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Berger Y, Zelezetsky M, Israeli A, Shomsky N, Nachmany I, Justo D, Gutman M. [THE MULTIDISCIPLINARY GERIATRIC SURGERY UNIT AT THE CHAIM SHEBA MEDICAL CENTER - FIRST YEAR OF ACTIVITY]. Harefuah 2024; 163:211-216. [PMID: 38616629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
INTRODUCTION Recently, a Geriatric Surgery Unit (GSU) was established in the Sheba Medical Center. The Unit's aims include: professional assessment of surgical candidates, approval of the surgical plan by a multidisciplinary team discussion (MTD), and meeting the specific needs of the geriatric patient undergoing surgery. METHODS We describe the establishment of the GSU and preliminary results from the first year of its activity (January-December 2022). The GSU team consisted of a geriatric nurse practitioner (NP), a geriatric physician, surgeons, anesthesiologists and a physiotherapist. Inclusion criteria for GSU assessment/treatment were age>80 years or substantial baseline geriatric morbidity. RESULTS In 2022, 276 patients were treated by the GSU: 110 underwent elective comprehensive preoperative assessment in the NP clinic and the rest were assessed urgently/semi-electively during their hospitalization. One hundred and fifteen cases (median age 86 (65-98) years) were brought to MTD and considered for elective cholecystectomy (46.1%), colorectal procedures (16.5%), hernia repair (13.9%), hepatobiliary procedures (9.6%) or other surgeries (13.9%); of those, 49 patients (median age 86 (72-98) years) eventually proceeded to surgery, following which the median length of hospital stay (LOS) was 3.5 (1-60) days and the rate of postoperative complications was 46.7%. After discharge, the median duration of follow-up was 2.5 (0-18) months during which 4 patients died. Compared with geriatric patients who underwent cholecystectomy during 2021-2023 without MTD (n=39), in the cases discussed by the MTD, patients (n=17) had a shorter LOS (2.0±0.9 vs. 2.4±2.1 days), less 30-day Emergency Department referrals (12.5% vs. 28.2%) and less 30-day re-admissions (6.2% vs. 15.4%; all p≥0.3). CONCLUSIONS Geriatric surgical patients require a designated professional approach to meet their unique perioperative needs. The effect of GSUs on perioperative outcomes merits further prospective studies.
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Affiliation(s)
- Yaniv Berger
- Department of General Surgery, the Chaim Sheba Medical Center, Tel Hashomer, Israel, affiliated to the Faculty of Medicine, Tel Aviv University
| | - Mila Zelezetsky
- Department of General Surgery, the Chaim Sheba Medical Center, Tel Hashomer, Israel, affiliated to the Faculty of Medicine, Tel Aviv University
| | - Alon Israeli
- Department of General Surgery, the Chaim Sheba Medical Center, Tel Hashomer, Israel, affiliated to the Faculty of Medicine, Tel Aviv University
| | - Natalia Shomsky
- Department of Anesthesia, the Chaim Sheba Medical Center, Tel Hashomer, Israel, affiliated to the Faculty of Medicine, Tel Aviv University
| | - Ido Nachmany
- Department of General Surgery, the Chaim Sheba Medical Center, Tel Hashomer, Israel, affiliated to the Faculty of Medicine, Tel Aviv University
| | - Dan Justo
- Division of Geriatric Medicine, the Chaim Sheba Medical Center, Tel Hashomer, Israel, affiliated to the Faculty of Medicine, Tel Aviv University
| | - Mordechai Gutman
- Department of General Surgery, the Chaim Sheba Medical Center, Tel Hashomer, Israel, affiliated to the Faculty of Medicine, Tel Aviv University
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Gutman M, Wu T, Son CH, Al-Hallaq HA, Hasan Y. Clinical Outcomes with Triple Tandem Brachytherapy for Medically Inoperable Endometrial Cancer in a Predominantly Black Patient Population. Int J Radiat Oncol Biol Phys 2023; 117:e22-e23. [PMID: 37784900 DOI: 10.1016/j.ijrobp.2023.06.697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Radiation outcomes for Black patients with medically inoperable endometrial cancer (MIEC) is limited, despite this demographic comprising a higher proportion of the MIEC patient population. We report clinical outcomes and toxicities using triple tandem brachytherapy (TTB) with or without external beam radiation therapy (EBRT) for MIEC in predominantly Black patients. MATERIALS/METHODS An IRB approved retrospective review was performed of all MIEC patients treated definitively with TTB ± EBRT from 2014-2021 at a single institution. Patients were divided based on stage. Group 1 = FIGO stage 1A/1B and Group 2 = FIGO stage 2-4B. Patients with cervical involvement were treated with TTB + ovoids. The Kaplan-Meier estimates were generated to estimate overall survival (OS) and local failure-free survival (LFFS). Local control (LC) was evaluated clinically. Acute and late toxicities were evaluated. Planning parameters for target volume(s) and OARs (organs at risk) were per ABS guidelines. Statistics reported are median values and ranges. RESULTS Of 30 patients, 93.3% received TTB + EBRT. Mean age at diagnosis was 65.3 years (40.5-88.7 years). 70% of patients were Black. Median prescribed doses were 45 Gy (range: 21-50.4 Gy) for EBRT and 22.25 Gy (range: 16.5-49.1 Gy) for brachytherapy. Median BMI was 48.1 (27.8- 69) and Charlson Comorbidity Index was 4 (1-11). Patient stages were FIGO 1A/B (n = 19), 2 (n = 1), 3 (n = 1), 3b (n = 1), 3C1 (n = 3), 3C2 (n = 2), and 4B (n = 2) due to inguinal lymphadenopathy. 90% had endometrioid histology while 6.7% and 3.3% had clear cell and serous carcinoma, respectively. Median follow up was 32.1 months (1.7-93.6). Median OS for Group 1 was 50.9 months and 43.5 months for Group 2, while 1-/4-year OS was 84.2%/54.4% and 90.9%/17.5% for Group 1 and 2, respectively (p = 0.616). 53.3% of patients died of non-EC causes. The 1-/4-year LFFS was 100%/93.3% for Group 1 and 90%/70.5% for Group 2 (p = 0.113). Four patients (13.3%) developed recurrence (stage 1A/B, 2, 3C1, and 4B), but only 1 died of disease (Stage 2 with clear cell histology). After EBRT but pre-TTB, 50% (n = 15) and 16.6% (n = 5) had acute grade 2 gastrointestinal (GI) and genitourinary (GU) toxicities, respectively. After TTB treatment, 2 more patients developed acute grade 2 GU toxicity. Late toxicities were Grade 2: GU (n = 1) and GI (n = 1) and Grade 4 GI bleed (n = 1) treated with argon plasma coagulation. CONCLUSION TTB ± EBRT for MIEC in predominantly Black patients was associated with excellent LFFS and acceptable toxicity rates, especially in early-stage MIEC with endometrioid histology. Furthermore, even in patients at high risk of death from other causes, LC may help preserve quality of life. Additional studies are needed to evaluate and optimize outcomes for Black patients with MIEC.
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Affiliation(s)
- M Gutman
- University of Chicago, Chicago, IL, United States
| | - T Wu
- Department of Radiation and Cellular Oncology, The University of Chicago Medicine, Chicago, IL
| | - C H Son
- Department of Radiation and Cellular Oncology, University of Chicago Medical Center, Chicago, IL
| | | | - Y Hasan
- Department of Radiation and Cellular Oncology, University of Chicago Medical Center, Chicago, IL
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Zager Y, Khalilieh S, Mansour A, Cohen K, Nadler R, Anteby R, Ram E, Horesh N, Nachmany I, Gutman M, Berger Y. Correction to: The value of CA125 in predicting acute complicated colonic diverticulitis. Int J Colorectal Dis 2023; 38:209. [PMID: 37556027 DOI: 10.1007/s00384-023-04486-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Affiliation(s)
- Yaniv Zager
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Saed Khalilieh
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Aiham Mansour
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Karin Cohen
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Roy Nadler
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Roi Anteby
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Edward Ram
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Nir Horesh
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Department of Colon and Rectal Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - Ido Nachmany
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Mordechai Gutman
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Yaniv Berger
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel.
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Zager Y, Khalilieh S, Mansour A, Cohen K, Nadler R, Anteby R, Ram E, Horesh N, Nachmany I, Gutman M, Berger Y. The value of CA125 in predicting acute complicated colonic diverticulitis. Int J Colorectal Dis 2023; 38:182. [PMID: 37389666 DOI: 10.1007/s00384-023-04478-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND CA125 is a widely used serum marker for epithelial ovarian cancer which levels may also rise in benign conditions involving peritoneal irritation. We aimed to determine if serum CA125 levels can predict disease severity in patients presenting with acute diverticulitis. METHODS We conducted a single-center prospective observational study, analyzing CA125 serum levels in patients who presented to the emergency department with computerized tomography-proven acute left-sided colonic diverticulitis. Univariate, multivariate, and receiver operating characteristic (ROC) analyses were used to correlate CA125 serum levels at time of initial presentation with the primary outcome (complicated diverticulitis) and secondary clinical outcomes (need for urgent intervention, length of hospital stay (LOS) and readmission rates). RESULTS One hundred and fifty-one patients were enrolled between January 2018 and July 2020 (66.9% females, median age 61 years). Twenty-five patients (16.5%) presented with complicated diverticulitis. CA125 levels were significantly higher among patients with complicated (median: 16 (7-159) u/ml) vs. uncomplicated (8 (3-39) u/ml) diverticulitis (p < 0.001) and also correlated with the Hinchey severity class (p < 0.001). Higher CA125 levels upon admission were associated with a longer LOS and a greater chance to undergo invasive procedure during the hospitalization. In patients with a measurable intra-abdominal abscess (n = 24), CA125 levels were correlated with the size of the abscess (Spearman's r = 0.46, p = 0.02). On ROC analysis to predict complicated diverticulitis, the area under the curve (AUC) for CA125 (AUC = 0.82) was bigger than for the leukocyte count (AUC = 0.53), body temperature (AUC = 0.59), and neutrophil-lymphocyte ratio (AUC = 0.70) - all p values < 0.05. On multivariate analysis of factors available at presentation, CA125 was found to be the only independent predictor of complicated diverticulitis (OR 1.12 (95% CI 1.06-1.19), p < 0.001). CONCLUSIONS The results from this feasibility study suggest that CA125 may accurately discriminate between simple and complicated diverticulitis, meriting further prospective investigation.
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Affiliation(s)
- Yaniv Zager
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Saed Khalilieh
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Aiham Mansour
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Karin Cohen
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Roy Nadler
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Roi Anteby
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Edward Ram
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Nir Horesh
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Department of Colon and Rectal Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - Ido Nachmany
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Mordechai Gutman
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Yaniv Berger
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel.
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Kabha K, Zager Y, Anteby R, Ram E, Khaikin M, Gutman M, Nachmany I, Horesh N. Risk Factors for Readmission and Mortality Following Colonic Surgery: A Consecutive Retrospective Series of More Than 2500 Cases. J Laparoendosc Adv Surg Tech A 2023. [PMID: 37036789 DOI: 10.1089/lap.2023.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023] Open
Abstract
Introduction: The optimal strategy to reduce short-term readmission rates following colectomy remains unclear. Identifying possible risk factors can minimize the burden associated with surgical complications leading to readmissions. Materials and Methods: A retrospective review of all adult patients who underwent colectomies between January 2008 and December 2020 in a large tertiary medical center was conducted. Data were collected from patient's medical charts and analyzed. Results: Overall, 2547 patients were included in the study (53% females; mean age 68.3 years). The majority of patients (83%, n = 2112) were operated in an elective setting, whereas 435 patients (17%) underwent emergency colonic resection. Overall, the 30-day readmission rate was 8.3% (n = 218) with an overall 30-day mortality rate of 1.65% (n = 42). Multivariable analysis of possible risk factors for 30-day readmission demonstrated that patient age (odds ratio [OR] 0.98; P = .002), length of stay before surgery (OR 1.01; P = .003), and blood transfusion rate during hospitalization (OR 2.09; P < .001) were all independently associated with an increased risk. Laparoscopic colectomy (OR 0.53; P = .001) was associated with a reduced risk for readmission. Multivariable analysis of risk factors for mortality showed that age (OR 1.10; P < .001), cognitive decline (OR 12.35; P < .001), diabetes (OR 1.00; P = .004), and primary ostomy formation (OR 2.80; P = .006) were all associated with higher mortality. Conclusion: Patient age, history of cognitive decline, and blood transfusion along with a longer hospital stay were all correlated with an increased risk for 30-day patient readmission following colectomy.
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Affiliation(s)
- Kamal Kabha
- Department of General Surgery and Transplantations, Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yaniv Zager
- Department of General Surgery and Transplantations, Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Roi Anteby
- Department of General Surgery and Transplantations, Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Edward Ram
- Department of General Surgery and Transplantations, Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Marat Khaikin
- Department of General Surgery and Transplantations, Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Mordechai Gutman
- Department of General Surgery and Transplantations, Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ido Nachmany
- Department of General Surgery and Transplantations, Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Nir Horesh
- Department of General Surgery and Transplantations, Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Colon and Rectal Surgery, Cleveland Clinic Florida, Weston, Florida, USA
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Nachliel E, Gutman M. Reaction within the coulomb-cage; science in retrospect. Biochim Biophys Acta Biomembr 2023; 1865:184071. [PMID: 36244436 DOI: 10.1016/j.bbamem.2022.184071] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 08/01/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022]
Abstract
The Coulomb-cage is defined as the space where the electrostatic interaction between two bodies is more intensive than the thermal energy (kBT). For small molecule, the Coulomb-cage is a small sphere, extending only few water molecules towards the bulk and its radius is sensitive to the ionic strength of the solution. For charged proteins or membranal structures, the Coulomb-cage can engulf large fraction of the surface and provides a preferred pathway for ion propagation along the surface. Similarly, electrostatic potential at the inner space of a channel can form preferential trajectories passage for ions. The dynamics of ions inside the Coulomb-cage of ions was formulated by the studies of proton-anion recombination of excited photoacids. In the present article, we recount the study of intra- Coulomb-cage reaction taking place on the surface of macro-molecular bodies like micelles, membranes, proteins and intra-protein cavities. The study progressed stepwise, tracing the dynamics of a proton ejected from a photo-acid molecule located at defined sites (on membrane, inter-membrane space, active site of enzyme, inside Large Pore Channels etc.). Accumulation of experimental observations encouraged us to study of the reaction mechanism by molecular dynamics simulations of ions within the Coulomb-cage of proteins surface or inside large pores. The intra-Coulomb-cage proton transfer events follows closely the fine structure of the electrostatic field inside the cage and reflects the shape of nearby dielectric boundaries, the temporal ordering of the solvent molecules and the structural fluctuations of the charged side chains. The article sums some 40 years of research, which in retrospect clarifies the intra-Coulomb-cage reaction mechanism.
