were significantly higher after RYGB surgeries compared to SG. Attention should be paid to patients undergoing RYGB to prevent the expected skeletal fragility over time.

Free Link: https://rdcu.be/cHWMT

 

 


 

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