外科杂志

Artificial intelligence has been increasingly applied in various fields of medicine, including surgery. AI is the ability of machines to learn and reason, enabling them to perform tasks that typically require human intelligence. In surgery, AI is being utilized to improve patient outcomes, enhance surgical precision, and reduce the risk of complications. In this article, we will explore the role of AI in surgery. One of the areas where AI is being utilized in surgery is in surgical planning. AI algorithms can be trained to analyze medical imaging data, such as CT scans and MRIs, to identify areas of concern and create 3D models of the affected areas. This can help surgeons to better understand the patient's anatomy, plan the surgical approach, and improve the accuracy of the procedure.

Background: Anti-reflux surgery has been shown to give superior quality of life compared to PPIs. Laparoscopic Nissen Fundoplication (LNF) is the most common surgical treatment for GERD and Hiatus hernia with good patient satisfaction rates. However, some complications following this intervention have been reported in various studies but these have not been studied in sub-Saharan Africa.

Methods: Cross sectional study that utilized secondary data of 70 patients who underwent LNF at St. Francis Hospital Nsambya from September 2020 to September 2022. The study determined the demographic characteristics, pre-operative symptoms, endoscopic findings and outcomes of these patients during a follow up period of 2months post-surgery.

Results: 62.9% of the patients in this study were females, the mean age was 39.7 years and 68.6% were from central region. The mean BMI was 25.9kg/m², 90% had a BMI of<30 and only 10% were obese. The most common GERD symptoms were epigastric pain (35.3%) and heart burn (19.6%). Major endoscopic findings included Hiatus hernia (45.1%) and GERD (28.8%). The mean length of hospital stay was 2 days (SD 1 day), patients were able to return to work after a mean duration of 3.1 weeks, 90% of patients had improvement in GERD symptoms with 35.7% completely resolved symptoms and 54.3% partially resolved symptoms. Only 10% had no change in GERD symptoms and there was no case of re-operation.

Conclusion: The outcomes of LNF in our study were good and comparable in terms of recovery, return to work, with low complication rates.

Background: Staple line integrity is of upmost importance to surgeons in gastric surgery. Staple line reinforcement is utilized to improve strength and stability of the staple line. The Echelon Endopath™ SLR (Staple Line Reinforcement, ESLR) was developed for staple line reinforcement. Our goal is to present results from a real-world study using the ESLR in gastric procedures.

Methods: A prospective, single-arm, multi-center, post-market study was performed to determine the incidence of device-related adverse events (AEs) through 70 days post-procedure in gastric procedures. AEs were defined as staple line bleeding, intra- or post-operative leak and radiographically documented stricture. Secondary outcomes were number of devices replaced intraoperatively due to bunching or slippage. Eligibility included subjects who underwent elective gastric resections in which ESLR was used.

Results: Of the 109 subjects enrolled, 98 completed the study with a mean age of 45.5 ± 11.3 years and a majority female (83.5%). All procedures were performed laparoscopically, with sleeve gastrectomy being the most commonly performed (77.1%), followed by Roux-en-Y gastric by-pass (22.9%) and other (0.9%). There were no reported cases of leak, bleeding, or strictures deemed device related though there was one intraoperative leak (anastomotic leak), which was deemed not related. Ten device replacements (out of 637 firings) occurred none of which was a result of slippage or bunching. Surgeons reported less frustration with set-up and ease-of-use of the device (100%), with the majority expressing strong or slight agreement that there was less buttress manipulation and movement during the procedure (75%).

Conclusion: In this study, the ESLR was shown to be effective and safe for buttressing staple lines during certain bariatric procedures.