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Affiliation(s)
- E Nachliel
- Laser Laboratory for Fast Reactions, Dep. Of Biochemistry and Molecular Biology, Life Sciences, Tel Aviv University, Israel
| | - M Gutman
- Laser Laboratory for Fast Reactions, Dep. Of Biochemistry and Molecular Biology, Life Sciences, Tel Aviv University, Israel.
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Ricon-Becker I, Haldar R, Shabat Simon M, Gutman M, Cole SW, Ben-Eliyahu S, Zmora O. Effect of perioperative COX-2 and beta-adrenergic inhibition on 5-year disease-free-survival in colorectal cancer: A pilot randomized controlled Colorectal Metastasis PreventIon Trial (COMPIT). Eur J Surg Oncol 2022. [DOI: 10.1016/j.ejso.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Aharoni M, Zager Y, Khalilieh S, Amiel I, Horesh N, Ram E, Gutman M, Rosin D. Reply to “Comments on ‘Laparoscopic fixation of volvulus by extra-peritonealization—a case series’”. Tech Coloproctol 2022; 26:685. [DOI: 10.1007/s10151-022-02652-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 05/29/2022] [Indexed: 10/18/2022]
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Mansour A, Horesh N, Gutman M, Goldes Y. Giant Diaphragmatic Hernia in Elastoderma. Isr Med Assoc J 2022; 24:121-122. [PMID: 35187904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Aiham Mansour
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Horesh
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordechai Gutman
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yuri Goldes
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Russell B, Zager Y, Mullin G, Cohen M, Dan A, Nevler A, Gutman M, Horesh N. Naples Prognostic Score to Predict Postoperative Complications After Colectomy for Diverticulitis. Am Surg 2022:31348211069803. [DOI: 10.1177/00031348211069803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background The Naples Prognostic Score (NPS) has proven efficacy as a prognostic tool for postoperative outcomes in patients undergoing surgery for neoplastic diseases. However, the role of the NPS score in inflammatory surgical diseases has not yet been studied. We aimed to evaluate NPS predictive value in patients undergoing colectomy due to diverticulitis. Methods A single-center retrospective study including all patients who underwent colectomy for diverticulitis between July 2008 and March 2020 was established. Patients' demographics, clinical and surgical data were recorded and analyzed. Patients were scored on a scale of 0-4 and received one point for preoperation albumin <4 g/dL, cholesterol ≤180 mg/dL, Neutrophil to Lymphocyte Ratio >2.96, and Lymphocyte to Monocyte ≤4.44. Results Out of 3292 patients admitted because of diverticulitis during the study period, 159 patients (4.83%) underwent colectomy. Of those patients, fifty patients were eligible for NPS analysis. 35 patients (70%) were females with a mean age of 62.81 ± 14.51. Thirty-two (64%) patients underwent an elective operation. The postoperative complications rate was 36% (N = 18). The mortality rate was 6% (N = 3). ROC showed a strong association between the NPS and mortality (area = .88, P = .03) and wound infection (area = .78, P = .01). In patients who underwent urgent surgery, there was an association between NPS and re-operation ( P = .04). There was a correlation between NPS and Clavien-Dindo score (Spearman’s coefficient = .284, P = .045). Conclusions/Discussion The Naples prognostic score is an effective tool for predicting postoperative complications in patients undergoing colectomy for diverticulitis. It may assist the surgeon in deciding on extent of the operation for diverticulitis and in elective cases also on timing.
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Affiliation(s)
- Benjamin Russell
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Yaniv Zager
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Surgery B Department of General Surgery and Transplantation, Sheba Medical Center, Ramat-Gan, Israel
| | - Gillie Mullin
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Matan Cohen
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Assaf Dan
- Surgery C Department of Surgical Oncology, Sheba Medical Center, Ramat-Gan, Israel
| | - Avinoam Nevler
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Mordechai Gutman
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Surgery B Department of General Surgery and Transplantation, Sheba Medical Center, Ramat-Gan, Israel
| | - Nir Horesh
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Surgery B Department of General Surgery and Transplantation, Sheba Medical Center, Ramat-Gan, Israel
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11
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Nizri E, Berger Y, Green E, Matan Kyzer, Aizic A, Nevo N, Gerstenhaber F, Klausner JM, Gutman M, Lahat G, Hoffman A, Geva R. ASO Visual Abstract: Lymph Node Metastases from Visceral Peritoneal Colorectal Metastases are Associated with Systemic Recurrence. Ann Surg Oncol 2021. [PMID: 34812986 DOI: 10.1245/s10434-021-10966-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Eran Nizri
- Department of Surgery A, Peritoneal Surface Malignancy and Melanoma Unit, Tel-Aviv Sourasky Medical Center, 6 Weizman Street, 6423906, Tel-Aviv, Israel. .,The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Yaniv Berger
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Surgery B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Eraan Green
- Department of Surgery A, Peritoneal Surface Malignancy and Melanoma Unit, Tel-Aviv Sourasky Medical Center, 6 Weizman Street, 6423906, Tel-Aviv, Israel
| | - Matan Kyzer
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Surgery B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Asaf Aizic
- Institute of Pathology, Tel- Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Nadav Nevo
- Department of Surgery A, Peritoneal Surface Malignancy and Melanoma Unit, Tel-Aviv Sourasky Medical Center, 6 Weizman Street, 6423906, Tel-Aviv, Israel
| | - Fabian Gerstenhaber
- Department of Surgery A, Peritoneal Surface Malignancy and Melanoma Unit, Tel-Aviv Sourasky Medical Center, 6 Weizman Street, 6423906, Tel-Aviv, Israel
| | - Joseph M Klausner
- Department of Surgery A, Peritoneal Surface Malignancy and Melanoma Unit, Tel-Aviv Sourasky Medical Center, 6 Weizman Street, 6423906, Tel-Aviv, Israel.,The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Mordechai Gutman
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Surgery B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Guy Lahat
- Department of Surgery A, Peritoneal Surface Malignancy and Melanoma Unit, Tel-Aviv Sourasky Medical Center, 6 Weizman Street, 6423906, Tel-Aviv, Israel.,The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Aviad Hoffman
- Department of General Surgery, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ravit Geva
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Oncology Division, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
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12
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Nizri E, Berger Y, Green E, Kyzer M, Aizic A, Nevo N, Gerstenhaber F, Klausner JM, Gutman M, Lahat G, Hoffman A, Geva R. Lymph Node Metastases from Visceral Peritoneal Colorectal Metastases are Associated with Systemic Recurrence. Ann Surg Oncol 2021; 29:2069-2075. [PMID: 34622371 DOI: 10.1245/s10434-021-10869-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 09/13/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Visceral peritoneal colorectal metastases (VPCMs) may further metastasize to lymph nodes that drain those organs. The rate of lymph node metastases (LNMs) from VPCMs and their clinical and prognostic significance are unknown. METHODS This study retrospectively analyzed the authors' institutional databases of 160 patients with peritoneal colorectal metastases who underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Patients with LNM-VPCM (n = 12) were identified by pathologic reports, and both their short- and long-term outcomes were compared with those of patients without LNM-VPCM. RESULTS The clinical presentation and primary tumor pathologic characteristics did not differ between the two groups. The patients with LNM-VPCM had a higher tumor burden (measured by the peritoneal carcinomatosis index [PCI]) and visible remnant disease compared with those who had no LNM-VPI (10 vs 5.5 [p = 0.03] vs 33.3% vs 6.8% [p = 0.007], respectively). The postoperative outcomes also were comparable. The patients with LNM-VPCM had a shorter overall survival (OS) than those without LNM-VPCM (median OS, 22.5 months; 95% confidence interval [CI], 15.1-29.9 months vs 40.1 months; 95% CI, 38.1-42 months; p = 0.02). However, only tumor grade and PCI were predictors of OS in the multivariate analysis (hazard ratio [HR], 2.33 [p = 0.001]; 1.77 [p = 0.03], respectively). The study showed that LNM-VPCM was associated with systemic but not peritoneal recurrence compared with non-LNM-VPCM (81.8% vs 51.6% for systemic recurrence, respectively; p = 0.05). CONCLUSION The small distinct group of patients defined by LNM-VPCM were prone to systemic recurrence. Given its correlation with systemic recurrence, LNM-VPCM may indicate the need for adjuvant treatment.
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Affiliation(s)
- Eran Nizri
- Peritoneal Surface Malignancy and Melanoma Unit, Department of Surgery A, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel. .,The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Yaniv Berger
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Surgery B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Eraan Green
- Peritoneal Surface Malignancy and Melanoma Unit, Department of Surgery A, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Matan Kyzer
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Surgery B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Asaf Aizic
- Institute of Pathology, Tel- Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Nadav Nevo
- Peritoneal Surface Malignancy and Melanoma Unit, Department of Surgery A, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Fabian Gerstenhaber
- Peritoneal Surface Malignancy and Melanoma Unit, Department of Surgery A, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Joseph M Klausner
- Peritoneal Surface Malignancy and Melanoma Unit, Department of Surgery A, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Mordechai Gutman
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Surgery B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Guy Lahat
- Peritoneal Surface Malignancy and Melanoma Unit, Department of Surgery A, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Aviad Hoffman
- Department of General Surgery, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ravit Geva
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Oncology Division, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
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13
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Khalilieh S, Horesh N, Cordoba M, Forschmidt E, Zager Y, Nadler R, Gutman M, Rosin D, Ram E. Surgical Outcomes of Minimally Invasive Trephine Surgery for Pilonidal Sinus Disease and Risk Factors for Recurrence. J Laparoendosc Adv Surg Tech A 2021; 32:288-292. [PMID: 33960849 DOI: 10.1089/lap.2021.0097] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Minimally invasive surgical (MIS) techniques for pilonidal sinus disease (PNS) have gained popularity in recent years, due to faster recovery and lower complication rate compared with conventional methods. Our aim was to assess recurrence rate following MIS Trephine procedure for PNS and to identify possible risk factors for recurrence. Materials and Methods: A prospective cohort, including patients who underwent PNS Excision by Trephine MIS Procedure over 5 years in a large tertiary medical center was established. Patient data were collected from medical charts and patient telephone survey to asses recurrence rate. Results: Two hundred three patients underwent MIS Trephine procedure for PNS, with data available on 130 patients (64.2%). Overall recurrence and nonhealing wound rate was 33.07% (43 patients), with disease recurrence occurring in mean time of 13.3 months (range 2-47 months). Thirty-six patients underwent repeat MIS Trephine surgery with recurrence occurring in 6 patients (4.6%). Overall healing rate following repeat surgery was 91.5% (119 patients). Univariate analysis of preoperative and clinical factors, including body mass index (P = .77), smoking status (P = .53), number of sinus tracts (P = .78), previous abscess drainage (P = .45), and diameter size of the trephine blade (P = .72) demonstrated no correlation to disease recurrence following surgery. Multivariate Cox regression analysis showed similar results, with only young age (<30 years) associated with disease recurrence (P = .01). Conclusion: Recurrence following minimally invasive trephine excision for PNS is fairly high, but repeat surgery in recurring patients has a high rate of a successful outcome.
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Affiliation(s)
- Saed Khalilieh
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel (Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel)
| | - Nir Horesh
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel (Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel)
| | - Mordehay Cordoba
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel (Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel)
| | - Eyal Forschmidt
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel (Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel)
| | - Yaniv Zager
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel (Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel)
| | - Roy Nadler
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel (Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel)
| | - Mordechai Gutman
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel (Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel)
| | - Danny Rosin
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel (Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel)
| | - Edward Ram
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel (Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel)
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14
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Aharoni M, Barash Y, Zager Y, Anteby R, Khalilieh S, Amiel I, Klang E, Goldes Y, Gutman M, Horesh N, Rosin D. Management of Acute Appendicitis during the COVID-19 Pandemic: A Single Tertiary Center Experience. Isr Med Assoc J 2021; 23:269-273. [PMID: 34024041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND The coronavirus disease-2019 (COVID-19) outbreak had an effect on healthcare. OBJECTIVES To evaluate the presentation and management of patients with acute appendicitis. METHODS A retrospective study was conducted of all patients presenting with acute appendicitis to the emergency department of a large tertiary center during March and April 2020. Clinical features, diagnostic workup, and management were compared. RESULTS Seventy-four patients presented with acute appendicitis during the pandemic compared to 60 patients during the same time the year before. There were no significant differences in patient demographics: age (P = 0.65), gender (P = 0.73), smoking status (P = 0.48). During COVID-19 patients were more likely to complain of right lower quadrant pain (100% vs. 78.3%, P < 0.01). Rates of surgical treatment was similar (83.8% vs. 81.7%, P = 1); mean operative time was longer during COVID-19 (63 ± 23 vs. 52 ± 26 minutes, P = 0.03). There were no significant differences in intra-operative findings including the presence of appendiceal perforation (16.3% vs. 14.5%, P = 0.8), abscess (6.1% vs. 9.7%, P = 0.73), or involvement of cecum or terminal ileum (14.28% vs. 19.63%, P = 1). Postoperative treatment with antibiotics was more prevalent during COVID-19 (37.1% vs. 18%, P = 0.04). Length of stay (1.82 ± 2.04 vs. 2.74 ± 4.68, P = 0.2) and readmission rates (6% vs. 11.3%, P =0.51) were similar. CONCLUSIONS The COVID-19 pandemic did not significantly affect the presentation, clinical course, management, and outcomes of patients presenting with acute appendicitis.
