Role of live animals in the training of microvascular surgery: a systematic review

As training in microvascular surgery often involves the use of live animals, it is important that such a practice is regularly revisited and justified, particularly in the context of emerging training strategies such as virtual simulation. This systematic review was therefore designed to assess the ongoing need for their use over other methods. A search of PubMed and MEDLINE using the major MeSH terms: anastomosis, surgical vascular procedures, microsurgery, and training, yielded 1386 titles from which 153 abstracts were read, 70 papers analysed, and 17 included. Nine of these papers were randomised studies that compared different methods of training. Other publications were included if the use of live animals was assessed or commented upon, or both (8 publications). Only one study randomised trainees to a non-living animal model or a living model, with detailed assessment that included clinical transfer to live surgery. It showed no significant difference in the quality of training, and excellent techniques of assessment. There was much discussion on the advantage of regular training and opportunities to practise without tuition, but there was no clear advantage for the use of live animals. Our review emphasises the lack of evidence regarding the need for live animals in the training of microsurgical or microvascular skills. Although the assumption remains that the use of live rats is essential, there is a clear need for a high-quality, comparative study to justify the continued use of such models given the quality of the alternatives now available.     

Risk factors for esophago-jejunal anastomosis leakage after total gastrectomy for cancer. A multicenter retrospective study of the Italian research group for gastric cancer

BackgroundMany Eastern reports attempted to identify predictive variables for esophago-jejunal anastomosis leakage (EJAL) after total gastrectomy for cancer. There are no definitive answers about reliable risk factors for EJAL. This retrospective study shows the largest Western series focused on this topic.MethodsThis is a multicenter retrospective study analyzing patients’ datasets collected by 18 Italian referral Centres of the Italian Research Group for Gastric Cancer (GIRCG) from 2000 to 2018. The inclusion criteria were pathological diagnosis of gastric and esophageal (Siewert III) carcinoma requiring total gastrectomy. The primary end point of risk analysis was the occurrence of EJAL; secondary end points were post-operative (30-day) morbidity and mortality, length of stay (LoS), and survival.ResultsData of 1750 patients submitted to total gastrectomy were collected. EJAL developed in 116 (6.6%) patients and represented the 26.3% of all the 441 observed post-operative surgical complications. EJAL diagnosis was followed by a reoperation in 39 (33.6%) patients and by an endoscopic/radiological procedure in 30 cases (25.9%). In 47 patients (40.5%) EJAL was managed with conservative approach. Post-operative LoS and mortality were significantly higher after EJAL occurrence (27 days versus 12 days and 8.6% versus 1.6%, respectively). At risk analysis, comorbidities (particularly, if respiratory), minimally invasive surgery, extended lymphadenectomy, and anastomotic technique resulted significant predictive factors for EJAL. EJAL did not significantly affect survival.ConclusionsThese results were consistent with Asian experiences: the frequency of EJAL and its higher rate observed in patients with comorbidities or after minimally invasive approach were confirmed.     

溃疡性结肠炎患者全结直肠切除+回肠贮袋肛管吻合术 术后自我关注的质性研究

目的：了解与探讨溃疡性结肠炎（ulcerative colitis，UC）患者全结直肠切除+回肠贮袋肛管吻合（ileal pouch anal anastomosis，IPAA）术后患者自我关注情况。方法：采用目的抽样法，选取14例UC 行IPAA术后患者，行半结构式深入访谈并采用Colaizzi 7步分析法分析访谈资料。结果：患者多因为自身对术后恢复的期望或疾病相关知识的不足引起对术后排便、饮食、贮袋状态等方面的自我关注。结论：医护人员应注重患者术后自我关注情况，采取相应的心理疏导措施，在饮食、贮袋状态等方面给予患者更加专业细致的指导和教育，加强出院后延续护理，以提高患者术后生活质量，促进疾病康复。     

Association of Multimodal Pain Control with Patient-Reported Outcomes in Children Undergoing Surgery

