Background: The aim of this study was to assess the usefulness of protective negative-pressure wound therapy (NPWT) in the reduction of wound healing complications (WHC) and surgical site infections (SSI) after diverting ileostomy closure in patients who underwent surgery for colorectal cancer. Methods: In this prospective randomized clinical trial in a tertiary academic surgical center, patients who had colorectal cancer surgery with protective loop ileostomy and were scheduled to undergo ileostomy closure with primary wound closure from January 2016 to December 2018 were randomized to be treated with or without NPWT. The primary endpoint was the incidence of WHC. Secondary endpoints were incidence of SSI, length of postoperative hospital stay (LOS), and length of complete wound healing (CWH) time. Results: We enrolled 35 patients NPWT (24 males [68.6%]; mean age 61.6 ± 11.3 years), with NPWT and 36 patients (20 males [55.6%]; mean age 62.4 ± 11.3 years) with only primary wound closure (control group). WHC was observed in 11 patients (30.6%) in the control group and 3 (8.57%) in the NPWT group (p = 0.020). Patients in the NPWT group had a significantly lower incidence of SSI (2 [5.71%] vs. 8 [22.2%] in the control group; p = 0.046) as well as significantly shorter median CWH (7 [7–7] days vs. 7 [7–15.5] days, p = 0.030). There was no difference in median LOS between groups (3 [2.5–5] days in the control group vs. 4 [2–4] days in the NPWT group; p = 0.072). Conclusions: Prophylactic postoperative NPWT after diverting ileostomy closure in colorectal cancer patients reduces the incidence of WRC and SSI. Clinical trial registration: clinicaltrials.gov (NCT04088162).

Introduction: As the number of elderly patients requiring surgical intervention rises, it is believed that frailty syndrome has a greater impact on perioperative course than on chronological age. The aim of this study was to evaluate the efficacy of various imaging features for frailty assessment in patients undergoing emergency laparotomy. Methods: The study included all patients that qualified for emergency surgery with preoperative CT scans between 2016 and 2020 in the Second Department of General Surgery. Multiple trauma patients were excluded from the analysis. The modified frailty index and brief geriatric assessment were used in the analysis. CT images were reviewed for the assessment of osteopenia, sarcopenia, sarcopenic obesity, renal volume and abdominal aorta calcification rate. Results: A total of 261 patients were included in the analysis. Multivariate logistic regression identified every next ASA class (OR: 4.161, 95%CI: 1.672–10.355, p = 0.002), intraoperative adverse events (OR: 12.397, 95%CI: 2.166–70.969, p = 0.005) and osteopenia (OR: 4.213, 95%CI: 1.235–14.367, p = 0.022) as a risk factor for 30-day mortality. Our study showed that every next ASA class (OR: 1.952, 95%Cl: 1.171–3.256, p = 0.010) and every point of the BGA score (OR: 1.496, 95%Cl: 1.110–2.016, p = 0.008) are risk factors for major complications. Conclusions: Osteopenia was the best parameter for perioperative mortality risk stratification in patients undergoing emergency surgical intervention. Sarcopenia (measured as psoas muscle area), sarcopenic obesity, aortic calcifications and mean kidney volume do not predict poor outcomes in those patients. None of the radiological markers appeared to be useful for the prediction of perioperative morbidity.

Introduction A narrow pelvis, obesity, and bulky low rectal tumor are perceived as risk factors for intraoperative difficulties during total mesorectal excision (TME), particularly in the laparoscopic approach. A transanal approach has been developed to overcome the difficulties encountered...

Objective: To assess whether PTeye-guided identification increases the number of parathyroid glands (PGs) preserved in situ and reduces hypoparathyroidism compared with visual identification alone. Background: Injury or inadvertent removal of PGs during thyroidectomy is the main cause of postoperative hypoparathyroidism. Reliance on visual inspection makes intraoperative PG identification difficult. Probe-based near-infrared autofluorescence (NIRAF) systems such as PTeye provide real-time, tissue-specific feedback that may enhance PG detection and preservation. Methods: In this single-center, prospective, randomized trial, patients undergoing first-time total thyroidectomy were allocated to PTeye-assisted or visual PG identification. Procedures were performed by 2 senior and 3 junior surgeons. The primary outcome was the number of PGs identified. Secondary outcomes included inadvertent parathyroidectomy, autotransplantation, and transient and last follow-up hypoparathyroidism. Results: Among 154 randomized patients (77 per group; mean age 53.4±14.3 y; 84.4% female), PTeye increased the mean number of PGs identified (3.81 vs. 2.73; P <0.001) and the proportion with 3–4 PGs preserved in situ (98.7% vs. 87.0%; P =0.004). Inadvertent parathyroidectomy was less frequent with PTeye (5.2% vs. 20.8%; P =0.004). Junior surgeons performed more autotransplantations than senior surgeons when using PTeye (33.3% vs. 10.5%; P =0.015). Female sex ( P =0.047), ≤2 PGs preserved ( P =0.008), and autotransplantation ( P =0.010) predicted low postoperative day-1 parathormone serum level. Among junior surgeons, transient hypoparathyroidism was lower with PTeye (20.5% vs. 55.2%; P <0.001), with no difference among senior surgeons. Permanent hypoparathyroidism rates were similar between groups. Conclusions: PTeye-guided NIRAF improves PG identification and in situ preservation and reduces transient hypoparathyroidism, particularly for junior surgeons, without affecting permanent hypoparathyroidism.