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Affiliation(s)
- Mor Aharoni
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yiftach Barash
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaniv Zager
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roi Anteby
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Saed Khalilieh
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Imri Amiel
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Klang
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yuri Goldes
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordechai Gutman
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Horesh
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Danny Rosin
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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15
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Zager Y, Khalilieh S, Ganaiem O, Gorgov E, Horesh N, Anteby R, Kopylov U, Jacoby H, Dreznik Y, Dori A, Gutman M, Nevler A. Low psoas muscle area is associated with postoperative complications in Crohn's disease. Int J Colorectal Dis 2021; 36:543-550. [PMID: 33236229 DOI: 10.1007/s00384-020-03799-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/10/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Crohn's disease (CD) is associated with increased postoperative morbidity. Sarcopenia correlates with increased morbidity and mortality in various medical conditions. We assessed correlations of the lean body mass marker and psoas muscle area (PMA), with postoperative outcomes in CD patients undergoing gastrointestinal surgery. METHODS We included patients with CD who underwent gastrointestinal surgery between June 2009 and October 2018 and had CT/MRI scans within 8 weeks preoperatively. PMA was measured bilaterally on perioperative imaging. RESULTS Of 121 patients, the mean age was 35.98 ± 15.07 years; 51.2% were male. The mean BMI was 21.56 ± 4 kg/m2. The mean PMA was 95.12 ± 263.2cm2. Patients with postoperative complications (N = 31, 26%) had significantly lower PMA compared with patients with a normal postoperative recovery (8.5 ± 2.26 cm2 vs. 9.85 ± 2.68 cm2, P = 0.02). A similar finding was noted comparing patients with anastomotic leaks to those without anastomotic leaks (7.48 ± 0.1 cm2 vs. 9.6 ± 2.51 cm2, P = 0.04). PMA correlated with the maximum degree of complications per patient, according to the Clavien-Dindo classification (Spearman's coefficient = -0.26, P = 0.004). Patients with major postoperative complications (Clavien-Dindo ≥ 3) had lower mean PMA (8.12 ± 2.75 cm2 vs. 9.71 ± 2.57 cm2, P = 0.03). Associations were similar when stratifying by gender and operation urgency. On multivariate analysis, PMA (HR = 0.72/cm2, P = 0.02), operation urgency (HR = 3.84, P < 0.01), and higher white blood cell count (HR = 1.14, P = 0.02) were independent predictive factors for postoperative complications. CONCLUSION PMA is an easily measured radiographic parameter associated with postoperative complications in patients with CD undergoing bowel resection.
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Affiliation(s)
- Yaniv Zager
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel HaShomer, Israel. .,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Saed Khalilieh
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel HaShomer, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Omar Ganaiem
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel HaShomer, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eli Gorgov
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel HaShomer, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Horesh
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel HaShomer, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roi Anteby
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel HaShomer, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Uri Kopylov
- Department of Gastroenterology, Sheba Medical Center, Ramat-Gan, and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Harel Jacoby
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel HaShomer, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Dreznik
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel HaShomer, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Assaf Dori
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel HaShomer, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordechai Gutman
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel HaShomer, Israel
| | - Avinoam Nevler
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel HaShomer, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
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16
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Cordoba M, Anteby R, Zager Y, Barash Y, Klang E, Nadler R, Amiel I, Gutman M, Horesh N, Aviran N, Klein Y. The Effect of the COVID-19 Outbreak on Trauma-Related Visits to a Tertiary Hospital Emergency Department. Isr Med Assoc J 2021; 23:82-86. [PMID: 33595211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND The novel coronavirus disease (COVID-19) pandemic changed medical environments worldwide. OBJECTIVES To evaluate the impact of the COVID-19 pandemic on trauma-related visits to the emergency department (ED). METHODS A single tertiary center retrospective study was conducted that compared ED attendance of patients with injury-related morbidity between March 2020 (COVID-19 outbreak) and pre-COVID-19 periods: February 2020 and the same 2 months in 2018 and 2019. RESULTS Overall, 6513 patients were included in the study. During the COVID-19 outbreak, the daily number of patients visiting the ED for acute trauma declined by 40% compared to the average in previous months (P < 0.01). A strong negative correlation was found between the number of trauma-related ED visits and the log number of confirmed cases of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in Israel (Pearson's r = -0.63, P < 0.01). In the COVID-19 period there was a significant change in the proportion of elderly patients (7% increase, P = 0.002), admissions ratio (12% increase, P < 0.001), and patients brought by emergency medical services (10% increase, P < 0.001). The number of motor vehicle accident related injury declined by 45% (P < 0.01). CONCLUSIONS A significant reduction in the number of trauma patients presenting to the ED occurred during the COVID-19 pandemic, yet trauma-related admissions were on the rise.
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Affiliation(s)
- Mordehay Cordoba
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
| | - Roi Anteby
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
| | - Yaniv Zager
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
| | - Yiftach Barash
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Radiology, Sheba Medical Center, Tel Hashomer, Israel
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel
| | - Eyal Klang
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Radiology, Sheba Medical Center, Tel Hashomer, Israel
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel
| | - Roy Nadler
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
| | - Imri Amiel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
| | - Mordechai Gutman
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
| | - Nir Horesh
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
| | - Nimrod Aviran
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Emergency Medicine, Sheba Medical Center, Tel Hashomer, Israel
| | - Yoram Klein
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Emergency Medicine, Sheba Medical Center, Tel Hashomer, Israel
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17
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Nevo Y, Shaltiel T, Constantini N, Rosin D, Gutman M, Zmora O, Nevler A. Activity Tracking After Surgery: Does It Correlate With Postoperative Complications? Am Surg 2021; 88:226-232. [PMID: 33522277 DOI: 10.1177/0003134820988818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Postoperative ambulation is an important tenet in enhanced recovery programs. We quantitatively assessed the correlation of decreased postoperative ambulation with postoperative complications and delays in gastrointestinal function. METHODS Patients undergoing major abdominal surgery were fitted with digital ankle pedometers yielding continuous measurements of their ambulation. Primary endpoints were the overall and system-specific complication rates, with secondary endpoints being the time to first passage of flatus and stool, the length of hospital stay, and the rate of readmission. RESULTS 100 patients were enrolled. We found a significant, independent inverse correlation between the number of steps on the first and second postoperative days (POD1/2) and the incidence of complications as well as the recovery of GI function and the likelihood of readmission (P < .05). POD2 step count was an independent risk factor for severe complications (P = .026). DISCUSSION Digitally quantified ambulation data may be a prognostic biomarker for the likelihood of severe postoperative complications.
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Affiliation(s)
- Yehonatan Nevo
- Department of General Surgery (Surgery B), Chaim Sheba Medical Center, Tel-Aviv University, Tel Hashomer, Israel
| | - Tali Shaltiel
- Division of General Surgery, 36632Rabin Medical Center, Petah Tikva, Israel
| | - Naama Constantini
- Sports Medicine Center, Department of Orthopedic Surgery, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Danny Rosin
- Department of General Surgery (Surgery B), Chaim Sheba Medical Center, Tel-Aviv University, Tel Hashomer, Israel
| | - Mordechai Gutman
- Department of General Surgery (Surgery B), Chaim Sheba Medical Center, Tel-Aviv University, Tel Hashomer, Israel
| | - Oded Zmora
- Division of General Surgery, 37256Assaf Harofeh Medical Center, Zerifin, Israel
| | - Avinoam Nevler
- Department of General Surgery (Surgery B), Chaim Sheba Medical Center, Tel-Aviv University, Tel Hashomer, Israel
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18
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Aviran E, Laks S, Benvenisti H, Khalilieh S, Assaf D, Aviran N, Hazzan D, Klein Y, Cohen A, Gutman M, Nissan A, Segev L. The Impact of the COVID-19 Pandemic on General Surgery Acute Admissions and Urgent Operations: A Comparative Prospective Study. Isr Med Assoc J 2020; 11:673-679. [PMID: 33249785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND As part of the effort to control the coronavirus disease-19 (COVID-19) outbreak, strict emergency measures, including prolonged national curfews, have been imposed. Even in countries where healthcare systems still functioned, patients avoided visiting emergency departments (EDs) because of fears of exposure to COVID-19. OBJECTIVES To describe the effects of the COVID-19 outbreak on admissions of surgical patients from the ED and characteristics of urgent operations performed. METHODS A prospective registry study comparing all patients admitted for acute surgical and trauma care between 15 March and 14 April 2020 (COVID-19) with patients admitted in the parallel time a year previously (control) was conducted. RESULTS The combined cohort included 606 patients. There were 25% fewer admissions during the COVID-19 period (P < 0.0001). The COVID-19 cohort had a longer time interval from onset of symptoms (P < 0.001) and presented in a worse clinical condition as expressed by accelerated heart rate (P = 0.023), leukocyte count disturbances (P = 0.005), higher creatinine, and CRP levels (P < 0.001) compared with the control cohort. More COVID-19 patients required urgent surgery (P = 0.03) and length of ED stay was longer (P = 0.003). CONCLUSIONS During the COVID-19 epidemic, fewer patients presented to the ED requiring acute surgical care. Those who did, often did so in a delayed fashion and in worse clinical condition. More patients required urgent surgical interventions compared to the control period. Governments and healthcare systems should emphasize to the public not to delay seeking medical attention, even in times of crises.
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Affiliation(s)
- Eyal Aviran
- Department of General and Oncological Surgery C, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shachar Laks
- Department of General and Oncological Surgery C, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Haggai Benvenisti
- Department of General and Oncological Surgery C, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Saed Khalilieh
- Department of Surgery B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dan Assaf
- Department of General and Oncological Surgery C, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nimrod Aviran
- Department of Surgery B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Hazzan
- Department of General and Oncological Surgery C, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoram Klein
- Department of Surgery B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Cohen
- Department of General Intensive Care Unit, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordechai Gutman
- Department of Surgery B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviram Nissan
- Department of General and Oncological Surgery C, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lior Segev
- Department of General and Oncological Surgery C, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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19
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Vinik Y, Ortega FG, Mills GB, Lu Y, Jurkowicz M, Halperin S, Aharoni M, Gutman M, Lev S. Proteomic analysis of circulating extracellular vesicles identifies potential markers of breast cancer progression, recurrence, and response. Sci Adv 2020; 6:6/40/eaba5714. [PMID: 33008904 PMCID: PMC7852393 DOI: 10.1126/sciadv.aba5714] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 08/21/2020] [Indexed: 05/03/2023]
Abstract
Proteomic profiling of circulating small extracellular vesicles (sEVs) represents a promising, noninvasive approach for early detection and therapeutic monitoring of breast cancer (BC). We describe a relatively low-cost, fast, and reliable method to isolate sEVs from plasma of BC patients and analyze their protein content by semiquantitative proteomics. sEV-enriched fractions were isolated from plasma of healthy controls and BC patients at different disease stages before and after surgery. Proteomic analysis of sEV-enriched fractions using reverse phase protein array revealed a signature of seven proteins that differentiated BC patients from healthy individuals, of which FAK and fibronectin displayed high diagnostic accuracy. The size of sEVs was significantly reduced in advanced disease stage, concomitant with a stage-specific protein signature. Furthermore, we observed protein-based distinct clusters of healthy controls, chemotherapy-treated and untreated postsurgery samples, as well as a predictor of high risk of cancer relapse, suggesting that the applied methods warrant development for advanced diagnostics.
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Affiliation(s)
- Yaron Vinik
- Weizmann Institute of Science, Rehovot, Israel
| | | | | | - Yilling Lu
- MD Anderson Cancer Center, Houston, TX 77030, USA
| | | | | | | | | | - Sima Lev
- Weizmann Institute of Science, Rehovot, Israel.
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20
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Zager Y, Hoffman A, Dreznik Y, Jacoby H, Cordoba M, Horesh N, Nevler A, Gutman M, Berger Y. Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy in patients with peritoneal carcinomatosis from colorectal cancer: The prognostic impact of baseline neutrophil-lymphocyte, platelet-lymphocyte and lymphocyte-monocyte ratios. Surg Oncol 2020; 35:321-327. [PMID: 32977104 DOI: 10.1016/j.suronc.2020.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 08/14/2020] [Accepted: 09/06/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE In this retrospective analysis we sought to determine if the preoperative neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and lymphocyte-monocyte ratio (LMR) were predictive of both operability and survival in those patients presenting with peritoneal carcinomatosis (PC) from colorectal cancer (CRC) who underwent cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC). METHODS Analysis included all patients admitted between 2009 and 2017 with PC from CRC who were treated with curative intent by CRS-Mitomycin C-HIPEC. Patients were assessed pre- and intra-operatively by the PC index (PCI) and by a completeness of cytoreduction (CC) score with calculation of Kaplan-Meier survival curves and multivariate analysis of prognostic factors. Discrimination was made for NLR >3.5, PLR >168.8 and LMR >4.4. RESULTS We identified 98 CRC patients undergoing 105 CRS-HIPEC procedures. There were no associations detected between NLR/PLR/LMR and the rates of incomplete or abandoned CRS cases. Overall survival (OS) after CRS-HIPEC was worse with high versus low NLR (19.9 mths vs. 45.7 mths, respectively; P = 0.009) and also with low versus high LMR (27.1 mths vs. 53.2 mths, respectively; P = 0.01). On multivariate analysis, a low LMR (P = 0.008), the preoperative CT PCI value (P = 0.004), poor tumor differentiation (P = 0.023) and the preoperative CEA level (P < 0.001) were all independent variables associated with a worse OS after surgery. CONCLUSIONS The baseline LMR value may have potential value as a selection tool for CRS-HIPEC in patients with CRC-related PC.