IntroductionOur aim was to describe practices in multimodal pain management at US children's hospitals and evaluate the association between non-opioid pain management strategies and pediatric patient-reported outcomes (PROs).MethodsData were collected as part of the 18-hospital ENhanced Recovery In CHildren Undergoing Surgery (ENRICH-US) clinical trial. Non-opioid pain management strategies included use of preoperative and postoperative non-opioid analgesics, regional anesthetic blocks, and a biobehavioral intervention. PROs included perioperative nervousness, pain-related functional disability, health-related quality of life (HRQoL). Associations were analyzed using multinomial logistic regression models.ResultsAmong 186 patients, 62 (33%) received preoperative analgesics, 186 (100%) postoperative analgesics, 81 (44%) regional anesthetic block, and 135 (73%) used a biobehavioral intervention. Patients were less likely to report worsened as compared to stable nervousness following regional anesthetic block (relative risk ratio [RRR]:0.31, 95% confidence interval [CI]:0.11–0.85), use of a biobehavioral technique (RRR:0.26, 95% CI:0.10–0.70), and both in combination (RRR:0.08, 95% CI:0.02–0.34). There were no associations of non-opioid pain control modalities with pain-related functional disability or HRQoL.ConclusionUse of postoperative non-opioid analgesics have been largely adopted, while preoperative non-opioid analgesics and regional anesthetic blocks are used less frequently. Regional anesthetic blocks and biobehavioral interventions may mitigate postoperative nervousness in children.Level of evidenceIII.     

食管黏膜延长预防食管吻合口瘘的临床研究

目的 研究食管黏膜延长能否预防食管吻合口瘘。方法 回顾性分析2018年1月至2019年12月在本院胸外科接受手术治疗的205例食管癌患者的临床资料。其中接受食管黏膜延长手术的食管癌患者65例为观察组,接受常规手术的140例为对照组。比较两组患者的基本临床资料、手术时间、术中出血量及术后食管吻合口瘘发生率。结果 两组患者的基本临床资料比较,差异无统计学意义(P0.05)。观察组手术时间明显短于对照组,差异有统计学意义(P0.05),两组术中出血量比较,差异无统计学意义(P0.05);观察组患者术后吻合口瘘的发生率为3.08%,明显低于对照组的12.86%,差异有统计学意义(P0.05)。结论 食管黏膜延长可以有效预防食管癌术后吻合口瘘的发生,不失为一种食管胃吻合的新方法。     

Resección anterior ultrabaja con anastomosis mecánica en el tratamiento del cáncer de recto del tercio inferior

Tumors of the lower third of the rectum are a challenge for the surgeon. Among the various techniques of surgical treatment of these lesions, radical surgery and ultra low anterior anastomosis is one of the therapeutic options. This technique is a defy both in the evaluation of the potential patient as in the surgical technique. Such evaluation and treatment processes must be audited in order to keep proper quality indices both in the oncological as in their functional results. This is only possible when both the multidisciplinary and surgical teams have an adequate and ongoing specialized training and a satisfactory volume of patients treated. Details of this technique, its indications and results are reported in this paper.     

全腹腔镜及腹腔镜辅助远端胃癌毕Ⅰ式胃肠道重建的对比研究

目的:探讨全腹腔镜毕Ⅰ式胃肠道重建(三角吻合)的可行性、安全性及临床疗效。方法:回顾分析2013年6月至2014年1月施行的41例腹腔镜远端胃癌根治术的临床资料,其中23例行全腹腔镜毕Ⅰ式胃肠道重建术(三角吻合,A组),18例行腹腔镜辅助毕Ⅰ式胃肠道重建术(B组),对比分析两组患者的手术疗效。结果:两组患者胃肠道重建时间[(24±12)min vs.(26±15)min]、术后首次进流食时间[(3.7±1.8)d vs.(3.9±2.1)d]、术后住院时间[(8.5±2.7)d vs.(8.7±2.9)d]差异无统计学意义。A组止痛药使用次数明显少于B组[(1.7±1.5)vs.(3.5±1.9),P<0.05]。术后随访3~10个月,均未发生吻合口狭窄、吻合口漏、吻合口出血等手术并发症。结论:全腹腔镜毕Ⅰ式胃肠道重建(三角吻合)是安全、可行的,近期疗效满意,远期疗效尚需进一步观察研究。