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Affiliation(s)
- Yaniv Zager
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Aviad Hoffman
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Yael Dreznik
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Harel Jacoby
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Mordehay Cordoba
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Nir Horesh
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Avinoam Nevler
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel; Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Mordechai Gutman
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Yaniv Berger
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel.
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21
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Shwaartz C, Pery R, Cordoba M, Gutman M, Rosin D. Laparoscopic Subtotal Cholecystectomy for the Difficult Gallbladder: A Safe Alternative. Isr Med Assoc J 2020; 22:538-541. [PMID: 33236550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND The safe completion of cholecystectomy is dependent on proper identification and secure closure of the cystic duct. Effecting this closure poses a great challenge when inflammatory changes obscure the anatomy. Subtotal cholecystectomy allows for near complete removal of the gallbladder and complete evacuation of the stones while avoiding dissection in the hazardous area. OBJECTIVES To describe experience with laparoscopic subtotal cholecystectomy. METHODS Subtotal cholecystectomy was performed when the critical view of safety could not be achieved. Surgical technique was similar in all cases and included opening the Hartmann's pouch, removing stones obstructing the gallbladder outlet, and identifying the opening of the cystic duct, as well as circumferential transection of the gallbladder neck, closure of the gallbladder stump, and excision of the gallbladder fundus. Data retrieved from patient charts included demographics, pre-operative history, operative and postoperative course, and late complications. No bile duct injuries were observed in this series. RESULTS A total of 53 patients underwent laparoscopic subtotal cholecystectomy (2010-2018). Ten patients were operated during the acute course of the disease and 43 electively. Acute cholecystitis was the leading cause for gallbladder removal. Cholecystostomy tube was placed in 18 patients during acute hospitalization. The gallbladder remnant was closed and a drain was placed in most patients. Of the 53 patients, 42 had an uneventful postoperative course. CONCLUSIONS Laparoscopic subtotal cholecystectomy is an effective surgical technique to avoid bile duct injury when the cystic duct cannot safely be identified. Subtotal cholecystectomy has acceptable morbidity and obviates the need for conversion in these difficult cases.
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Affiliation(s)
- Chaya Shwaartz
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Pery
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordechay Cordoba
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordechai Gutman
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Danny Rosin
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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22
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Zager Y, Horesh N, Dan A, Aharoni M, Khalilieh S, Cordoba M, Nevler A, Gutman M, Rosin D. Associations of novel inflammatory markers with long-term outcomes and recurrence of diverticulitis. ANZ J Surg 2020; 90:2041-2045. [PMID: 32856387 DOI: 10.1111/ans.16220] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 07/08/2020] [Accepted: 07/16/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have emerged as markers of various outcomes of inflammatory and malignant diseases. The association of those markers with short-term outcomes of acute diverticulitis has been discussed in recent studies. This study aimed at evaluation of the association of NLR and PLR with long-term outcomes in patients presenting with acute diverticulitis. METHODS A retrospective single institute study included patients admitted with acute diverticulitis between 2012 and 2016. Associations were analysed of NLR and PLR values at admission with patient outcomes. RESULTS A total of 456 patients were included in the study. High NLR and PLR values were associated with complicated disease (P < 0.01 for both). Among patients with complicated diverticulitis, for those with high NLR, the interval to a recurrent episode of acute diverticulitis was shorter (68.3 days versus 83.7 days, P = 0.044). Patients with high NLR had higher mean number of readmissions (0.54 versus 0.34, P = 0.035). High NLR (10.06 ± 11.23 versus 7.6 ± 8.04, P = 0.012) and PLR (9.64 days ±10.56 versus 7.47 days ±8.225, P = 0.018) were associated with longer cumulative hospital stay due to acute diverticulitis. CONCLUSIONS High NLR and PLR values were associated with recurrence in acute diverticulitis in terms of shorter interval between recurrent episodes and longer cumulative hospitalization days.
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Affiliation(s)
- Yaniv Zager
- Department of Surgery and Transplantation, Chaim Sheba Medical Center (affiliated to the Faculty of Medicine, Tel Aviv University), Tel Hashomer, Israel
| | - Nir Horesh
- Department of Surgery and Transplantation, Chaim Sheba Medical Center (affiliated to the Faculty of Medicine, Tel Aviv University), Tel Hashomer, Israel
| | - Assaf Dan
- Department of Surgery and Transplantation, Chaim Sheba Medical Center (affiliated to the Faculty of Medicine, Tel Aviv University), Tel Hashomer, Israel
| | - Mor Aharoni
- Department of Surgery and Transplantation, Chaim Sheba Medical Center (affiliated to the Faculty of Medicine, Tel Aviv University), Tel Hashomer, Israel
| | - Saed Khalilieh
- Department of Surgery and Transplantation, Chaim Sheba Medical Center (affiliated to the Faculty of Medicine, Tel Aviv University), Tel Hashomer, Israel
| | - Mordehay Cordoba
- Department of Surgery and Transplantation, Chaim Sheba Medical Center (affiliated to the Faculty of Medicine, Tel Aviv University), Tel Hashomer, Israel
| | - Avinoam Nevler
- Department of Surgery and Transplantation, Chaim Sheba Medical Center (affiliated to the Faculty of Medicine, Tel Aviv University), Tel Hashomer, Israel.,Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mordechai Gutman
- Department of Surgery and Transplantation, Chaim Sheba Medical Center (affiliated to the Faculty of Medicine, Tel Aviv University), Tel Hashomer, Israel
| | - Danny Rosin
- Department of Surgery and Transplantation, Chaim Sheba Medical Center (affiliated to the Faculty of Medicine, Tel Aviv University), Tel Hashomer, Israel
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23
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Anteby R, Zager Y, Barash Y, Nadler R, Cordoba M, Klang E, Klein Y, Ram E, Gutman M, Horesh N. The Impact of the Coronavirus Disease 2019 Outbreak on the Attendance of Patients with Surgical Complaints at a Tertiary Hospital Emergency Department. J Laparoendosc Adv Surg Tech A 2020; 30:1001-1007. [PMID: 32589496 DOI: 10.1089/lap.2020.0465] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Introduction: Emergency departments (EDs) during the novel coronavirus disease 2019 (COVID-19) pandemic are perceived as possible sources of infection. The effects of COVID-19 on patients presenting to the hospital with surgical complaints remain uncertain. Methods: A single tertiary center retrospective study analysis compared the ED attendance rate and severity of patients with surgical complaints between March 2020 (COVID-19 outbreak) and pre-COVID-19 periods: February 2020 and the same 2 months in 2019 and 2018. Results: Overall, 6,017 patients were included. The mean daily ED visits of patients with nontrauma surgical complaints in the COVID-19 outbreak period declined by 27%-32% (P value <.01) compared with pre-COVID-19 periods. The log number of confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cases in Israel in March 2020 was negatively correlated with the number of ED visits (Pearson's r = -0.59, P < .01). The proportion of patients requiring hospitalization increased by up to 8% during the outbreak period (P < .01), and there was a higher proportion of tachycardic patients (20% versus 15.5%, P = .01). The percentage of visits to the ED by men declined by 5% (P < .01). The ED diagnosis distribution significantly changed during COVID-19 (P = .013), with an 84% decrease in the number of patients hospitalized for diverticular disease (P < .05). Conclusion: During the COVID-19 outbreak, the overall number of patients presenting at the ED with surgical complaints decreased significantly, and there was a higher admissions ratio. The extent to which the pandemic affects hospital ED attendance can help health care professionals prepare for future such events. ClinicalTrials.gov ID: NCT04338672.
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Affiliation(s)
- Roi Anteby
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Yaniv Zager
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Yiftach Barash
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Diagnostic Imaging, The Chaim Sheba Medical Center, Tel Hashomer, Israel.,Deep Vision Lab, Sheba Medical Center, Tel Hashomer, Israel
| | - Roy Nadler
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Mordehay Cordoba
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Eyal Klang
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Diagnostic Imaging, The Chaim Sheba Medical Center, Tel Hashomer, Israel.,Deep Vision Lab, Sheba Medical Center, Tel Hashomer, Israel
| | - Yoram Klein
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Edward Ram
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Mordechai Gutman
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Nir Horesh
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
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24
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Haldar R, Ricon-Becker I, Radin A, Gutman M, Cole SW, Zmora O, Ben-Eliyahu S. Perioperative COX2 and β-adrenergic blockade improves biomarkers of tumor metastasis, immunity, and inflammation in colorectal cancer: A randomized controlled trial. Cancer 2020; 126:3991-4001. [PMID: 32533792 DOI: 10.1002/cncr.32950] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 02/16/2020] [Accepted: 02/26/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Preclinical studies have implicated excess release of catecholamines and prostaglandins in the mediation of prometastatic processes during surgical treatment of cancer. In this study, we tested the combined perioperative blockade of these pathways in patients with colorectal cancer (CRC). METHODS In a randomized, double-blind, placebo-controlled biomarker trial involving 34 patients, the β-blocker propranolol and the COX2-inhibitor etodolac were administered for 20 perioperative days, starting 5 days before surgery. Excised tumors were subjected to whole genome messenger RNA profiling and transcriptional control pathway analyses. RESULTS Drugs were well-tolerated, with minor complications in both the treatment group and the placebo group. Treatment resulted in a significant improvement (P < .05) of tumor molecular markers of malignant and metastatic potential, including 1) reduced epithelial-to-mesenchymal transition, 2) reduced tumor infiltrating CD14+ monocytes and CD19+ B cells, and 3) increased tumor infiltrating CD56+ natural killer cells. Transcriptional activity analyses indicated a favorable drug impact on 12 of 19 a priori hypothesized CRC-related transcription factors, including the GATA, STAT, and EGR families as well as the CREB family that mediates the gene regulatory impact of β-adrenergic- and prostaglandin-signaling. Alterations observed in these transcriptional activities were previously associated with improved long-term clinical outcomes. Three-year recurrence rates were assessed for long-term safety analyses. An intent-to-treat analysis revealed that recurrence rates were 12.5% (2/16) in the treatment group and 33.3% (6/18) in the placebo group (P = .239), and in protocol-compliant patients, recurrence rates were 0% (0/11) in the treatment group and 29.4% (5/17) in the placebo group (P = .054). CONCLUSIONS The favorable biomarker impacts and clinical outcomes provide a rationale for future randomized placebo-controlled trials in larger samples to assess the effects of perioperative propranolol/etodolac treatment on oncological clinical outcomes.
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Affiliation(s)
- Rita Haldar
- Sagol School of Neuroscience and School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Itay Ricon-Becker
- Sagol School of Neuroscience and School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Arielle Radin
- Department of Psychology, UCLA, Los Angeles, California, USA
| | - Mordechai Gutman
- Department of Surgery and Transplantation, Sheba Medical Center, Ramat-Gan, Israel
| | - Steve W Cole
- Departments of Medicine and Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Oded Zmora
- Department of Surgery, Shamir Medical Center, Be'er-Ya'akov, Israel
| | - Shamgar Ben-Eliyahu
- Sagol School of Neuroscience and School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
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25
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Ram E, Meyer R, Carter D, Gutman M, Rosin D, Horesh N. The efficacy of sacral neuromodulation in the treatment of low anterior resection syndrome: a systematic review and meta-analysis. Tech Coloproctol 2020; 24:803-815. [PMID: 32350733 DOI: 10.1007/s10151-020-02231-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 04/22/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Sacral neuromodulation (SNM) has become one of the main treatment options in patients with fecal incontinence. The aim of this study was to determine the efficacy of sacral neuromodulation in the treatment of low anterior resection syndrome (LARS). METHODS A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The search was conducted using the Pubmed, Embase, Ovid, and Cochrane databases, restricted to the English language and to articles published from 2000 to November 2018. RESULTS A total of 434 articles on the efficacy of SNM in the treatment of LARS were retrieved, and 13 studies were included in the final analysis, with a total of 114 patients treated with SNM for LARS The overall success rate excluding study heterogeneity was 83.30% [95% CI (71.33-95.25%)]. Improvement in anal continence was seen in several clinical and functional parameters, including the Wexner Score [10.78 points, 95% CI (8.55-13.02), p < 0.0001], manometric maximum resting pressure [mean improvement of 6.37 mm/Hg, 95% CI (2.67-10.07), p = 0.0007], maximum squeeze pressure [mean improvement of 17.99 mm/Hg, 95% CI (17.42-18.56), p < 0.0001] and maximum tolerated volume [mean improvement of 22.74 ml, 95% CI (10.65-34.83), p = 0.0002]. Quality of life questionnaires also demonstrated significant improvement in patients' quality of life, but were reported only in a small group of included patients. CONCLUSIONS SNM significantly improves symptoms and quality of life in patients suffering from fecal incontinence following low anterior resection.
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Affiliation(s)
- E Ram
- Department of Surgery B, Sheba Medical Centre, Tel Hashomer, Israel.
- Tel Aviv University, Tel Aviv, Israel.
| | - R Meyer
- Tel Aviv University, Tel Aviv, Israel
- Department of Gynecology and Obstetrics, Sheba Medical Centre, Tel Hashomer, Israel
| | - D Carter
- Tel Aviv University, Tel Aviv, Israel
- Department of Gastroenterology, Sheba Medical Centre, Tel Hashomer, Israel
| | - M Gutman
- Department of Surgery B, Sheba Medical Centre, Tel Hashomer, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - D Rosin
- Department of Surgery B, Sheba Medical Centre, Tel Hashomer, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - N Horesh
- Department of Surgery B, Sheba Medical Centre, Tel Hashomer, Israel
- Tel Aviv University, Tel Aviv, Israel
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26
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Horesh N, Abu-Ghanem Y, Erlich T, Rosin D, Gutman M, Zilberman DE, Ramon J, Dotan ZA. Management of Pancreatic Injuries Following Nephrectomy. Isr Med Assoc J 2020; 22:244-248. [PMID: 32286029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Pancreatic injuries during nephrectomy are rare, despite the relatively close anatomic relation between the kidneys and the pancreas. The data regarding the incidence and outcome of pancreatic injuries are scarce. OBJECTIVES To assess the frequency and the clinical significance of pancreatic injuries during nephrectomy. METHODS A retrospective analysis was conducted of all patients who underwent nephrectomy over a period of 30 years (1987-2016) in a large tertiary medical center. Demographic, clinical, and surgical data were collected and analyzed. RESULTS A total of 1674 patients underwent nephrectomy during the study period. Of those, 553 (33%) and 294 patients (17.5%) underwent left nephrectomy and radical left nephrectomy, respectively. Among those, four patients (0.2% of the total group, 0.7% of the left nephrectomy group, and 1.36% of the radical left nephrectomy) experienced iatrogenic injuries to the pancreas. None of the injuries were recognized intraoperatively. All patients were treated with drains in an attempt to control the pancreatic leak and one patient required additional surgical interventions. Average length of stay was 65 days (range 15-190 days). Mean follow-up was 23.3 months (range 7.7-115 months). CONCLUSIONS Pancreatic injuries during nephrectomy are rare and carry a significant risk for postoperative morbidity.
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Affiliation(s)
- Nir Horesh
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yasmin Abu-Ghanem
- Department of Urology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tomer Erlich
- Department of Urology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Danny Rosin
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordechai Gutman
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dorit E Zilberman
- Department of Urology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Ramon
- Department of Urology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zohar A Dotan
- Department of Urology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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27
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Amiel I, Anteby R, Cordoba M, Laufer S, Shwaartz C, Rosin D, Gutman M, Ziv A, Mashiach R. Experienced surgeons versus novice surgery residents: Validating a novel knot tying simulator for vessel ligation. Surgery 2020; 167:699-703. [DOI: 10.1016/j.surg.2019.09.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/23/2019] [Accepted: 09/11/2019] [Indexed: 11/25/2022]
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28
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Hoffman A, Ben Ishay O, Horesh N, Shabtai M, Forschmidt E, Rosin D, Gutman M, Ram E. Breast Cancer in Men: A Single Center Experience Over a Period of 22 years. Isr Med Assoc J 2020; 22:160-163. [PMID: 32147980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Male breast cancer (MBC) is a rare disease that is poorly understood. Treatment protocols are widely extrapolated from breast cancer in women. OBJECTIVES To review the experience with MBC of a single center in Israel over a period of 22 years. METHODS This single center retrospective study evaluated all patients diagnosed with MBC over a period of 22 years (1993-2015). Data were extracted from patient medical charts and included demographics, clinical, surgical, and oncological outcomes. RESULTS The study comprised 49 patients. Mean age at diagnosis was 64.1 ± 13.5 years. The majority were diagnosed at early stages (1A-2A) (54.4%), 30.6% were stage 3B mostly due to direct skin and nipple involvement, and 59.2% of the patients had node negative disease. All of the patients were diagnosed with invasive ductal carcinoma and 30.6% had concomitant ductal carcinoma in situ. Estrogen receptor (ER) status was predominantly positive and luminal B (HER2-) was the most common subtype. Of the patients, 18.4% were BRCA carriers. The majority of patients underwent mastectomy. Radiotherapy was delivered to 46.9% and hormonal therapy to 89.8%. Chemotherapy was administered to 42.9%. Overall survival was 79.6% with a median survival of 60.1 (2-178) months; 5- and 10-year survival was 93.9% and 79.6%, respectively. Progesterone receptor (PR)-negative patients had a significantly improved overall survival. CONCLUSIONS MBC has increasing incidence. PR-negative status was associated with better overall survival and disease-free interval. Indications to radiotherapy and hormonal therapy need standardization and will benefit from prospective randomized control trials.
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Affiliation(s)
- Aviad Hoffman
- Department of General Surgery, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ofir Ben Ishay
- Department of General Surgery, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Nir Horesh
- Department of Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moshe Shabtai
- Department of Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Forschmidt
- Department of Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Danny Rosin
- Department of Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordechai Gutman
- Department of Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Edward Ram
- Department of Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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29
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Horesh N, Lessing Y, Rudnicki Y, Kent I, Kammar H, Ben-Yaacov A, Dreznik Y, Zbar AP, Tulchinsky H, Avital S, Mavor E, Kashtan H, Klausner JM, Gutman M, Zmora O, Wasserberg N. Timing of colostomy reversal following Hartmann's procedure for perforated diverticulitis. J Visc Surg 2020; 157:395-400. [PMID: 31954631 DOI: 10.1016/j.jviscsurg.2020.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
AIM Hartmann's procedure is the surgical treatment of choice for perforated acute diverticulitis. Hartmann's reversal (HR) that is performed at a later stage may be challenging. The optimal timing for HR is still a subject for controversy. The aim of this study is to assess whether the timing of HR affects surgical outcome. PATIENTS AND METHODS A retrospective-cohort multi-center study was conducted, including all patients who underwent HR for acute diverticulitis from January 2004 to June 2015 in 5 medical centers. Patient data included demographics, surgical data and post-operative outcome. RESULTS One hundred and twenty-two patients were included in the database. Median time from Hartmann's procedure to reversal was 182.7 days, with the majority of patients (76 patients, 62.2%) operated 60 to 180 days from the Hartmann's procedure. Fifty-seven patients (46.7%) had post-operative complications, most commonly wound infections (27 patients, 22.1%). Receiver operating characteristic (ROC) curve and a propensity score match analysis (P=0.43) correlating between days to HR from the index procedure showed no specific cut-off point regarding post-operative complications (P=0.16), Major (Clavien-Dindo score of 3 or more) complications (P=0.19), Minor (Clavien Dindo 1-2) and no complications (P=0.14). Median length of stay was 10.9 days (range 3-90) and Pearson correlation failed to demonstrate a correlation between timing of surgical intervention and length of stay (P=0.4). CONCLUSION Hartmann's Reversal is a complex surgical procedure associated with high rates of complications. In our series, timing of surgery did not affect surgical complications rate or severity or the length of hospital stay.
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Affiliation(s)
- N Horesh
- Department of General Surgery B and Organ Transplantation, Sheba Medical Center, Tel Hashomer, 5262601 Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801 Israel.
| | - Y Lessing
- Department of Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, 6423906 Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801 Israel
| | - Y Rudnicki
- Department of Surgery B, Meir Medical Center, Kfar Saba, 4428164 Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801 Israel
| | - I Kent
- Department of Surgery B, Meir Medical Center, Kfar Saba, 4428164 Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801 Israel
| | - H Kammar
- Department of Surgery, Kaplan Medical Center, Rehovot, 7661041 Israel; The Hebrew University-Hadassah Medical School, Jerusalem 9112001 Israel
| | - A Ben-Yaacov
- Department of Surgery B, Rabin Medical Center-Beilinson Hospital, Petach Tikva 4941492 Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801 Israel
| | - Y Dreznik
- Department of General Surgery B and Organ Transplantation, Sheba Medical Center, Tel Hashomer, 5262601 Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801 Israel
| | - A P Zbar
- Department of General Surgery B and Organ Transplantation, Sheba Medical Center, Tel Hashomer, 5262601 Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801 Israel
| | - H Tulchinsky
- Department of Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, 6423906 Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801 Israel
| | - S Avital
- Department of Surgery B, Meir Medical Center, Kfar Saba, 4428164 Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801 Israel
| | - E Mavor
- Department of Surgery, Kaplan Medical Center, Rehovot, 7661041 Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801 Israel
| | - H Kashtan
- Department of Surgery B, Rabin Medical Center-Beilinson Hospital, Petach Tikva 4941492 Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801 Israel
| | - J M Klausner
- Department of Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, 6423906 Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801 Israel
| | - M Gutman
- Department of General Surgery B and Organ Transplantation, Sheba Medical Center, Tel Hashomer, 5262601 Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801 Israel
| | - O Zmora
- Department of General Surgery B and Organ Transplantation, Sheba Medical Center, Tel Hashomer, 5262601 Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801 Israel
| | - N Wasserberg
- Department of Surgery B, Rabin Medical Center-Beilinson Hospital, Petach Tikva 4941492 Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801 Israel
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Amiel I, Anteby R, Cordoba M, Laufer S, Shwaartz C, Rosin D, Gutman M, Ziv A, Mashiach R. Feedback based simulator training reduces superfluous forces exerted by novice residents practicing knot tying for vessel ligation. Am J Surg 2019; 220:100-104. [PMID: 31806168 DOI: 10.1016/j.amjsurg.2019.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 11/18/2019] [Accepted: 11/18/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Technological advances have led to the development of state-of-the-art simulators for training surgeons; few train basic surgical skills, such as vessel ligation. METHODS A novel low-cost bench-top simulator with auditory and visual feedback that measures forces exerted during knot tying was tested on 14 surgical residents. Pre- and post-training values for total force exerted during knot tying, maximum pulling and pushing forces and completion time were compared. RESULTS Mean time to reach proficiency during training was 11:26 min, with a mean of 15 consecutive knots. Mean total applied force for each knot were 35% lower post-training than pre-training (7.5 vs. 11.54 N (N), respectively, p = 0.039). Mean upward peak force was significantly lower after, compared to before, training (1.29 vs. 2.12 N, respectively, p = 0.004). CONCLUSIONS Simulator training with visual and auditory force feedback improves knot-tying skills of novice surgeons.
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Affiliation(s)
- Imri Amiel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel; Israel Center for Medical Simulation (MSR), Tel-Hashomer, Israel; Talpiot Medical Leadership Program, Sheba Medical Center, Israel.
| | - Roi Anteby
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel.
| | - Moti Cordoba
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Shlomi Laufer
- Technion, Israel Institute of Technology, Haifa, Israel
| | - Chaya Shwaartz
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Danny Rosin
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Mordechai Gutman
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Amitai Ziv
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel; Israel Center for Medical Simulation (MSR), Tel-Hashomer, Israel
| | - Roy Mashiach
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel; Israel Center for Medical Simulation (MSR), Tel-Hashomer, Israel
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Horesh N, Hoffman A, Zager Y, Cordoba M, Haikin M, Rosin D, Gutman M, Lebedeyev A. Value of Routine Colonic Evaluation Prior To Ileostomy Closure. Isr Med Assoc J 2019; 21:728-731. [PMID: 31713360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Evaluation of low rectal anastomosis is often recommended prior to ostomy closure, but the efficacy of such evaluations is uncertain. OBJECTIVES To assess whether routine colonic preoperative evaluation has an effect on postoperative ileostomy closure results. METHODS We performed a retrospective study evaluating all patients who underwent ileostomy closure over 9 years. Patient demographics, clinical, surgical details, and surgical outcomes were recorded and analyzed. RESULTS The study comprised 116 patients who underwent ileostomy closure, of them 65 were male (56%) with a mean age of 61 years (range 20-91). Overall, 98 patients (84.4%) underwent colonic preoperative evaluation prior to ileostomy closure. A contrast enema was performed on 61 patients (62.2%). Abnormal preoperative results were observed in 12 patients (12.2%). The overall complication rate was 35.3% (41 patients). No differences in postoperative outcome was observed in patient gender (P = 1), age (P = 0.96), body mass index (P = 0.24), American Society of Anesthesiologists score (P = 0.21), and the Charlson Comorbidity Index score (P = 0.93). Among patients who had postoperative complications, we did not observe a difference between patients who underwent preoperative evaluation compared to those who did not (P = 0.42). No differences were observed among patients with preoperative findings interpreted as normal or abnormal (P = 1). The time difference between ileostomy creation and closure had no effect on the ileostomy closure outcome (P = 0.34). CONCLUSIONS Abnormal findings in preoperative colonic evaluation prior to ileostomy closure were not associated with worse postoperative outcome.
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Affiliation(s)
- Nir Horesh
- Department of Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviad Hoffman
- Department of Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaniv Zager
- Department of Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordechai Cordoba
- Department of Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Marat Haikin
- Department of Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Danny Rosin
- Department of Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordechai Gutman
- Department of Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alexander Lebedeyev
- Department of Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Goshen-Gottstein E, Shapiro R, Shwartz C, Nissan A, Oberman B, Gutman M, Zimlichman E. Incidence and Risk Factors for Anastomotic Leakage in Colorectal Surgery: A Historical Cohort Study. Isr Med Assoc J 2019; 21:732-737. [PMID: 31713361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Anastomotic leakage (AL) is a major complication following colorectal surgery, with many risk factors established to date. The incidence of AL varies in the medical literature and is dependent on research inclusion criteria and diagnostic criteria. OBJECTIVES To determine the incidence of and the potential risk factors for AL following colorectal surgery at a single academic medical center. METHODS We retrospectively reviewed all operative reports of colorectal procedures that included bowel resection and primary bowel anastomosis performed at Sheba Medical Center during 2012. AL was defined according to the 1991 United Kingdom Surgical Infection Study Group criteria. Data were assessed for leak incidence within 30 days. In addition, 17 possible risk factors for leakage were analyzed. A literature review was conducted. RESULTS This cohort study comprised 260 patients, and included 261 procedures performed during the study period. The overall leak rate was 8.4%. In a univariate analysis, male sex (odds ratio [OR] 3.37, 95% confidence interval [95%CI] 1.21-9.43), pulmonary disease (OR 3.99, 95%CI 1.49-10.73), current or past smoking (OR 2.93, 95%CI 1.21-7.10), and American Society of Anesthesiologist score ≥ 3 (OR 3.08, 95%CI 1.16-8.13) were associated with an increased risk for anastomotic leakage. In a multivariate analysis, male gender (OR 3.62, 95%CI 1.27-10.33) and pulmonary disease (OR 4.37, 95%CI 1.58-12.10) were associated with a greater risk. CONCLUSIONS The incidence of AL in the present study is similar to that found in comparable series. Respiratory co-morbidity and male sex were found to be the most significant risk factors.
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Affiliation(s)
| | - Ron Shapiro
- Department of General and Oncological Surgery C, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Chaya Shwartz
- Department of General and Oncological Surgery B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviram Nissan
- Department of General and Oncological Surgery C, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Bernice Oberman
- Gertner Institute for Epidemiology and Health Policy, Sheba Medical Center, Tel Hashomer, Israel
| | - Mordechai Gutman
- Department of General and Oncological Surgery B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Zimlichman
- Department of Central Management, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Barda L, Nevler A, Rosin D, Shabtai EL, Gutman M, Shabtai M. [THE EFFECTS OF HORMONAL REPLACEMENT THERAPY (HRT) ON MAMMOGRAPHIC BREAST DENSITY AND ABNORMAL MAMMOGRAMS PROMPTING FURTHER INVESTIGATION]. Harefuah 2019; 158:239-243. [PMID: 31032556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
AIMS The purpose of this study was to portray and analyze the inter-relationship between the use of HRT, mammographic breast density and the finding of any mammographic abnormality that prompted further investigation such as core needle biopsy or additional imaging testing, while controlling for obstetric and relevant demographic data. BACKGROUND Mammographic breast density has been associated with higher risk of breast cancer and decrease in its sensitivity, while hormonal replacement therapy (HRT) in turn, has been implicated in increasing mammographic density and is considered a risk factor for breast cancer by itself. The inter-relationship between HRT, breast density and any mammographic or sonographic finding requiring further investigation has not been fully investigated. METHODS A total of 2,758 consecutive, screening mammograms performed during one year in a single academic medical center in Israel were analyzed. Each mammogram was supplemented by high resolution ultrasound. Density was measured by a visual, semi-quantitative, 5-grade scale, based on Boyd's classification and grouped into low density mammograms (LDM) (1-3) and high density mammograms (HDM) (4-5). Demographic and obstetric data, personal and family history of breast cancer, and the use of HRT were entered into the database. These parameters were correlated with breast density and any detected abnormality that prompted further investigation. Univariate and multivariate analyses as well as multivariate logistic regression were performed using SAS 9.2. RESULTS A significant difference in density was observed between pre- and post-menopausal women (p = 0.0001). However, the use of HRT in post-menopausal women was not associated with higher incidence of HDM (18.6%, n=110/592) compared to post-menopausal women without HRT (15.4%, n=211/1370) (p=n.s). Mammographic abnormality was more likely to occur in post-menopausal women without HRT (52%, n=711/1370) compared with women on HRT (38.7% n=229/592) (p = 0.0001). This held true for solid lump (p=0.0001), tissue irregularity (p=0.016) and calcifications (p=0.0005). Menopause was associated with higher likelihood (48%) of any mammographic finding compared with 41.6% in pre-menopausal women (p = 0.0017). A total of 266 women with mammographic findings prompting histological assessment were identified, revealing 105 malignant lesions. HRT in post-menopausal women was associated with lower incidence (28%) of malignancy compared to post-menopausal women without HRT (50%). CONCLUSIONS The present study, portraying the inter-relationship between mammographic breast density, any abnormal finding in screening mammograms, and the use of HRT has not found such treatment to be associated neither with increased density, nor with higher probability of finding malignancy. Furthermore, a lower incidence of mammographic abnormality was noted in HRT users. Albeit, further and larger studies are required to substantiate these findings. The results of this study do not support the notion that HRT increases the likelihood of malignancy or affects breast density.
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Affiliation(s)
- Liran Barda
- Department of Surgery, Sheba Medical Center, Tel Aviv University, Tel Hashomer, Israel
| | - Avinoam Nevler
- Department of Surgery, Sheba Medical Center, Tel Aviv University, Tel Hashomer, Israel
| | - Danny Rosin
- Department of Surgery, Sheba Medical Center, Tel Aviv University, Tel Hashomer, Israel
| | - Esther L Shabtai
- Tel Aviv University, Statistical Service, Communication Disorders, Tel Hashomer, Israel
| | - Mordechai Gutman
- Department of Surgery, Sheba Medical Center, Tel Aviv University, Tel Hashomer, Israel
| | - Moshe Shabtai
- Department of Surgery, Sheba Medical Center, Tel Aviv University, Tel Hashomer, Israel
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Berger Y, Jacoby H, Zager Y, Lebedyev A, Gutman M, Hoffman A. [CYTOREDUCTIVE SURGERY AND HYPERTHERMIC INTRAPERITONEAL CHEMOTHERAPY FOR PERITONEAL CARCINOMATOSIS OF COLORECTAL ORIGIN - FIRST 100 CASES]. Harefuah 2019; 158:227-232. [PMID: 31032553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is an effective treatment for selected patients with peritoneal carcinomatosis of colorectal origin. We present our experience with the first 100 consecutive cases of this combined treatment. METHODS CRS/HIPEC procedures were performed between 4/2009-8/2016. HIPEC was initially delivered using the "Open" abdomen technique; beginning in January 2014, HIPEC was delivered using the "Closed" technique. As a chemotherapeutic agent we used Mitomycin-C, perfused for duration of 90 minutes at 41 degrees Celsius. RESULTS A total of 100 procedures were performed in 94 patients (64% females, median age 62 (22-83) years) with colon (n=89) or rectal (n=5) cancer. Complete cytoreduction (CC score≤1) was achieved in 91 procedures. The average duration of surgery was 7.5±2.3 hours, the median number of organs resected was 2 (0-6) and the median length of hospital stay was 9 (5-101) days. Postoperative complications occurred in 54% of procedures and the incidence of major complications (Clavien-Dindo 3-4) was 12%. Three patients (3%) died within 90 days postoperatively. Higher peritoneal cancer index (PCI) score, higher number of organs resected/anastomoses created and longer duration of surgery were associated with perioperative morbidity (all p≤0.05). The median follow-up period was 2.1 years during which 50 patients died. The median overall survival (OS) and disease free survival were 3.1 years and 10.7 months, respectively; 7 patients survived ≥5 years after surgery. Higher PCI score and occurrence of major postoperative complications were associated with poorer OS. CONCLUSIONS CRS/HIPEC for peritoneal carcinomatosis of colorectal cancer origin is feasible and safe. This treatment may benefit selected patients in terms of OS.
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Affiliation(s)
- Yaniv Berger
- Department of Surgery B, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to the Faculty of Medicine, Tel Aviv University
| | - Harel Jacoby
- Department of Surgery B, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to the Faculty of Medicine, Tel Aviv University
| | - Yaniv Zager
- Department of Surgery B, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to the Faculty of Medicine, Tel Aviv University
| | - Alexander Lebedyev
- Department of Surgery B, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to the Faculty of Medicine, Tel Aviv University
| | - Mordechai Gutman
- Department of Surgery B, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to the Faculty of Medicine, Tel Aviv University
| | - Aviad Hoffman
- Department of Surgery B, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to the Faculty of Medicine, Tel Aviv University
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Horesh N, Klein Y, Gutman M. [ACUTE DIVERTICULAR DISEASE - IS IT STILL A "SURGICAL" CONDITION?]. Harefuah 2019; 158:253-257. [PMID: 31032559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The therapeutic approach to diverticular disease has changed significantly in recent decades. From a disease treated almost exclusively by surgery, diverticulitis is nowadays treated operatively in specific indications, shifting the majority of patients towards an outpatient based treatment. Significant changes occurred not only in uncomplicated diverticular disease but also in complicated cases, treated in the past with emergency surgery. These changes have been studied relentlessly around the world, and despite the fact that the vast majority of patients presenting with acute diverticular disease are not treated with surgery, it is still considered a surgical condition. In this review article, we set out to examine whether there is still justification to consider acute diverticulitis as a surgical disease and in addition, to examine whether the changes in treatment seen around the world are compatible with the current treatment strategies implemented in Israel.
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Affiliation(s)
- Nir Horesh
- Department of Surgery and Transplantation, Chaim Sheba Medical Center Ramat Gan, Israel (affiliated to the Faculty of Medicine, Tel Aviv University)
| | - Yoram Klein
- Department of Surgery and Transplantation, Chaim Sheba Medical Center Ramat Gan, Israel (affiliated to the Faculty of Medicine, Tel Aviv University)
| | - Mordechai Gutman
- Department of Surgery and Transplantation, Chaim Sheba Medical Center Ramat Gan, Israel (affiliated to the Faculty of Medicine, Tel Aviv University)
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Berger Y, Jacoby H, Kaufmann MI, Ben-Yaacov A, Westreich G, Sharon I, Barda L, Sharif N, Nadler R, Horesh N, Nissan A, Gutman M, Hoffman A. Correlation Between Intraoperative and Pathological Findings for Patients Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. Ann Surg Oncol 2019; 26:1103-1109. [PMID: 30746598 DOI: 10.1245/s10434-019-07219-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND This study aimed to examine the correlation between intraoperative and pathological findings for patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) and to determine their prognostic significance. METHODS Pathological reports of all colorectal cancer (CRC) patients undergoing CRS/HIPEC between 2009 and 2016 were retrospectively reviewed. Pathological specimens lacking tumor cells were defined as negative pathological specimens (NPS). The intraoperative peritoneal cancer index (PCI) and pathological PCI (excluding NPS) were calculated separately. Receiver operating characteristic (ROC) curves were applied to compare the prognostic value of intraoperative and pathological scoring systems. RESULTS For 108 CRC patients, 113 CRS/HIPEC procedures were performed. Of 959 pathological specimens examined, 178 (18.6%) were NPS. Overall, 78 procedures (69%) showed NPS. In 52 procedures (46%), the pathological PCI differed from the intraoperative PCI (∆PCI > 0). The ROC areas for intraoperative PCI and pathological PCI were similar in predicting 1-year overall survival (OS), 2-year OS, and 1-year disease-free survival (all p values not significant). However, for the patients with NPS, the number of positive specimens (containing tumor tissue) was superior to intraoperative PCI in predicting 2-year OS (ROC under the curve areas, 0.69 vs. 0.58, respectively; p = 0.012). In addition, a subgroup of 15 patients with a high ∆PCI (≥ 3) had a more favorable median OS than a matched group of 30 patients with similar intraoperative PCI and a ∆PCI of 0 (median survival not reached vs. 21.6 months, respectively; p = 0.05). CONCLUSIONS In the majority of CRC CRS/HIPEC procedures, NPS may be found. Among patients with NPS, pathological correlation may have a prognostic significance.
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Affiliation(s)
- Y Berger
- Department of General Surgery and Transplantation-Surgery B, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler School of Medicine, Tel Aviv, Israel.
| | - H Jacoby
- Department of General Surgery and Transplantation-Surgery B, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler School of Medicine, Tel Aviv, Israel
| | - M I Kaufmann
- Department of Pathology, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler School of Medicine, Tel Aviv, Israel
| | - A Ben-Yaacov
- Department of General and Oncological Surgery-Surgery C, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler School of Medicine, Tel Aviv, Israel
| | - G Westreich
- Department of General and Oncological Surgery-Surgery C, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler School of Medicine, Tel Aviv, Israel
| | - I Sharon
- Department of General and Oncological Surgery-Surgery C, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler School of Medicine, Tel Aviv, Israel
| | - L Barda
- Department of General Surgery and Transplantation-Surgery B, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler School of Medicine, Tel Aviv, Israel
| | - N Sharif
- Department of General Surgery and Transplantation-Surgery B, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler School of Medicine, Tel Aviv, Israel
| | - R Nadler
- Department of General Surgery and Transplantation-Surgery B, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler School of Medicine, Tel Aviv, Israel
| | - N Horesh
- Department of General Surgery and Transplantation-Surgery B, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler School of Medicine, Tel Aviv, Israel
| | - A Nissan
- Department of General and Oncological Surgery-Surgery C, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler School of Medicine, Tel Aviv, Israel
| | - M Gutman
- Department of General Surgery and Transplantation-Surgery B, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler School of Medicine, Tel Aviv, Israel
| | - A Hoffman
- Department of General Surgery and Transplantation-Surgery B, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler School of Medicine, Tel Aviv, Israel
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Horesh N, Lessing Y, Rudnicki Y, Kent I, Kammar H, Ben-Yaacov A, Dreznik Y, Avital S, Mavor E, Wasserberg N, Kashtan H, Klausner J, Gutman M, Zmora O, Tulchinsky H. Comparison between laparoscopic and open Hartmann's reversal: results of a decade-long multicenter retrospective study. Surg Endosc 2018; 32:4780-4787. [PMID: 29766303 DOI: 10.1007/s00464-018-6227-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 05/09/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hartmann's reversal is a challenging surgical procedure with significant postoperative morbidity rates. Various surgical methods have been suggested to lower the risk of postoperative complications. In this study, we aimed to compare the postoperative results between open and laparoscopic techniques for Hartmann's reversal. METHODS A retrospective study of all patients who underwent Hartmann's reversal in five centers in central Israel between January 2004 and June 2015 was conducted. Medical charts were reviewed, analyzing preoperative and operative parameters and short-term postoperative outcomes. RESULTS 260 patients were included in the study. 76 patients were operated laparoscopically with a conversion rate of 26.3% (20 patients). No differences were found between patients operated laparoscopically and those operated in an open technique regarding gender (p = 0.785), age (61.34 vs. 62.64, p = 0.521), body mass index (26.6 vs. 26.2, p = 0.948), Charlson index score (1.79 vs. 1.95, p = 0.667), and cause for Hartmann's procedure (neoplastic vs. non-neoplastic, p = 0.644). No differences were seen in average time from the Hartmann's procedure to reversal (204.89 vs. 213.60 days, p = 0.688) and in overall complication rate (46.4 vs. 46.5%, p = 1). The Clavien-Dindo score for distinguishing between minor (0-2 score, p = 1) and major complications (3-5 score, p = 0.675) failed to demonstrate an advantage to laparoscopy, as well as to average length of stay (10.91 days in the laparoscopic group vs. 11.72 days in the open group, p = 0.529). An analysis based on the intention-to-treat with laparoscopy, including converted cases in the laparoscopic group, showed similar results, including overall complication rate (48.6 vs. 45.6%, p = 0.68) and Clavien-Dindo score in both minor (p = 0.24) and major complications (p = 0.44). Length of stay (10.92 vs. 11.81 days, p = 0.45) was also similar between the two groups. CONCLUSION In this series, a laparoscopic approach to Hartmann's reversal did not offer any short-term advantage when compared to an open surgical approach.
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Affiliation(s)
- Nir Horesh
- Department of General Surgery and Transplantations B, Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel. .,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Yonatan Lessing
- Division of Surgery, Tel-Aviv Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaron Rudnicki
- Department of Surgery B, Meir Medical Center, Kfar Saba, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilan Kent
- Department of Surgery B, Meir Medical Center, Kfar Saba, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Haguy Kammar
- Department of Surgery, Kaplan Medical Center, Rehovot, Israel.,School of Medicine, Hadassah-Hebrew University, Jerusalem, Israel
| | - Almog Ben-Yaacov
- Department of Surgery B, Rabin Medical Center, Petah Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Dreznik
- Department of General Surgery and Transplantations B, Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shmuel Avital
- Department of Surgery B, Meir Medical Center, Kfar Saba, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eli Mavor
- Department of Surgery, Kaplan Medical Center, Rehovot, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Wasserberg
- Department of Surgery B, Rabin Medical Center, Petah Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hanoch Kashtan
- Department of Surgery B, Rabin Medical Center, Petah Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Joseph Klausner
- Division of Surgery, Tel-Aviv Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordechai Gutman
- Department of General Surgery and Transplantations B, Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oded Zmora
- Department of General Surgery and Transplantations B, Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hagit Tulchinsky
- Division of Surgery, Tel-Aviv Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Nevo Y, Goldes Y, Barda L, Nadler R, Gutman M, Nevler A. Risk Factors for Complications of Total/Subtotal Gastrectomy for Gastric Cancer: Prospectively Collected, Based on the Clavien-Dindo Classification System. Isr Med Assoc J 2018; 20:277-280. [PMID: 29761671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Recent studies have analyzed risk factors associated with complications after gastric cancer surgery using the Clavien-Dindo classification (CD). However, they have been based on Asian population cohorts (Chinese, Japanese, Korean). OBJECTIVES To prospectively analyze all post-gastrectomy complications according to severity using CD classification and identify postoperative risk factors and complications. METHODS We analyzed all gastrectomies for gastric cancer performed 2009-2014. Recorded parameters included demographic data, existing co-morbidities, neo-adjuvant treatment, intra-operative findings, postoperative course, and histologic findings. Postoperative complications were graded using CD classification. RESULTS The study comprised 112 patients who underwent gastrectomy. Mean age was 64.8 ± 12.8 years; 53 patients (47%) underwent gastrectomy, 37 (34%) total gastrectomy, and 22 (19%) total extended gastrectomy. All patients had D2 lymphadenectomy. The average number of retrieved lymph nodes was 35 ± 17. Severe complication rate (≥ IIIa) was 14% and mortality rate was 1.8%. In a univariate analysis, age > 65 years; ASA 3 or higher; chronic renal failure; multi-organ resection; and tumor, node, and metastases (TNM) stage ≥ IIIc were found to be significantly associated with CD complication grade > III (P = 0.01, P = 0.05, P = 0.04, P = 0.04, and P = 0.01, respectively). Multivariate regression analysis revealed advanced stage (≥ IIIc) and age > 65 years to be significant independent risk factors (P < 0.05). CONCLUSIONS Age > 65 and advanced stage (≥ IIIc) were the primary risk factors for complications of grade > III according to the CD classification following gastrectomy for gastric cancer.
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Affiliation(s)
- Yehonatan Nevo
- Department of General Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yuri Goldes
- Department of General Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liran Barda
- Department of General Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roy Nadler
- Department of General Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordechai Gutman
- Department of General Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avinoam Nevler
- Department of General Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Borenstein Talpiot Medical Leadership Program, 2012, Sheba Medical Center, Tel Hashomer, Israel
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39
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Horesh N, Rosin D, Dreznik Y, Amiel I, Jacoby H, Nadler R, Gutman M, Klang E. A Single Tertiary Center 10-Year Experience in the Surgical Management of Gastrointestinal Bezoars. J Laparoendosc Adv Surg Tech A 2018; 28:967-971. [PMID: 29641363 DOI: 10.1089/lap.2017.0752] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Gastrointestinal (GI) bezoars are the most common foreign bodies causing obstruction in the GI tract. They are frequently seen following upper GI tract surgery and surgical intervention is required often. The aim of this study is to describe the surgical management of GI bezoars. MATERIALS AND METHODS A retrospective cohort study, including all patients diagnosed with bezoars between May 2008 and May 2017, was conducted. Patient charts were reviewed, and demographics, clinical, surgical, and postoperative data were collected and analyzed. RESULTS Forty-five patients were included, with a mean age of 62.04 years (Range 18-91). Thirty patients underwent previous surgery (66.6%), most commonly surgical interventions for peptic ulcer disease (22 patients, 73.3%). Obstruction was most common in the ileum (27 patients, 60%). Thirty-nine patients (86.7%) required surgical intervention. Laparoscopy was attempted in 20 patients (51.2%), but conversion to open procedure was required in 11 patients (55%). Postoperative complication rate was 41%. No preoperative factors were found to be correlated with postoperative complications. Postoperative complications were associated with a longer length of stay (P = .006) and a higher readmission rate (P = .04). Patients treated with laparoscopy tended to have a lower BMI (P = .04), less previous surgeries (P = .04), and a bezoar located more proximally (P = .03), however, laparoscopy showed no benefit in complications rate, readmissions, and length of stay. CONCLUSIONS GI bezoars require surgical intervention at high rates. Postoperative complications are common. Completion of an upper GI endoscopy is important and should be performed at an early stage of management.
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Affiliation(s)
- Nir Horesh
- 1 Department of General Surgery and Transplantations, Tel Aviv University , Ramat Gan, Israel
| | - Danny Rosin
- 1 Department of General Surgery and Transplantations, Tel Aviv University , Ramat Gan, Israel
| | - Yael Dreznik
- 1 Department of General Surgery and Transplantations, Tel Aviv University , Ramat Gan, Israel
| | - Imri Amiel
- 1 Department of General Surgery and Transplantations, Tel Aviv University , Ramat Gan, Israel
| | - Harel Jacoby
- 1 Department of General Surgery and Transplantations, Tel Aviv University , Ramat Gan, Israel
| | - Roy Nadler
- 1 Department of General Surgery and Transplantations, Tel Aviv University , Ramat Gan, Israel
| | - Mordechai Gutman
- 1 Department of General Surgery and Transplantations, Tel Aviv University , Ramat Gan, Israel
| | - Eyal Klang
- 2 Department of Radiology, Chaim Sheba Medical Center, affiliated with The Faculty of Medicine, Tel Aviv University , Ramat Gan, Israel
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40
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Dreznik Y, Hoffman A, Hamburger T, Ben-Yaacov A, Dux Y, Jacoby H, Berger Y, Nissan A, Gutman M. Hospital readmission rates and risk factors for readmission following cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal surface malignancies. Surgeon 2018; 16:278-282. [PMID: 29429947 DOI: 10.1016/j.surge.2018.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 01/05/2018] [Accepted: 01/05/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cytoreductive surgery and Hyperthermic intra-peritoneal chemotherapy (CRS/HIPEC) for peritoneal surface malignancies is associated with high morbidity. The increased numbers of patients undergoing CRS/HIPEC in recent years mandates risk analysis and quality assurance. However, only scarce data exist regarding causative parameters for readmission. The aim of this study was to assess readmission rates and risk factors associated with readmission. METHODS A retrospective-cohort study including patients from two high-volume centers who underwent CRS/HIPEC surgery between the years 2007-2016 was performed. Patients' demographics, peri-operative data and readmission rates were recorded. RESULTS 223 patients were included in the study. The 7 and 30-day readmission rates were 3.5% (n = 8) and 11% (n = 25), respectively. Late readmission rates (up to 90 days) were 11% (n = 25). The most common causes of readmission were surgical related infections (35%), small bowel obstruction (17.5%) and dehydration (14%). Post-operative complications were associated with higher readmission rates (p = 0.0001). PCI score was not associated with higher rates of readmission. CONCLUSION Readmissions following CRS/HIPEC occur mainly due to infectious complications and dehydrations. Patients following CRS/HIPEC should be discharged after careful investigation to a community based continuing care with access for IV fluid replacement or antibiotics administration when required.
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Affiliation(s)
- Yael Dreznik
- Department of Surgery B, Chaim Sheba Medical Center, Tel-Hashomer, Israel; Affiliated to the Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Aviad Hoffman
- Department of Surgery B, Chaim Sheba Medical Center, Tel-Hashomer, Israel; Affiliated to the Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Tamar Hamburger
- Division of Clinical Research, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Almog Ben-Yaacov
- Affiliated to the Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Department of General and Oncological Surgery-Surgery C, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Yossi Dux
- Affiliated to the Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Department of General and Oncological Surgery-Surgery C, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Harel Jacoby
- Department of Surgery B, Chaim Sheba Medical Center, Tel-Hashomer, Israel; Affiliated to the Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yaniv Berger
- Department of Surgery B, Chaim Sheba Medical Center, Tel-Hashomer, Israel; Affiliated to the Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Aviram Nissan
- Affiliated to the Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Department of General and Oncological Surgery-Surgery C, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Mordechai Gutman
- Department of Surgery B, Chaim Sheba Medical Center, Tel-Hashomer, Israel; Affiliated to the Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Pery R, Shaharabani E, Gazer B, Gutman M, Rosin D. Laparoscopic Fixation for Torsion of Transplanted Kidney: A Case Report. Transplant Proc 2017; 49:2378-2380. [PMID: 29198683 DOI: 10.1016/j.transproceed.2017.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 09/23/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Kidney graft torsion and subsequent acute kidney injury is a rare yet potentially devastating complication of intraperitoneal kidney transplant. We report a case of this elusive diagnosis and describe kidney salvage by using laparoscopic fixation. CASE REPORT A 49-year-old male patient presented with multiple episodes of anuric acute kidney injury 16 months after an uneventful combined orthotopic liver and kidney transplantation. After a thorough investigation, a diagnosis of kidney torsion was made, and the patient was urgently operated. Upon surgery, a complete torsion of a viable kidney was found. Laparoscopic fixation was achieved by using an absorbable mesh "pocket." The patient has experienced no similar episodes in the subsequent year. CONCLUSIONS Nephrologists and surgeons should be aware of this rare complication. Prompt diagnosis and operative repair are crucial to save the graft. Prophylactic nephropexy should be considered in all intraperitoneal transplantations.
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Affiliation(s)
- R Pery
- Department of General Surgery and Transplantation, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - E Shaharabani
- Department of General Surgery and Transplantation, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - B Gazer
- Department of General Surgery and Transplantation, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - M Gutman
- Department of General Surgery and Transplantation, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - D Rosin
- Department of General Surgery and Transplantation, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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42
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Horesh N, Lessing Y, Rudnicki Y, Kent I, Kammar H, Ben-Yaacov A, Dreznik Y, Tulchinsky H, Avital S, Mavor E, Wasserberg N, Kashtan H, Klausner JM, Gutman M, Zmora O. Considerations for Hartmann's reversal and Hartmann's reversal outcomes-a multicenter study. Int J Colorectal Dis 2017; 32:1577-1582. [PMID: 28879552 DOI: 10.1007/s00384-017-2897-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/30/2017] [Indexed: 02/04/2023]
Abstract
PURPOSE Hartmann's procedure is commonly practiced in emergent cases with the restoration of bowel continuity planned at a second stage. This study assessed the rate of restorations following Hartmann's procedure and evaluated factors affecting decision-making. METHODS Data on patient demographics, comorbidities, causes for Hartmann's procedure, reversal rate, and complications were collected in a multicenter retrospective cohort study of patients who underwent Hartmann's procedure in five medical centers. RESULTS Six hundred forty patients underwent Hartmann's procedure for diverticular disease (36.1%), obstructing malignancy (31.8%), benign obstruction (5%), and other reasons (23.1%). Overall, 260 (40.6%) patients underwent subsequent restoration of bowel continuity. One hundred twenty-one (46.5%) patients had post-reversal complications, with an average Clavien-Dindo score of 1.4 and a mortality rate of 0.77%. Decision to avoid reversal was mostly related to comorbidities (49.7%) and metastatic disease (21.6%). Factors associated with the decision to restore bowel continuity included male gender (P = 0.02), patient age (62.3 years in Hartmann's reversal patients vs 73.5 years in non-reversal patients; P < 0.0001), number of comorbidities (1.1 vs 1.58; P < 0.001), average Charlson score (1.93 vs 3.44; P < 0.001), and a neoplastic etiology (P < 0.0001). A sub-analysis excluding all patients who died in the 30 days following Hartmann's procedure showed similar factors associated with ostomy closure. CONCLUSION Many patients do not have restoration of bowel continuity after undergoing Hartmann's procedure. Hartmann's reversal is associated with a significant postoperative morbidity. Surgeons and patients should be aware of the possibility that the colostomy might become permanent.
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Affiliation(s)
- Nir Horesh
- Department of General Surgery and Transplantations B, Sheba Medical Center, Ramat Gan, Israel. .,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. .,Department of Surgery and Transplantations B, Sheba Medical Center, 52621, Tel-Hashomer, Israel.
| | - Yonatan Lessing
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Yaron Rudnicki
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Surgery B, Meir Medical Center, Kfar Saba, Israel
| | - Ilan Kent
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Surgery B, Meir Medical Center, Kfar Saba, Israel
| | - Haguy Kammar
- Department of Surgery, Kaplan Medical Center, Rehovot, Israel.,School of Medicine, Hadassah-Hebrew University, Jerusalem, Israel
| | - Almog Ben-Yaacov
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Surgery B, Rabin Medical Center, Petah Tikva, Israel
| | - Yael Dreznik
- Department of General Surgery and Transplantations B, Sheba Medical Center, Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hagit Tulchinsky
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Shmuel Avital
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Surgery B, Meir Medical Center, Kfar Saba, Israel
| | - Eli Mavor
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Surgery, Kaplan Medical Center, Rehovot, Israel
| | - Nir Wasserberg
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Surgery B, Rabin Medical Center, Petah Tikva, Israel
| | - Hanoch Kashtan
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Surgery B, Rabin Medical Center, Petah Tikva, Israel
| | - Joseph M Klausner
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Mordechai Gutman
- Department of General Surgery and Transplantations B, Sheba Medical Center, Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oded Zmora
- Department of General Surgery and Transplantations B, Sheba Medical Center, Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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43
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Dreznik Y, Horesh N, Gutman M, Gravetz A, Amiel I, Jacobi H, Zmora O, Rosin D. Preoperative Nutritional Optimization for Crohn's Disease Patients Can Improve Surgical Outcome. Dig Surg 2017; 35:442-447. [PMID: 29130989 DOI: 10.1159/000481408] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 09/10/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Preoperative preparation of patients with Crohn's disease is challenging and there are no specific guidelines regarding nutritional support. The aim of this study was to assess whether preoperative nutritional support influenced the postoperative outcome. METHODS A retrospective, cohort study including all Crohn's disease patients who underwent abdominal surgery between 2008 and 2014 was conducted. Patients' characteristics and clinical and surgical data were recorded and analyzed. RESULTS Eighty-seven patients were included in the study. Thirty-seven patients (42.5%) received preoperative nutritional support (mean albumin level 3.14 vs. 3.5 mg/dL in the non-optimized group; p < 0.02) to optimize their nutritional status prior to surgery. Preoperative albumin level, after adequate nutritional preparation, was similar between the 2 groups. The 2 groups differ neither in demographic and surgical data, overall post-op complication (p = 0.85), Clavien-Dindo score (p = 0.42), and length of stay (p = 0.1). Readmission rate was higher in the non-optimized group (p = 0.047). CONCLUSION Nutritional support can minimize postoperative complications in patients with low albumin levels. Nutritional status should be optimized in order to avoid hazardous complications.
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44
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Gazer B, Rosin D, Bar-Zakai B, Willenz U, Doron O, Gutman M, Nevler A. Accuracy and inter-operator variability of small bowel length measurement at laparoscopy. Surg Endosc 2017; 31:4697-4704. [DOI: 10.1007/s00464-017-5538-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 03/20/2017] [Indexed: 12/19/2022]
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45
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Nevler A, Har-Zahav G, Abraham A, Schiby G, Zmora O, Shabtai M, Gutman M, Rosin D. Laparoscopic Lymph Node Biopsy: Efficacy and Advantages. Isr Med Assoc J 2017; 19:231-233. [PMID: 28480676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Diagnosis of abdominal lymphadenopathy is challenging when not accompanied by peripheral lymphadenopathy. Computed tomography-guided core-needle biopsy has largely replaced open procedures in recent years, but this approach is limited by access to the anatomic region and the amount of tissue acquired. OBJECTIVES To demonstrate the feasibility of the laparoscopic approach in obtaining abdominal lymph node biopsies and to evaluate the diagnostic adequacy of the technique. METHODS We reviewed the data of patients who underwent laparoscopic lymph node biopsy between 2014 and 2014 in our department. Demographics, intra-operative parameters and postoperative course were examined, as were histological reports. Postoperative complications were categorized according to the Clavien-Dindo(CD) classification. RESULTS Between 2004 and 2014, 57 laparoscopic biopsies were performed for intra-abdominal lymphadenopathy. One case was a repeated attempt due to limited histologic material. The mean age was 49.5 ± 19.6 years. There were two conversions to open laparotomy, one due to small bowel injury and the other due to a sizable mass. Overall, 56 cases had full clinical data: 48 cases (85.7%) had CD=0, six (10.7%) had CD=1, one postoperative severe complication (CD=3) and one mortality (CD=5), which was related to preexisting hepatic insufficiency. Mean hospital stay was 1.6 days. Overall, adequate tissue samples were acquired in 96.7% and only 3 of these cases resulted in inconclusive diagnoses. CONCLUSIONS Laparoscopic lymph node biopsy is a viable alternative to the currently available methods of tissue retrieval. It provides an access for nodes which are inaccessible percutaneously, and may allow a superior diagnostic yield.
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Affiliation(s)
- Avinoam Nevler
- Department of Surgery and Transplantation
- Borenstein Talpiot Medical Leadership Program, 2012, Sheba MedicalCenter, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Avigdor Abraham
- Institute of Hematology Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ginette Schiby
- Department of Pathology Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oded Zmora
- Department of Surgery and Transplantation
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46
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Dux J, Rayman S, Zendel A, Segev L, Hoffman A, Ben Yaacov A, Marom G, Aderka D, Shacham Shmueli E, Beny A, Ayala H, Grenader T, Brenner B, Purim O, Gutman M, Venturero M, Nissan A. 117. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) for the treatment of peritoneal surface malignancies in the elderly. Eur J Surg Oncol 2016. [DOI: 10.1016/j.ejso.2016.06.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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47
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Horesh N, Wasserberg N, Zbar AP, Gravetz A, Berger Y, Gutman M, Rosin D, Zmora O. Changing paradigms in the management of diverticulitis. Int J Surg 2016; 33 Pt A:146-50. [DOI: 10.1016/j.ijsu.2016.07.072] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 07/21/2016] [Accepted: 07/26/2016] [Indexed: 12/15/2022]
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48
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Horesh N, Klang E, Gravetz A, Nevo Y, Amiel I, Amitai MM, Rosin D, Gutman M, Zmora O. Jejunal Diverticulitis. J Laparoendosc Adv Surg Tech A 2016; 26:596-9. [DOI: 10.1089/lap.2016.0066] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Nir Horesh
- Department of Surgery and Transplantation, Chaim Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Klang
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Radiology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Aviad Gravetz
- Department of Surgery and Transplantation, Chaim Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yehonatan Nevo
- Department of Surgery and Transplantation, Chaim Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Imri Amiel
- Department of Surgery and Transplantation, Chaim Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Marianne Amitai
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Radiology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Danny Rosin
- Department of Surgery and Transplantation, Chaim Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordechai Gutman
- Department of Surgery and Transplantation, Chaim Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oded Zmora
- Department of Surgery and Transplantation, Chaim Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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49
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Horesh N, Saeed Y, Horesh H, Berger Y, Speter C, Pery R, Rosin D, Gutman M, Zmora O. Colonoscopy after the first episode of acute diverticulitis: challenging management paradigms. Tech Coloproctol 2016; 20:383-387. [PMID: 27170283 DOI: 10.1007/s10151-016-1478-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 04/28/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Colonoscopy is commonly recommended after the first episode of acute diverticulitis to exclude colorectal neoplasia. Recent data have challenged this paradigm due to insufficient diagnostic yield. The aim of this study was to assess whether colonoscopy after the first episode of acute diverticulitis is needed to exclude colorectal neoplasia. METHODS We performed a retrospective cohort analysis of medical records of patients admitted for the first episode of acute diverticulitis between January 2008 and December 2012. Ambulatory colonoscopy was routinely recommended at discharge. Clinical follow-up and telephone surveys were used for data collection. RESULTS Four hundred and twenty-five patients with a mean age of 62.6 years (range 21-98 years) were admitted during the 5-year period. Three hundred and ten (72.9 %) patients underwent colonoscopy at median time of 3.2 months after discharge. Five patients (1.6 %) of the 310 available for evaluation had malignant findings in colonoscopy. Of those, one patient had rectal carcinoma away from the inflamed site and one had colonic lymphoma. None of the 95 patients <50 years of age was found to have adenocarcinoma of the colon. CONCLUSIONS Cancer is rarely detected in colonoscopy following the first episode of acute diverticulitis. These results question this indication for colonoscopy, especially in patients under 50.
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Affiliation(s)
- N Horesh
- Department of Surgery and Transplantations B, Chaim Sheba Medical Center (Affiliated to the Faculty of Medicine, Tel Aviv University), 52621, Tel-Hashomer, Ramat Gan, Israel.
| | - Y Saeed
- Department of Surgery and Transplantations B, Chaim Sheba Medical Center (Affiliated to the Faculty of Medicine, Tel Aviv University), 52621, Tel-Hashomer, Ramat Gan, Israel
| | - H Horesh
- Department of Surgery and Transplantations B, Chaim Sheba Medical Center (Affiliated to the Faculty of Medicine, Tel Aviv University), 52621, Tel-Hashomer, Ramat Gan, Israel
| | - Y Berger
- Department of Surgery and Transplantations B, Chaim Sheba Medical Center (Affiliated to the Faculty of Medicine, Tel Aviv University), 52621, Tel-Hashomer, Ramat Gan, Israel
| | - C Speter
- Department of Surgery and Transplantations B, Chaim Sheba Medical Center (Affiliated to the Faculty of Medicine, Tel Aviv University), 52621, Tel-Hashomer, Ramat Gan, Israel
| | - R Pery
- Department of Surgery and Transplantations B, Chaim Sheba Medical Center (Affiliated to the Faculty of Medicine, Tel Aviv University), 52621, Tel-Hashomer, Ramat Gan, Israel
| | - D Rosin
- Department of Surgery and Transplantations B, Chaim Sheba Medical Center (Affiliated to the Faculty of Medicine, Tel Aviv University), 52621, Tel-Hashomer, Ramat Gan, Israel
| | - M Gutman
- Department of Surgery and Transplantations B, Chaim Sheba Medical Center (Affiliated to the Faculty of Medicine, Tel Aviv University), 52621, Tel-Hashomer, Ramat Gan, Israel
| | - O Zmora
- Department of Surgery and Transplantations B, Chaim Sheba Medical Center (Affiliated to the Faculty of Medicine, Tel Aviv University), 52621, Tel-Hashomer, Ramat Gan, Israel
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Horesh N, Shwaartz C, Amiel I, Nevler A, Shabtai E, Lebedeyev A, Nadler R, Rosin D, Gutman M, Zmora O. Diverticulitis: does age matter? J Dig Dis 2016; 17:313-8. [PMID: 27106275 DOI: 10.1111/1751-2980.12350] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 03/01/2016] [Accepted: 04/18/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Acute diverticulitis has been traditionally associated with worse outcome in young patients, indicating a more aggressive surgical approach is required for them. The aim of this study was to assess whether acute diverticulitis was more virulent in young patients. METHODS A retrospective, cross-sectional study included all patients who were admitted for a first episode of acute diverticulitis between January 2004 and December 2013. The patients were divided into two groups (≤50 years and >50 years) based on their age. Patients' characteristics, clinical and surgical data were recorded and analyzed. RESULTS Overall, 636 patients were included in the database, including 177 (27.8%) in the younger group and 459 in the elder group. There were no significant differences between the groups in disease complexity, peritonitis, laboratory work-up, vital signs on presentation, bowel obstruction or the presence of fistula and abscess in need of drainage. Younger patients had more free extra-luminal air on computed tomography (CT) scan (P = 0.03). Surgical data, including the intra-operative modified Hinchey score and the need for emergency and additional surgery did not significantly differ between the two groups. Young patients had more readmissions (P = 0.01) due to acute diverticulitis, diverticular complications and elective surgery. Length of hospital stay (P = 0.0001) was longer and postoperative complications were more common in the elder patients. CONCLUSIONS The clinical presentation of acute diverticulitis does not seem to be worse in the young population. Younger patients tend to have a more severe presentation on CT scan and more readmissions, but this did not translate to a more severe disease course.
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Affiliation(s)
- Nir Horesh
- Department of Surgery and Transplantation, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Chaya Shwaartz
- Department of Surgery and Transplantation, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Imri Amiel
- Department of Surgery and Transplantation, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Avinoam Nevler
- Department of Surgery and Transplantation, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Esther Shabtai
- Department of Surgery and Transplantation, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Alexander Lebedeyev
- Department of Surgery and Transplantation, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Roi Nadler
- Department of Surgery and Transplantation, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Danny Rosin
- Department of Surgery and Transplantation, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Mordechai Gutman
- Department of Surgery and Transplantation, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Oded Zmora
- Department of Surgery and Transplantation, Chaim Sheba Medical Center, Ramat Gan, Israel
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